The Power of A

Despite the seeming setback dealt to the Democrats comprehensive health care reform efforts this weekend by Senator Lieberman (I-CT) and Ben Nelson (D-NE), Senate Democrats are planning a procedural move to set-up a December 23 vote on their health care legislation and have indicated they are close to 60 votes.

Over the weekend, Senator Lieberman publicly stated he would not vote for a bill with a “public option” or the compromise “Medicare buy-in” provision; that left the Democratic caucus with less than 60 votes needed to pass the bill over a filibuster.  However, after a closed-door caucus meeting and a meeting with the president, the Democratic leadership is moving forward with a bill without a public option or Medicare buy-in and expects to have 60 Senators voting for the legislation.

Senate journalists expect Majority Leader Reid (D-NV) to announce the final bill’s language today, have the Senate debate and vote on the Defense Department appropriations bill the rest of the week, and file for cloture on the health care bill Friday.  This would set up the chamber procedurally for a vote as early as the 23^rd.

A few outstanding issues remain:

-          The Congressional Budget Office has not yet released a revised score of the Senate legislation, but that score is expected to be released today.  Some fiscally conservative Democratic Senators have said they will not publicly support the bill until they see that the legislation does not increase the deficit.

-          Senator Ben Nelson, Senator Reid, Senator Robert Casey (D-PA) and the White House are continuing to negotiate over the abortion language in the bill.  An amendment offered by Nelson on abortion was defeated last week, but he has withheld support until the issue is resolved.  The expected compromise will likely include strict segregation of what funds insurance companies can use to cover abortion, as well as subsidies and financial support for a series of pregnant women support programs.

-          Some of the chamber’s public-option supporters have publicly expressed their discontent with a bill lacking a government-run insurance offering.  What remains to be seen is if any of these Senators will vote against a bill without a public option.

Quick Hits

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In an effort to gain the 60 votes needed for passage, moderate Democratic Senators leaked a potential compromise yesterday that would remove the public option from the Senate health care bill and replace it with a larger Medicare pool.

The proposal would be to replace the public option language in the bill with a provision allowing Americans as young as 55 with no insurance to be eligible to buy into Medicare, the federal insurance plan for the elderly.  The advantage to this plan is that it takes an in-existence federal government insurance option (like the public plan) and makes it available to more people.  Additionally, the bill would grant the Office of Personnel Management (OPM) the ability to create a national pool for health insurance by contracting with private insurance companies and offering reduced rates to the uninsured.  The idea is similar to the current health care system for federal government employees.  The expected savings provided by these two proposals would allow the Senate to increase the subsidies given through Medicaid to people at 150% of the federal poverty limit, up from 133% currently in the legislation.

Most moderate Democratic Senators have expressed tepid support, but will wait until the Congressional Budget Office has a chance to score the compromise before commenting.

Critics of the proposal reply that increasing the number of people in both Medicare and Medicaid would actually increase government expenditures in health care.  They also note that the increased number of enrollees could add to the funds’ solvency issues and drive up the rates for current enrollees.

Do you think the Medicare/Medicaid idea is a viable public option compromise?

Quick Hits

Politico on the health care policies of the National Restaurant Association and CEO Dawn Sweeney… The Nelson/Hatch abortion amendment will receive a vote today… The “tanning bed tax” (subscription) could soon join the “Botox tax” in the Senate health care bill… The American College of Cardiologists “Hospital to Home” program is used as a model for Medicare patient hospitalization resolution.

For only the fifteenth time since 1861, the Senate was in session on a Sunday.  And while over the weekend the number of amendments considered was few, Senate leadership was optimistic that they were close to securing the compromises needed to gain 60 votes and passage.

Over the past few days the Senate has debated and voted on a few amendments, including the major ones below:

• The Mikulski amendment (#2791) removing a co-payment requirement for mammograms and preventative women’s health screenings. Passed 61-39
• The Vitter amendment (#2808) to prevent the USPSTF recommendation on mammograms from taking effect. Passed by unanimous consent.
• The Lincoln amendment (#2905) that would limit the executive compensation of insurance company executives. Amendment was withdrawn after not receiving 60 votes.

The two major amendments/issues remaining deal with abortion and the public option.  Senators Ben Nelson (D-NE) and Orrin Hatch (R-UT) will offer an amendment today or tomorrow that would incorporate the House’s abortion language in the Senate bill.  On the public option, Senator Reid (D-NV) has convened a working group of ten Democratic Senators to compose a compromise on the issue.  The latest compromise that seems to be gaining support is the creation of a national health insurance plan administered by the Office of Personnel Management that would be a list of private insurance offerings.  The plan’s appeal is that it would be similar to the current federal government employee health care system.

While the timeline is still uncertain, if compromises can be reached quickly on the outstanding issues the bill could receive a vote before December 25.  However, the key is whether the compromises can be reached and if the Democratic leadership can corral 60 votes for the bill.

Quick Hits

The President visited Capitol Hill yesterday to rally Democratic Senators for the health care bill…  Kaiser Health analyzes the major issues that are slowing passage of the health care bill… The IRS is reporting a marked increase in the number of nonprofit organizations nationwide in the past decade… ASAE has created a document outlining the major similarities and differences between the House and Senate health care bills.

Update - The text of the House bill can be seen here. (10:56 AM Eastern)

Today at 10:30 AM on the west front of the Capitol, the House Democratic leadership will unveil its compromise comprehensive health care bill, the product of the Tri-Committee bill merged with a series of deficit-friendly changes designed to gain the necessary votes for passage.

Keep checking The Power of A for details on the legislation, but a few details have been obtained by the media.  The bill will contain a public option with rates negotiated by the insurer; the public option will not have the Medicare reimbursement rate that was sought by the liberal members of the caucus.  In terms of budget scoring, the bill is expected to run a surplus in the first five years, then a deficit in the subsequent five making the legislation budget neutral for the first ten years.  The major pay-for is a surtax on high-income households, with singles making over $500,000 and couples making over $1 million being the new income floor for the tax.  The bill also has a 2.5% tax on medical device manufacturers and cuts Medicare spending.

Also today the White House will host a small business health care event with the U.S. Chamber of Commerce, the National Federation of Independent Business (NFIB), and other associations and small businesses.  The goal is to highlight the need for health care reform in the small business sector, and how the community needs reform to continue providing insurance for its employees.  A paper that summarizes the president’s talking points can be seen here.

The Power of A will have an analysis of the House bill once it becomes available.

Quick Hits

The American League of Lobbyists (ALL) sends a letter (subscription) to the White House defending registered lobbyists serving on federal councils and advisory boards… The Senate reaches a preliminary agreement to extend the homebuyers tax credit… Google Voices argues it does not need the same regulation as telecoms (subscription).

Yesterday, Senator Majority Leader Harry Reid (D-NV) held a press conference to unveil a few details of the Senate’s merged comprehensive health care bill.  Earlier in the day Reid sent a few variations of the comprehensive bill to the Congressional Budget Office (CBO) to be scored, so his press conference lacked a discussion of many of the details contained in the legislation.

However, the one detail that has been receiving attention is Reid’s inclusion of the “opt-out public option” in the bill.  The legislation would create a government-run insurance company through which unemployed individuals in a health care exchange could buy health coverage.  The public plan would be a national plan, and under Reid’s proposal, a state could “opt-out” of offering the public plan in their insurance exchange.  Reid noted that every version of his health care bill forwarded to CBO contained this language.

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In a move the national media is decrying as the death of the public option, the Senate Finance Committee voted down two amendments yesterday that would have inserted language into the Chairman’s Mark creating and funding a public insurance plan run by the federal government.

The Chairman’s Mark currently has language funding the creation of nonprofit cooperative health care plans, an idea meant to entice Republican and moderate Democratic votes for the Finance Committee legislation.  Both amendments sought to replace the cooperative language with public option language.  The first amendment, offered by Senator Rockefeller (D-WV), would have created a public option with a reimbursement structure for the first two years that mirrored Medicare, after which the government would have negotiated reimbursement rates with providers.  The proposal, seen as the most liberal public option plan, was defeated 15-8 with opponents claiming the Medicare rates were too low for doctors and hospitals.

The second amendment was offered by Senator Charles Schumer (D-NY).  Like the Rockefeller amendment, the Schumer amendment would have created a public plan but have negotiated reimbursement rates with providers from its creation.  That amendment was defeated by a 13-10 vote, with all 10 Republican committee members voting against it with Senators Lincoln (D-AR), Conrad (D-ND), and Baucus (D-MT).  After considering those two amendments, the committee moved through a few more amendments (including approving a Republican amendment requiring members and staff to participate in a state-based exchange for insurance) before adjourning around 10 PM.  The markup will continue at 10 AM today, and is being broadcast over the internet at the committee website.

The 10^th Annual Summit Awards Dinner

A special thanks to those who attended and supported the 10^th Annual Summit Awards Dinner last night at the National Building Museum.  The dinner honors six incredible association programs (which you can see here) that exemplify the Power of A message of associations as pioneers of collaborative problem solving.  Please visit our site www.asaecenter.org/summitdinner in the upcoming weeks to view pictures of the event and find out more information about next year’s dinner.

Quick Hits

Roll Call (subscription) is reporting this morning that the White House is preparing a draft (or possibly multiple drafts) of health care legislation that can be introduced or use to influence the debate if Congress stalls on consideration of comprehensive legislation… America’s Health Insurance Plans, the trade association for the insurance industry, released an outline of how the Finance language would affect the insurance industry… Senator Carper (D-DE) is discussing with Democratic senators a state-based alternative to co-ops and the public plan… House leadership tries to trim the cost (subscription) of the Tri-Committee bill back to $900 billion.