The Power of A

Today, beginning at 10 AM, the Senate Finance Committee will vote to pass its version of health care reform.  If the bill passes committee (as it is expected to do) it will be merged by the Senate Majority Leader with the Senate HELP bill for Senate floor consideration.  There are some storylines the media are following leading up to the vote, including:

-  Whether Senator Olympia Snowe (R-ME) will vote for the bill: Senator Snowe is the only Republican on the committee who has indicated she could vote for the health care bill.  Finance Chair Baucus has been working with her to ensure some of her provisions have been included in the legislation, but Senator Snowe still has not indicated whether she will vote for it.  Politico breaks down the impact of her vote either way.

-  Will any Democrats vote against the bill: Senator Rockefeller (D-WV) does not like that the bill does not have a public option.  Senator Wyden (D-OR) wanted the insurance exchange open to more individuals, not just small businesses.  Senator Lincoln (D-AR) has expressed concern over the cost of the legislation.  The loss of more than one of these Senators with no Republican votes would defeat the bill.

-  The AHIP report: Yesterday, America’s Health Insurance Plans (AHIP) released a report stating the Finance Committee bill would end up costing families $4,000 more for insurance by 2019.  You can find the report here.  The White House yesterday accused insurance groups of playing politics with the timing and content of their report.  Today’s vote could show if the new information has an impact on anyone’s vote in committee.

Quick Hits

PBS’s The News Hour holds a conversation with the White House Office of Health Reform’s Nancy DeParle and AHIP’s Karen Ignagni… Senators John Kerry (D-MA) and Lindsay Graham (R-SC) write a New York Times editorial on climate change legislation… The Supreme Court is considering major case that could impact campaign financing for all corporations.

Senator Olympia Snowe (R-ME) emerged from a bipartisan conference yesterday to confirm that the Senate Finance Committee negotiators will not include two major components of the Democratic health care plan in their bill: the creation of a government-run insurance company (”public plan”) nor a requirement that all employers provide their employees with health care coverage.

Instead, the committee’s bill will likely include two concepts that so far have only been discussed by the Finance Committee.  Instead of a public plan to act as a competitor to private insurance companies, the bill will include “co-ops”, or a series of non-profit, non-government insurance options for the self-employed or small businesses regulated by standards from the National Association of Insurance Commissioners. These types of arrangements are found in other sectors of the economy, including agriculture. The National Cooperative Business Association and National Rural Electric Cooperative Association provide good examples of how current cooperatives operate.

In addition, the Finance Committee bill will not have a “pay or play” employer mandate but a so-called “free rider” approach.  The concept is that while there is no absolute mandate for employers to provide insurance for employees, employers (with 50 or more employees) whose workers receive Medicaid or a tax credit through a health insurance exchange must contribute half of the average Medicaid cost for workers or 100% of the cost of the tax credit received for providing the workers with health insurance.

The Finance Committee negotiators also said yesterday a bill is close to being completed, but there was still no timetable to release the bill.  The final list of revenue raisers is also being discussed, but none of the negotiators would comment definitively on what would be included.  Snowe suggested that taxing the “Cadillac” health insurance plans was being considered, and the committee could reduce the minimum level for the tax.

An idea that surfaced in discussions (subscription) Monday was a surtax on medically-unnecessary plastic surgery, also known informally as the “Botox” tax.  The surtax would be 10% on the cost of the procedures and would include things like Botox shots, face-lifts, and teeth whitening.  The feasibility of the tax being included in the Finance bill is unknown, however, as committee chair Max Baucus seemed to shoot down the idea talking with reporters: “That hasn’t been on any list I’ve seen in a long time.”

Quick Hits

The removal of a health care bill from the Senate’s floor schedule opens room for other issues, including the Travel Promotion Act of 2009… Energy & Commerce Chair Henry Waxman (D-CA) makes an offer (subscription) to address the Blue Dogs 10 points of concerns, but there has yet to be a formal reply… The House Democratic caucus goes through the health care bill section by section… Is the reason health care reform has not passed the absence of these four critical people?… The New York Times has a picture showing and explaining some of the key negotiators in the Senate… Volunteering (especially through nonprofits) is up, showing another way associations advance America.

In an interview with the Associated Press, Maine Senator Olympia Snowe (R-ME) outlined her support for a public plan with a trigger option as a possible compromise to the stalemate over inclusion of a public plan in comprehensive health care reform.

The trigger option would mean a government-run insurance company would only come into existence if private insurance companies failed to enact specified reforms. Senator Snowe stated her opposition to a public plan that is immediately created, saying: “If you establish a public option at the forefront that goes head-to-head and competes with the private health insurance market … the public option will have significant price advantages”

However, in the interview she expressed a desire to reform the insurance market. “I don’t think we can entirely depend on the private insurance market to deliver. They haven’t delivered thus far, and that’s why we’re in the predicament we’re in today,” she said.

Also this morning, Politico obtained a Senate Health Education Labor and Pension (HELP) Committee document outlining its proposal for a public plan in its legislation. The proposal would be a weaker version of the House version of the public plan, but more government-oriented than the co-op proposal. Details of the “Community Health Insurance Option” can be found here, but highlights include:

- The public plan would be an offering to the bill’s insurance exchange, and would follow the same rules as private insurers except the federal government would set reserve requirements.

- For the first three months, the government (specifically HHS) would pay the plan’s claims. This would be considered a loan to be repaid by the plan.

- The payment rates paid by the public plan would be no more than the local average of private rates, but could be less.

- There is no requirement that a health care provider participate in the plan.

Quick Hits

White House Press Secretary Robert Gibbs gives a non-committal answer (subscription) to whether the president is open to taxing employer-provided health care… the Small Business Coalition for Affordable Healthcare releases its first YouTube video… a list of other groups advertising (subscription) over the Congressional recess.