The Grand Unveiling Of Senate Healthcare Reform
The CBO score on the merged Senate bill is expected to be released early today, and Harry Reid is reported to be pleased with what he's seen so far.
The Senate Democrats will meet today
at 5:00, where Reid will unveil the bill to the caucus, most of whom
haven't seen the combined bill yet. Brian Beutler reports that "Reid
may give the public 72 hours to review the bill before holding a
cloture vote on a motion to proceed this weekend, though he may call
for that vote slightly earlier."
I am guessing here, but I think the final Senate Bill will resemble the Senate HELP committee bill worked out by Dodd a lot more than the Senate Finance Committee bill put together by Baucus. As for the CBO scoring of it and process? Some Dems are indicating they may short circuit the process, according to ThinkProgress, and the numbers look OK:
Democrats are also indicating that they may “short-circuit the legislative process”
to pass health care reform by December 18th, the last day Congress is
in session. “The most talked about method is end running the formal
conference committee process in favor of some sort of mini-conference.
Democratic officials in the White House and Congress are envisioning an
end game similar to the way the $787 billion stimulus package came
together with congressional leaders and White House aides hashing out the differences behind closed doors.”
Details of the merged legislation remain elusive but here is the latest:
- Bill will cost less than $894B/10 years: The
“preliminary estimates by the nonpartisan Congressional Budget Office,
the legislation’s official scorekeeper, have indicated that the Senate
measure would cost far less than the bill the House approved last week,
while lowering the federal deficit further over the long term.” This
suggests that Reid was able to bring down the price tag and increase
the new revenue. To lower the price tag he could have lowered the
amount the bill spends on subsidies, further expanded Medicaid,
decreased funding for prevention and wellness, or tinkered with a few
other provisions like the tax credit for small businesses. Reid may
also replace the opt-out national public option with Sen. Tom Carper’s
(D-DE) ‘non profit board’ trigger compromise.- Bill may lower the maximum contribution for premiums for families 133-150% FPL from 12% to 10%: Family USA’s Ron Pollack tells TNR’s Suzy Khimm that “the Senate leadership has basically decided to give more help to middle-class families on the higher of the subsidy spectrum,
whose incomes are 300 to 400% above the poverty line.” The legislation
may lower the maximum premium contribution from 12% to 10%, but
increase the premium contribution for the lower end of the spectrum
(Americans between 133-150% of the federal poverty line) from 2% to
about 3%.- Roll back Cadillac health plan tax, replace some of the revenue with a payroll tax: “To scale back a plan to tax high-cost insurance policies, an idea that is highly unpopular among labor unions, Reid is expected to propose an increase in the Medicare payroll tax
for families earning more than $250,000 a year.” “The provision would
be expected to generate about $50 billion over the next 10 years” and
“the extra revenue would allow Reid to reduce the number of people who
would be hit by a new 40 percent tax on the most expensive insurance
policies.” According to the Dow Jones, “Reid has already raised the family threshold by $2,000 for everybody.”- Bill will invest in the CLASS Act: Reid is
expected to incorporate the Community Living Assistance Services and
Supports Act, or CLASS Act, a long-term care program championed by the
late Sen. Ted Kennedy. The program was part of the HELP Committee’s
bill and generated some $59 billion in new revenues
from premiums to help fund reform. The CLASS Act establishes “a
national insurance program to be financed by voluntary payroll
deductions to provide benefits to adults who become severely
functionally impaired.” All working adults will be automatically
enrolled in the program, unless they choose to opt out. “Fiscal
conservatives and government economists have questioned whether the program would be financially sustainable over the long run, and insurance companies are lobbying to strip it from the health care bill.”- Bill could remove a provision that removes insurers’ anti-trust exemption: The
New York Times suggests that in response to demands from Sen. Ben
Nelson (D-NE), “the leaders appear willing to drop plans to use the
bill to strip health insurance companies of their antitrust exemption.”
A little more from The Politico:
CONFIDENTIAL MCKINSEY REPORT ANALYZES REFORM
- TNR's Jonathan Cohn has the goods: "The medical-care industry would
need to make significant, and socially beneficial, changes in response
to the bills currently moving through Congress; but such changes won't
come remotely close to destroying the industry's profitability. Of
course, reports on health care come out all the time. But this one
deserves special attention--because it was prepared by the nation's
most famous consulting firm and was never meant to see the light of
day. ... McKinsey seems convinced that this entire package of reforms
will influence behavior. Over and over again, it tells Client X that
the world is changing. Hospitals, McKinsey says, will face 'increased
requirements to coordinate care across system/care continuum,'
'significantly more value-conscious consumer decision-making,' and
'intensified focus on performance measurement and improvement.' It has
even starker warnings for the drug industry: 'Big Pharma faces the
largest potential revenue risk,' the document predicts. Partly that's
because of existing trends in the drug industry. But it's also because
studies of comparative effectiveness are sure to reduce the sale of
drugs that don't work as well. McKinsey suggests that the drug industry
can survive and even thrive in this environment 'by focusing on
'productive' innovation (supported by strong evidence), collaborating
with payors and providers in new ways, and revamping commercial and
R&D models to significantly improve effectiveness and efficiency.'"
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