Monday, November 30, 2009

US Senate Debates Health Care Reform

Senate opens health care debate - CNN

Senate opens health care debate
November 30, 2009 5:02 p.m. EST

Sen. Harry Reid called the health care debate one of the most important in the nation's history.

Washington (CNN) -- The U.S. Senate opened debate Monday on a sweeping bill to overhaul the nation's health care system.

Senate Majority Leader Harry Reid launched what is expected to be a lengthy and rancorous legislative battle by hailing the debate as one of the most important in U.S. history.

However, the process quickly bogged down in Republican procedural objections, causing Reid to lament, "This is not a good way to start this debate."

Republican Sen. Mike Enzi of Wyoming challenged a motion by Reid that he said would unfairly cut off the proposal of amendments, including a planned Republican amendment that would prevent any cuts to the government-run Medicare health program for senior citizens.

Democrats contend that the bill will ensure Medicare's future financial stability by eliminating waste and reducing costs. Reid said the bill "saves money, saves lives and saves Medicare."

Republicans argue that proposed Medicare cuts would harm senior citizens, with Sen. Jon Kyl of Arizona saying the bill "can't be fixed" if the Medicare provisions it contains remain intact.

The House has passed its version of a health care bill, and if the Senate passes its bill, the two measures would be merged by a congressional conference committee. Both chambers then would have to approve the revised bill before it could go to President Obama's desk.

Republicans unanimously oppose the $849 billion Democratic proposal that would expand health coverage to 31 million more Americans. The Senate voted 60-39 to launch debate on the bill, overcoming a Republican filibuster through support from every member of the Democratic caucus.

Reid also will need 60 votes to eventually close the debate, and his ability to secure that support remains uncertain.

The debate will feature amendments intended to delete or change controversial provisions in the 2,074-page bill, including creation of a government-run public health insurance option to compete against private insurers, tax increases and provisions intended to prevent federal tax dollars from paying for abortion except in cases of rape, incest or danger to the mother's life.

For the most part, battle lines are clearly drawn. Liberal-minded senators such as Bernie Sanders of Vermont, an independent who sits with the Democratic caucus, favor a public option as the best way to force competition on private insurers to bring down costs, but fiscally conservative Democrats such as Nebraska's Ben Nelson are concerned about the cost and scope of a government-run alternative.

Nelson has said he would join a Republican filibuster against closing debate on the bill if it retains the current public option provision, which allows states to opt out of a national plan. Another Democratic caucus member, independent Joe Lieberman of Connecticut, says he also will prevent a final vote if the bill contains any form of public option.

However, Sanders said Sunday on the ABC show "This Week" that he would be "very reluctant" to support a bill that lacks a strong public option. Dean also called for a public option to provide a choice for consumers.

On the Republican side, none of the 40 senators supports a public option, but one -- moderate Olympia Snowe of Maine -- has discussed a trigger mechanism that would automatically bring a public option if thresholds for expanded coverage and lower costs go unmet. The trigger idea is considered the lone chance of a compromise that could gain the support of any Republicans.

For Democrats, each vote is crucial. Overcoming a filibuster requires support every member of the Democratic caucus, so if Lieberman or others oppose a public option, Reid would need a GOP senator to switch sides on the bill.

Senate Democrats concede that some changes are necessary to get the health care bill passed. They contend that their comprehensive approach is necessary to reform a system in which higher costs are draining the national economy and harming businesses and individuals.

Republicans call for an incremental approach that they say would reduce the costs of health care without needing to create new bureaucracies and raise taxes in a huge overhaul.

Other risky issues for Senate Democrats include abortion and tax increases to pay for health care reform. The bill includes tax increases aimed at those earning more than $200,000 a year and insurers providing "Cadillac" health plans worth more than $8,500 a year for individuals or $23,000 for families. It also would set a 5 percent tax on elective cosmetic surgery.

In contrast, a health care bill narrowly passed by the House of Representatives this month includes an income tax surcharge on individuals earning more than $500,000 a year and couples making more than $1 million.

Republicans say that any tax increase is bad in a struggling economy because it hinders growth and gets passed on to consumers, but Democrats argue that the bill's tax provisions wouldn't hit the lower or middle classes and would create incentive for private insurers to lower the cost of policies.

However, a key Democratic constituency -- organized labor -- opposes taxing the "Cadillac" health plans negotiated for workers in lieu of wage increases.

On abortion, the House bill has more restrictive language regarding the use of federal funding, and some Senate Democrats say they oppose adding it to their chamber's proposal.

According to the nonpartisan Congressional Budget Office, the Senate health care bill would reduce the federal deficit by about $130 billion over the next 10 years, through 2019.

Any effect on the deficit in the following decade would be "subject to substantial uncertainty" but probably would result in "small reductions in federal budget deficits," the budget office report said.

It also reported that health insurance premiums would remain roughly the same for most people, with costs for lower-income Americans reduced due to subsidies under the plan. According to the budget office, more than 80 percent of Americans would remain in employer-based health plans.

Both the Senate and House bills would require individuals to buy health insurance, with penalties for noncompliance. Unlike the House version, the Senate bill does not mandate that all employers offer health care.

The two bills are virtually identical on a broad range of changes, including creating health insurance exchanges, expanding Medicaid, subsidizing insurance for low- and some middle-income families, and capping out-of-pocket medical expenses while preventing insurance companies from denying coverage for pre-existing conditions.

CNN's Ted Barrett, Alan Silverleib and Tom Cohen contributed to this report.

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