{"id":444144,"date":"2010-03-18T17:38:03","date_gmt":"2010-03-18T21:38:03","guid":{"rendered":"http:\/\/washingtonindependent.com\/?p=79681"},"modified":"2010-03-18T17:38:03","modified_gmt":"2010-03-18T21:38:03","slug":"how-reconciliation-irons-out-the-house-and-senate-health-bills","status":"publish","type":"post","link":"https:\/\/mereja.media\/index\/444144","title":{"rendered":"How Reconciliation Irons Out the House and Senate Health Bills"},"content":{"rendered":"<div id=\"attachment_79683\" class=\"wp-caption alignnone\" style=\"width: 490px\"><a href=\"http:\/\/washingtonindependent.com\/wp-content\/uploads\/2010\/03\/pelosi.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-79683\" title=\"Pelosi\" src=\"http:\/\/washingtonindependent.com\/wp-content\/uploads\/2010\/03\/pelosi-480x328.jpg\" alt=\"House Speaker Nancy Pelosi, with Majority Leader Steny Hoyer, discusses the health reform bill on Thursday. ( EPA\/ZUMApress.com)\" width=\"480\" height=\"328\" \/><\/a><\/p>\n<p class=\"wp-caption-text\">House Speaker Nancy Pelosi, with Majority Leader Steny Hoyer, discusses the health reform bill on Thursday. ( EPA\/ZUMApress.com)<\/p>\n<\/div>\n<p>Democratic leaders pushing health care reform this year like to  argue that a vast majority of the proposals represent uncontroversial  changes backed by most Capitol Hill lawmakers. And while that might be  true, it hasn\u2019t prevented some sharp disagreements between House and  Senate Democrats over a handful of high-profile reform provisions.<\/p>\n<p>Indeed, the House-passed reform bill strayed from the Senate  proposal on a number of key issues, from children\u2019s coverage to Medicaid  payments to the creation of a public health insurance plan. Here\u2019s how  the reconciliation bill &#8212; which House leaders <a href=\"http:\/\/www.rules.house.gov\/111_hr4872_secbysec.html\">unveiled  today<\/a> to address what they considered weaknesses in the Senate  legislation &#8212; would tweak (or not) some of the most contentious  provisions in the upper chamber\u2019s bill.<\/p>\n<p><div id=\"attachment_3087\" class=\"wp-caption alignleft\" style=\"width: 140px\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-3087\" title=\"congress\" src=\"http:\/\/washingtonindependent.com\/wp-content\/uploads\/2008\/08\/congress.jpg\" alt=\"Image by: Matt Mahurin\" width=\"130\" height=\"130\" \/><\/p>\n<p class=\"wp-caption-text\">Image by: Matt Mahurin<\/p>\n<\/div>\n<div class=\"floatButtons\">\n<div style=\"float: left; margin-right: 10px; margin-bottom: 10px;\"><script src=\"http:\/\/digg.com\/tools\/diggthis.js\" type=\"text\/javascript\"><\/script><\/div>\n<div style=\"float: left; margin-bottom: 10px;\"><script type=\"text\/javascript\"\n\tsrc=\"http:\/\/d.yimg.com\/ds\/badge2.js\"\n\tbadgetype=\"square\">\n\t<?php the_permalink(); ?><\/script><\/div>\n<div style=\"float: left; margin-right: 10px;\">\n\t<script type=\"text\/javascript\">\ntweetmeme_source = \"TWI_news\";\ntweetmeme_service = \"bit.ly\";\n<\/script> <script src=\"http:\/\/tweetmeme.com\/i\/scripts\/button.js\" type=\"text\/javascript\"><\/script>\n<\/div>\n<div style=\"float: left;\"><a name=\"fb_share\" type=\"box_count\" href=\"http:\/\/www.facebook.com\/sharer.php\">Share<\/a><script src=\"http:\/\/static.ak.fbcdn.net\/connect.php\/js\/FB.Share\" type=\"text\/javascript\"><\/script><\/div>\n<\/div>\n<p> <strong>Paying the  Freight <\/strong><\/p>\n<p>A central disagreement between House and Senate Democrats has  been over how to pay the substantial costs associated with covering  tens of millions of uninsured Americans. The House paid much of the tab  with a 5.4 percent tax on the nation\u2019s highest earners &#8212; individuals  making more than $500,000 per year, and families pulling in more than $1  million. The Senate, meanwhile, passed a 0.5 percent hike on Medicare\u2019s  payroll tax for individuals earning more than $200,000 and families  earning more than $250,000. But a larger chunk of funding under the  Senate bill would come from an 40 percent excise tax on high-cost  insurance plans &#8212; a provision that\u2019s wildly unpopular among a key  Democratic constituency: Organized labor.<\/p>\n<p>The  reconciliation bill alters both funding mechanisms. First, it scales  back the insurance excise tax by increasing the dollar thresholds from  $8,500 to $10,200 for single coverage, and from $23,000 to $27,500 for  family coverage. It also delays the application of that tax until 2018.  To make up the revenues lost by changes to the excise tax, the  reconciliation bill also expands the Medicare tax to include net  investment income (i.e. unearned income).<\/p>\n<p><strong>Kids\u2019 Care<\/strong><\/p>\n<p>After years of promoting the virtues of the Children\u2019s Health Insurance  Program, House Democrats did a strange thing: They proposed to eliminate  CHIP altogether, instead moving those kids into either Medicaid or  private plans on newly created insurance marketplaces, dubbed exchanges.  The Senate bill took a different tack, reauthorizing CHIP through 2019,  while funding it through 2015. Despite a more recent White House  proposal to provide an extra year of funding (through 2016), the  reconciliation bill doesn\u2019t touch the issue, leaving the original Senate  provision intact (and kids welfare advocates happy).<\/p>\n<p><strong>Pharma  Deal<\/strong><\/p>\n<p>A behind-the-scenes deal cut last year between Sen. Max Baucus  (D-Mont.) and the pharmaceutical lobby drew a good deal of attention:  The nation\u2019s drug makers, under that agreement, would dedicate $80  billion toward health care reform over the next decade if Democrats  would oppose further industry reforms &#8212; including a proposal allowing  Americans to buy their prescriptions from abroad, and another empowering  states to negotiate directly with companies on behalf of their  lowest-income seniors.<\/p>\n<p>While the White House endorsed  the deal, House Democrats didn\u2019t. Instead, Rep. Henry Waxman (D-Calif.),  chairman of the House Energy and Commerce Committee, included the state  negotiation provision as part of the House-passed bill. While the  reconciliation bill <a href=\"http:\/\/prescriptions.blogs.nytimes.com\/2010\/03\/18\/in-new-health-care-package-drug-makers-to-pay-more\/#more-22401\">does  tap<\/a> the drug makers for $28 billion over 10 years ($5 billion more  than the original Senate bill), it doesn\u2019t dabble with the other terms  of the Pharma deal.<\/p>\n<p><strong>Abortion<\/strong><\/p>\n<p>Always the  hot-button issue, abortion has emerged as the one topic that still  really threatens House passage of health care reform. Late last year,  Speaker Nancy Pelosi (D-Calif.) had negotiated a delicate compromise  designed to satisfy a number of anti-abortion Democrats &#8212; notably Rep.  Bart Stupak (Mich.) &#8212; who were concerned that the reform bill would  allow taxpayer dollars to subsidize abortions. The so-called Stupak  amendment would ban exchange plans from offering abortion coverage,  forcing women to buy a separate policy covering abortion services. The  Senate bill is a bit less strict, allowing abortion coverage on the  exchange, but requiring women to write a separate check for those  services to ensure that no federal funds go toward them. It\u2019s the Senate  provision that\u2019s going to the floor of the House early next week,  leaving Stupak and roughly a dozen other House Democrats <a href=\"http:\/\/thehill.com\/homenews\/house\/87519-its-been-a-living-hell-says-rep-stupak\">vowing<\/a> their opposition.<\/p>\n<p><strong>Anti-Trust Exemption<\/strong><\/p>\n<p>For 64 years,  the health insurance industry has reaped the benefits of a rare  exemption to federal anti-trust laws, which allows companies to share  cost and coverage information without scrutiny from Washington. And for a  number of years, Democrats have had their eyes on repealing it. The  House bill would have done just that, but the provision didn\u2019t make the  cut in the Senate, due largely to the opposition of Sen. Ben Nelson  (Neb.), the moderate Democrat whose close ties to the insurance industry  include a stint as CEO of the Omaha-based Central National Insurance  Group.<\/p>\n<p>Like many other insurance reforms, this  provision is one of those non-budget related items not eligible to move  under the reconciliation process. The Democrats, though, are hoping to  repeal the exemption later this year through separate legislation.  Indeed, the House has already <a href=\"http:\/\/www2.dailyprogress.com\/cdp\/news\/local\/local_govtpolitics\/article\/house_approves_antitrust_exemption_for_health_industry._perriello_co-author\/52729\/\" >passed<\/a> such a bill last month.<\/p>\n<p><strong>Medicaid  Rates<\/strong><\/p>\n<p>The headlines today will likely focus on the plan to eliminate  the sweetheart Medicaid deal that Senate leaders cut with Nebraska\u2019s  Nelson &#8212; a deal so unpopular that even Nelson himself claims now to  oppose it. But much more significant for purposes of ensuring care is a  provision of the reconciliation bill that hikes Medicaid rates to  primary care physicians to at least the level of what Medicare pays for  those same services. That provision was contained in the House bill, but  not the Senate proposal.<\/p>\n<p><a href=\"http:\/\/washingtonindependent.com\/60433\/medicaid-expansion-would-guarantee-coverage-not-care\">The  issue isn\u2019t trivial<\/a>. Medicaid rates are so low that many doctors  refuse to see Medicaid patients. Only about 40 percent of physicians  accept all new Medicaid patients, versus 58 percent for Medicare  patients, according to <a href=\"http:\/\/www.hschange.com\/CONTENT\/1078\/\">a  September study<\/a> from the Center for Studying Health System Change,  which randomly surveyed more than 4,700 physicians. And that number  drops to about 31 percent among family doctors and general  practitioners.<\/p>\n<p>For dental care, the numbers are even  worse. Only 27 percent of the nation&#8217;s dentists will treat  Medicaid-insured patients, according to a 2007 survey by the American  Dental Association survey. Those trends raise important questions about  the value of an insurance program that nobody accepts &#8212; and led  directly to the Democrats&#8217; decision to hike Medicaid rates.<\/p>\n<p><strong>Closing  the Doughnut Hole<\/strong><\/p>\n<p>Though seniors participating in Medicare\u2019s  prescription drug program are generally happy with their benefits, a  painful thorn plagues the program: Seniors are forced to pay the full  cost of drugs when annual expenses hit $2,700, and the subsidies don&#8217;t  return until total costs hit $6,154 &#8212; a coverage gap known (not  endearingly) as the doughnut hole. The Senate bills took steps to reduce  the size of that gap, relying mostly on the pharmaceutical companies,  who offered a 50 percent discount through the doughnut hole as part of  their $80 billion deal with Democrats.<\/p>\n<p>The  reconciliation bill expands on that plan, offering seniors an additional  $250 rebate in 2010, and closing the doughnut hole entirely by 2020.<\/p>\n<p><strong>Illegal Immigrants<\/strong><\/p>\n<p>While both the Senate and House bills would  prohibit illegal immigrants from receiving federal subsidies on the  exchanges, the Senate took the restriction <a href=\"http:\/\/washingtonindependent.com\/70075\/on-the-baffling-push-to-prohibit-illegals-from-buying-insurance\">a  long step further<\/a> by preventing those folks from buying insurance  from the exchanges at all &#8212; even if they paid the full price of  coverage using their own money. (The House bill would allow such  unsubsidized purchases.) Although some members of the House Hispanic  caucus have advocated for the House language in the reconciliation bill,  it didn\u2019t make its way in.<\/p>\n<p><strong>Public Option<\/strong><\/p>\n<p>The House  bill included the creation of a government-backed insurance plan to  compete with private companies on a national exchange, while the Senate  bill contained no such thing. Despite a late push from liberal groups to  include the House provision in the reconciliation bill, House Speaker  Nancy Pelosi (D-Calif.) declined, citing a lack of support in the  Senate.<\/p>\n<p>House Majority Leader Steny Hoyer (D-Md.) <a href=\"http:\/\/www.modernhealthcare.com\/article\/20100318\/NEWS\/303189967#\">said<\/a> today that the lower chamber hopes to vote on the reconciliation bill  Sunday afternoon.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>House Speaker Nancy Pelosi, with Majority Leader Steny Hoyer, discusses the health reform bill on Thursday. ( EPA\/ZUMApress.com) Democratic leaders pushing health care reform this year like to argue that a vast majority of the proposals represent uncontroversial changes backed by most Capitol Hill lawmakers. And while that might be true, it hasn\u2019t prevented some [&hellip;]<\/p>\n","protected":false},"author":4315,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[],"class_list":["post-444144","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts\/444144","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/users\/4315"}],"replies":[{"embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/comments?post=444144"}],"version-history":[{"count":0,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts\/444144\/revisions"}],"wp:attachment":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/media?parent=444144"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/categories?post=444144"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/tags?post=444144"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}