Now that the Senate voted in favor of beginning debate on a health care reform bill, despite an attempted Republican filibuster and attacks from moderate Democrats, the hard work begins.
Debate on the legislation will begin after Thanksgiving, but Republicans as well as some conservative Democrats have said that they will take steps to keep the bill from being passed.
Sens. Blanche Lincoln (D-Arkansas), Mary Landrieu (D-Louisiana) and Ben Nelson (D-Nebraska), all of whom sat on the fence in the days leading up to the procedural vote, remain unconvinced of many of the key components of the bill. Sen. Joe Lieberman (I-Connecticut), who often votes on the Democratic line but left legislators guessing in the days leading up to Saturdays vote before siding in favor of a vote, may be another essential swing vote in passing comprehensive health care legislation.
Sen. Orrin G. Hatch (R-Utah) predicted “a holy war” and vowed to thwart Democratic efforts to reform health care as defined by the provisions contained in the Patient Protection and Affordable Care Act.
The legislation would create a public insurance plan to compete with private insurers, and provide coverage to 31 million people who are uninsured. It would also allow states the option to opt out of the public plan by passing state-level legislation.
Though it seeks to cover five million fewer than the House bill, on the individual level most people would be required to carry insurance. The penalty of not doing so, though less stringent than the provision contained in the House bill, would start at $95 per person in 2014 and rise to $750 in 2016. It would, however, be capped at $2,250 per family in insurance penalties.
The plan also places an emphasis on employers – though it would not explicitly require them to give the option of health insurance coverage, any company with more than 50 employees who does not offer coverage will pay a penalty of roughly $750 per employee.
The plan also allows option for abortion coverage, one of the most contentious topics in the health care debate. Under Reid’s bill, insurers would not be either required or forbidden to cover abortions. However, the government would federally mandate that every part of the country would have the option between a plan which covers abortion and one which does not.
The ban on federal money used for abortions would remain in place, and if insurers cover abortion they cannot use federal money to subsidize the procedure.
The majority of the provisions in the bill, estimated to cost about $848 billion over ten years, would take effect in 2014. Senate Majority Leader Harry Reid plans to raise revenues with fees on health insurance companies and pharmaceutical manufacturers, thought the budget office estimated that, despite these measures, 24 million people would still be uninsured in 2019, one-third of whom would be undocumented immigrants.
Reid praised the bill, saying it would “save lives, save money and save Medicare.”
Reid projects the final bill will use a new method of financial coverage – a 5 percent tax on the full cost of nonessential, cosmetic surgery procedures that would be paid by the patient or insurer and collected by doctors and clinics to bolster federal health care funds. He also plans to increase the Medicare payroll tax for high-income people.
The legislation also proposes a tax on “Cadillac” insurance plans exceeding $8,500 for individuals and $23,000 for families.
It is new taxes and fees such as this that Reid says would reduce projected budget deficits by $130 billion over ten years on Medicaid and subsidies.
Sen. Kent Conrad (D-North Dakota), chairman of the Senate Budget Committee, told Fox News that Reid’s bill is “going in the right direction” and yields significant savings.
Others, however, are not as supportive.
Sen. Mike Johanns (R-Nebraska) called the bookkeeping subtleties a shell game, but said he did not see the Senate adopting an abortion bill as stringent as that of the House.
“I don’t see it in the final bill,” Johanns said. “I don’t believe there are enough pro-life senators to break a filibuster to make this a part of the final bill.”
Rep. Patrick Kennedy (D-Rhode Island), a Catholic who is pro-choice and contributed to the debate on the House bill’s abortion clause, was asked by the Roman Catholic Bishop Thomas Tobin not to receive communion unless he changed his views on abortion.
The US Conference of Catholic Bishops, commenting on the Senate bill, called it a “fundamental failure.”
Moderate Democrats, who wavered over the weekend in their support for the bill but in the end voted with the party to help block a Republican filibuster, are also voicing their opposition.
Sen. Blanche Lincoln said she would not support the Senate bill if the provision to create a government-run insurance option remains. Lincoln, who would not say whether she supported the bill until Saturday evening, said she does not think that government finances made a government-run plan viable.
“I have said I don’t support a government-funded, government-run public option,” she said. “I just don’t think it’s fair in these economic times to put at risk the taxpayers and the treasury.”