Debating Done, Now Comes a Budget Work-Up Before Voting on the Baucus Bill

By David M. Herszenhorn

DESCRIPTIONPablo Martinez Monsivais/AP From left, Senators Jay Rockefeller of West Virginia, John Kerry of Massachusetts, and Max Baucus of Montana congratulating one another early Friday morning as the Senate Finance Committee wraps up negotiations on health care legislation.

It wasn’t pretty at times, but at 2:15 a.m. Friday, the Senate Finance Committee finished debating amendments to its sweeping health care legislation. The bill will now be delivered to the Congressional Budget Office for a crucial cost estimate. A final vote on the measure is expected next week.

And while the committee adopted a number of important amendments in its final marathon session, just as critical may be the issues that the panel chose not to address.

The outstanding issues could be handled when the majority leader, Senator Harry Reid, Democrat of Nevada, works to meld the Finance Committee bill with an alternate measure approved by the Senate health committee back in July. Or these issues could wait until floor debate by the full Senate later this month.

The Finance Committee’s work, in the end, is just a dress rehearsal for the floor debate. And many of the big amendments that failed in committee debate, including a proposal by liberal Democrats to add a government-run insurance plan, or public option, will probably be proposed again for the entire Senate to consider.

My colleagues, Robert Pear and Jackie Calmes, who followed the committee proceedings through the wee hours of the morning, report some of the crucial changes that were made to the bill in the final session, including an easing of penalties the new law would require for people who fail to obtain health insurance.

The committee, in its homestretch, also adopted a proposal by Senator John D. Rockefeller IV, Democrat of West Virginia, to retain the Children’s Health Insurance Program as a stand-alone benefits package — rather than shift children and families onto plans to be offered through new state-run insurance marketplaces.

Mr. Reid’s office has already started working on combining the two bills.
Attention will also now shift back to the House, where Democrats are still wrangling over their version of the health legislation.

That effort should get a lift from the completion of the Finance Committee’s work, allowing lawmakers to take into account with greater certainty the Senate’s position on crucial issues, particularly how to pay for the health care overhaul.

House Democrats are still proposing a surtax on high-income Americans as a way to generate revenue. But the Senate shunned that idea, choosing instead to tax high-cost health insurance plans.

That proposal, which is opposed by labor unions that have negotiated generous benefits packages for their members, is viewed more warily in the House — where organized labor is a crucial constituency for many rank-and-file Democrats.

House leaders are considering whether they can incorporate some version of the tax on costly insurance policies into their bill.

As the process wrapped up on the Finance Committee, Republican senators sought assurances from the Finance Committee chairman, Senator Max Baucus, Democrat of Montana, that they would have sufficient time to study the completed bill and also to review the cost analysis that will be prepared by the nonpartisan budget office.

Mr. Baucus said, “I will make, in good faith, make sure there is a reasonable time in which senators, staffs, the public, can review the score by C.B.O.” He also said senators would be able to review the bill while the budget office completes its work, which could take three to four days.

If the cost analysis produces an acceptable price tag – lawmakers are hoping for no more than $900 billion over 10 years, fully offset by new taxes or reductions in government spending – Mr. Baucus said the panel would vote to send the bill to the full Senate.

“If the bill scores, then we vote on the bill, if it scores well,” he said. “On the other hand, if we have got a problem. We’ll have to make some adjustments.”

The Finance Committee is next scheduled to meet on Tuesday.

As exhausted, bleary-eyed staffers looked on, Mr. Baucus applauded the panel for its work and cheered the outcome.

“We have a product here that accomplishes our objectives,” he said. “It’s fiscally responsible. We can all be very proud of what we have achieved here.”

President Obama who was traveling in Europe, quickly issued a statement praising the Finance Committee’s efforts. “Thanks to the unyielding commitment of Senator Baucus and members of the Senate Finance Committee, we have reached another milestone in our effort to pass health insurance reform,” Mr. Obama said in the statement.

Mr. Obama added: “We have a long way to go, but I am confident that as we move forward, we will continue to engage with each other as productively as the members of the Finance Committee, and will get reform passed this year.”

Senator Charles E. Grassley of Iowa, the senior Republican on the Finance Committee, warned that most if not all of the Republicans on the panel would vote against the bill next week. But he praised Mr. Baucus for conducting a fair process.

Keep an eye on Prescriptions as we begin to comb through all of the amendments and bring you more news and analysis of the Finance Committee’s work.

Comments are no longer being accepted.

pipian October 2, 2009 · 10:51 am

So, it is getting to the point that the People need to get out their Pitchforks & Torches to get the politicians to understand the meaning of the word NO.

Marcus Welby October 2, 2009 · 10:53 am

What a disappointment. We need true reform which would result in affordable and sustainable universal coverage, something the nation agrees we need. That is not possible while still rewarding big Congressional contributors — the insurers and Big Pharma. So this final Committee version has Co-ops? My understanding is that this is an unproven method with only one or two successes in the country and Puget Sound’s Coop took over 60 years to get enough enrollees to pass the 500,000 threshold to be able to bargain successfully for slight lowering of costs. So we have a Senate Finance Committee effort which is not bipartisan, which has very little cost control, no price control, is not universal, may not truly be affordable, and with inadequate subsidies, but fines if you do not purchase insurance which may be out of your price range and which many who will be threatened with fines will think they do not need. We have mandates in California and Florida to buy auto insurance if you drive a car but only about 85% do so. And the bureaucracy needed to run this will take 4 years to assemble and will be added to the worst in the world 31% overhead we already have…they need to start over with single payer on the table. The blame for this awful legislation will fall on anyone who votes for it when it fails to work.

djaymick October 2, 2009 · 11:07 am

It would have been nice if you informed readers that two amendments were presented to eliminate loopholes. Those involved illegal immigrants and abortion. Both were addressed as myths by the President in his address to Congress. However, these amendments were dropped on partyline votes.
My question is this – Are Democrats destroying Obama’s Presidency by killing these amendments or are they under the White House orders to kill the loopholes? Either way, the public will find out about it and the President will have to answer those questions. What people forget about the inpeachments of Nixon and Clinton is that the biggest issue that faced both of them was not the acts themselves, but the lies they told the American public. Those two Presidents lost all credibility with the public.

Scott October 2, 2009 · 11:33 am

Wait just a minute, I thought it was REPUBLICANS who were going to cut Medicare.

At least I heard that right before every election…….

Jeremy October 2, 2009 · 11:58 am

While I would support a public option or even nationalize health care, I am strongly opposed to any individual mandate that has been proposed. All of them are likely to increase my costs many times over for the sake of insuring more people. Just a mandate and nothing else would be fine; it would be status quo for me and would help get those who can afford health insurance and simply elect not to have it covered. However, the scope of all proposals to date is much larger. None provide reasonable incentives to employers and almost all place the burden on the middle class and those struggling to maintain their foothold in the American Dream. My employer currently pays 90% of my insurance premium, or $6,000 per annum. My obligation is $600 per year. That’s affordable. Under every proposed plan, my employer looses incentives to provide such coverage. The quality of my insurance will go down while my out-of-pocket expense will go up.

Why? Someone has to pay for these plans. Although, today, when I do seek healthcare, I already pay for them. Congress wants to take more money from me to prevent people who get sick from going bankrupt. Sadly, I can’t afford to bail out big industry and bail out the sick and provide for my own well being. If this passes, it will be far more cost-effective for me to leech off of the system and pay the penalty for not having insurance than to actually carry insurance. Thus, if I get sick, I will go bankrupt.

What people don’t seem to understand is that it’s not “insurance” if providers are forced to cover individuals who are already ill. Take this analogy: I buy a new $50,000 car and total it. Then, I call Geiko and buy a $100 per month insurance policy which cannot be refused for the existing condition of my car having been totaled. Then, I make a claim and get $50,000. Once my car is replaced, I drop my insurance plan and wait until I need it to carry it.

How is this in Geiko’s interest? It’s not. Insurance is not supposed to be a money-machine that pays your bills for you. Insurance is supposed to insure you by collecting a small amount of money and hedging bets against your becoming ill. Congress should just mandate that insurance companies cannot drop people who become ill for minor reasons. They should not force insurance companies to “cover” individuals at $100/mo whose known health care costs are $5,000/mo. Doing so merely means that I must pay more to cover the difference.

Taking care of your body, dieting, exercising, avoiding drinking and smoking… doing all the right things regardless of how expensive and time consuming they are and allocating a portion of your income as insurance against catastrophic illness suddenly doesn’t make any sense. Instead, congress wants me to pay many times more than I am so that obese smokers with 10 children and a botched education won’t become more of a drain on society than they already are. But, the sad fact is, I already pay for their drain on society… why must I pay MORE to save doctors and insurance companies from sharing the burden?

Single-payer or status quo — either case is strictly better. If this burden to the middle class passes, I am one democrat who will be voting republican in the next election.

Hilary October 2, 2009 · 12:32 pm

Oh. My. God. Why don’t we all just contribute a certain percentage of our income/profit to a health care fund that can be used by everybody? We are making it so complicated just to avoid putting the health insurance industry out of business. The health insurance industry represents a middleman. It doesn’t actually deliver care. Furthermore, it’s failed miserably in stated mission. Who cares if they go out of business?

RLS October 2, 2009 · 12:37 pm

Four out of five congressional bills have a public option — the Senate Health bill and the three House bills. The Baucus bill needs to be scrapped.

Sen. Bernie Sanders on the public option:
//sandersunfiltered.com/blog/?p=22

D KIlgariff October 2, 2009 · 1:20 pm

Consider; In Australia we have ‘universal healthcare’ for all Australians. This means that all people over 18 have a Medicare Card & No and receive a free service from any medical service provider they choose to see. The program is funded by a 1.5% levy on income and an extra 1% if you are a high income earner ($100k) without private health insurance. In practice, you see a GP and pay nothing UNLESS the doctor charges above the scheduled fee and you then pay the ‘gap’ which may be from $5-15 extra. Some of them always want more than the set rate. The majority doctors ‘bulk bill’ in other words you sign and they send the bill to the govt. With hospitals you are given no cost treatment. You front up, are admitted or seen as outpatient and you see a specialist working through the hospital. You will usually see the same specialist. The downside of this is that you may have to to wait and be buggared around a bit but you still get treated. If you have private cover (up to $200 a month or more and the funds are forever qualifying what they will treat and pay, you can go to a private hospital, see the specialist of your choice and probably eat tuna and have a glass of wine with your dinner if admitted. Most of the health funds are for profit though the we did have a private scheme publicly managed but sold off over the privatisation era. Membership of private health funds in Australia is falling. The recent conservative govt wanted to get rid of publicly managed health care by selling it but never quite had the courage even with both houses of parliament controlled by their party. They did give $1billion dollars as a subsidy to people for private healthcare membership to encourage higher membership (the funds put their fees up and people are deserting the ship in droves back to the public system). Now I have cancer. I see a private oncologist and pay approximately a $35 gap between his fee and the medicare scheduled rate. I choose to do this. However, treatment is at a public hospital at no cost. But having a private specialist does not guarantee quality care in my opinion (am an ex nurse). On pharmaceuticals, Australia has a Pharmaceutical Benefits Scheme (PBS). This means that there is a prescribed list of pharmaceuticals that the government pays benefits against. If your drug is not on that chances are it wont be prescribed. The PBS allows for a set rate for that drug and no more. In rhe recently negotiated free trade agreement between Australia and the US, the US wanted to us to get rid of the PBS for obvious reasons but we refused. The biggest problem, and it is raised by many in this blog, is that we forever look at the demand side but no-one is prepared to tackle the supply side where services (technology changes too) are frequently described as ‘lucrative’ in terms of fees. But from what I understand of the US system, a health insurer can prescribe which doctor and treatment a person will receive in some cases and there is at times a level of horizontal and vertical intregration so that they (the health funds) clip the ticket at every stop. That does not happen here and if it were tried they would probably find themselves out. Our system is not perfect but for the life of me, I fail to see how a country as welathy as the US can have so many people thrown on the streets and denied treatment. The US seems to see healthcare as a privilege whereas we state it to be a human right. There is further argument here that no-one should profit from health – taxpayers subsidise medical training after all for people who for some inexplicable reason are deemed to be on a higher level of humanity when in fact, many are small businessman (and I dont begrudge them their income. But profiteering is wrong at any level when a person needs healthcare. Americans do not have to be afraid of a public option. Some call it communism, socialism or whatever. – its not. Its about caring for everyone in society. Fortget the labels and ask (if nothing else) what will happen to you and your family members if you are struck down with a catastrophic injury/illness in your life (US unemployment is currently at 9% plus ). A note – in the eighties the Australian health system moved partly to an american model of managed care. There was a massive shift of health dollars from the public to the private system and little public benefit. The process is now being reversed. We, taxpayers, still fund to a large part the private system yet they charge like wounded bulls. Care? Maybe I am biased but from what I have seen as a nurse working within both systems, the private provides the luxury and excess needed to feed some the egos while others honestly hope for better care yet receive less. After all, they want your money. Our public system is world class in teaching, research and practice. Its so simple really.

Nick October 2, 2009 · 2:03 pm

“We have a product here that accomplishes our objectives,” he said. “It’s fiscally responsible. We can all be very proud of what we have achieved here.”

Yes, the bill goes far to help all those special interest who bought and paid for the Senate Finance Committee and most of Congress. It also adds new taxes on the middle class, while it lets the wealthy tax cuts stand. And, it starts taxing employer provided benefits starting at high cost health plans opening the door to taxing all employer provided benefits. Finally, it doe snot control any costs, and is very weak on addressing the rising cost of health care, and the industry profits that go with them. In this vain, I think the GOP is the only hope from preventing this travesty from getting passed.

I want health care reform, I want universal health care and I want the health care industry be held accountable to reign in costs. I want a public plan, so it is void of profits. If not, I want insurance policies to be available nationwide, regulated nation wide and all have the same provisions; getting rid of out of network and the various state regulations. I want tort reform. I want doctors to be paid a salary. I want those who go to medical school on government loans/grants/scholarships to be required to to serve as a general practician for five years We the government to merge Medicaid, Medicare and VA into one public system to reduce administration costs. This is what health care reform is; not having to buy insurance or be penalized for not having it. Combining the best of the German and Swiss system, with a a dose of Canada’s system is what we need. If not, then the Democrats are in for a rude awakening come the next election cycle.

I do not blame Olympia Snowe at all; it seems she is the only one on that committee, besides the liberal Democrats, who actually cares about Americans. The rest of the committee seems to care only about getting re-elected with contributions from the health care industry.

ed October 2, 2009 · 2:16 pm

There comes a time in everyone’s life when you must decide to stand up for what you believe or allow the wil of others to be imposed on you. Our elected officials apparently do not appreciate the seriousness of this moment and are willing to make compromises when they should be standing by their principles. Health care is not a privilege it is a right and if we do not fight for what we believe our rights wil be negotiated for the benefit of the privileged, namely the insurance companies and health providers.

We need to make our voices heard and show our elected officials what we mean by voting for change.

Go to //www.standupforchangeusa.org for more information

Wonks Anonymous October 2, 2009 · 2:28 pm

The public option would save money by decreasing the cost of health insurance. Less costly health insurance would mean lower total subsidies.

Can the budget folks who are currently working sophisticated models to show how putting us all on bare bones high deductible policies is the only way to save money please do some simple thinking on this one?

B. Mull October 2, 2009 · 3:01 pm

The funding of this bill is one of the more sickening aspects.

Democrats have conceded that a tax on “Cadillac” insurance policies will be the main source of revenue. In fact it doesn’t raise the big money until it starts hitting the middle class hard in about 10 years.

Meanwhile Democrats are unable to agree on even a slight limit on tax deducitions for charitable donations. All that’s really being asked of the wealthy is that a tiny fraction of the money that goes to, say, Steve Wynn’s art gallery in Vegas, be taxed to help pay for health care for poor Nevadans. No dice.

And of course we know that the health care industry is not chipping in, because President Obama promised them backroom deals. It even emerged yesterday that the White House will substitute its own reform bill if Congress tries to break any of those deals. And that includes a strong Public Option.

This health care plan is an insult to middle class voters. I pray there is at least one principled Senator who will break with the Democrats and vote NO.

Nick October 2, 2009 · 4:13 pm

B. Mull,

We need at least 10 Senators on the Democratic side to break ranks. And if the bill passes, as is, President Obama will be looking fro a new job in 2012; and much of the Democratic caucus in 2010 and 2012.

We moderates helped put these people in and we can help replace them. This is not a free pass to the GOP. Anyone who is an incumbent is going to be looking for a new job. Washington won’t clean itself up; so we, the voters, need to clean it up by voting all 100 Senators and 435 Congressman out. For states, which have primaries, vote against the incumbent. It is time to take OUR government back.

Bill Watson October 2, 2009 · 4:27 pm

Today’s drastic job loss information screams why we need to throw out the health care reform efforts to date and start over.

Mr. Baucus’s plan will produce obscene profits for the health care industry while bleeding the life blood out of consumers, employers, and taxpayers.

To assure no more medical bankruptcies, no more uninsured people denied care, no more forced dilemmas between going without food or other necessities in order to pay for needed medications or care, (Seniors and everyone choosing public care could have it no restrictions, no insurance, no co pays, free period.), to eliminate health care burdens for employers, (Employers who select public care for their employees would not be required to pay for or have any further involvement with health care.), and save hundreds of billions of dollars annually for taxpayers, instead of adding to the national debt, we need to start over on health care reform by using what President Obama calls “government’s unfair advantages” which lower costs far below what private systems can ever attain and offer free public or private care private pay.

Mary October 2, 2009 · 7:10 pm

“Can the budget folks who are currently working sophisticated models to show how putting us all on bare bones high deductible policies is the only way to save money please do some simple thinking on this one?” — Wonks Anonymous

A bare-bones policy means higher out-of-pocket costs and will put more people at risk of going bankrupt. The Baucus proposal is a win-win for the insurance industry. It’s a TERRIBLE plan for the American people!!

Vincent Brogan October 2, 2009 · 8:40 pm

I know that, idealogically, Americans must oppose the public healthcare option, but sometimes, just sometimes, gut instinct should prevail. And mine, speaking as a patient and doctor, says go with Obama and ignore the vested interests who, for their own end, are desperately trying to derail his plan.
I live in the UK and have had plenty of exposure to both private and public systems. Private healthcare is fine if you can afford it, but most who have it can’t. And the reason being that privatised medicine is not healthcare. It is wealthcare.
Now don’t get me wrong. Private medicine works, and works well. It has a place in the greater scheme of things. But it only works for the lucky minority. If you take away Medicare, Medicaid, publicly funded programmes and the forty five or so million who have no cover, what are you left with? A fair number of people with decent but very expensive healthcare and corporations like GM that are driven to the edge trying to pay unaffordable premiums for workers who otherwise could’nt afford them. And, of course, the minority who can.
When you are genuinely ill the last thing you need to worry about is money. Or the lack of it. Which is why so many Americans are stressed out by the prospect of illness, never mind the disease itself. Europeans, likewise, don’t want to be ill. But when they are, at least the vast majority of them who live in countries with public or state controlled insurance systems, then their ability to pay is not an issue. And that is how it should be in wealthy democracies.
There are, of course, scare stories and blunders but these, I warrant, are no different to what happens in the US. Indeed Europeans are, on average, far happier with their public systems than the average American is with his private one. That is, if he has one.
And pound for pound, dollar for dollar, a German, Brit or French patient gets far better value from his healthcare system than does the American one, notwithstanding the fact that the US is a world leader in high tech medicine.
But, as used to be the case in the UK’s NHS, there is little point in having top class specialists and technology if you can’t have access to them when you need it.
Now that spending on UK healthcare has increased to European averages over the past ten years or so access to and standards of healthcare make the NHS one of the top and more affordable systems in the world, even though it still has it’s problems.
If Americans spent something between the sixteen percent of GDP they now spend, and the ten or so per cent which Europeans do on healthcare then they could have a world class system, available to all. And save themselves billions of dollars in the process. If they have doubts about publicly funded healthcare then they should ask the average European patient, and not the lobbyists with their own agendas, if socialised medicine works. There is only one ansewr.

Mike October 2, 2009 · 11:38 pm

To readers in the Boston area:

John Kerry is a fine public servant and an American hero, but his vote on the Iraq War proved that he cannot be trusted to do the right thing in Congress when it counts.

John Kerry “supports” the public option, but will not commit to voting against a health care reform package that does not include the public option. If we don’t speak up, history will repeat itself, and Kerry will end up being “for the public option before he was against it.”

Let your voice be heard! Join us on Tuesday, October 13th, as we demonstrate at John Kerry’s Boston office. Let the Senator know that reform lacking in substance is no reform at all.

It is very important that we make ourselves visible. After all, over 2/3rds of the American people support the public option. Therefore, all we have to do is keep reminding the Democrats and the media that the people are united in their desire to put an end to gross profits for the insurance companies.

There are no excuses. Meaningful reform is within our sights, but it won’t happen unless we continue to speak up. The insurance companies are doing everything possible to preserve their sick profits, so we must make our voices heard in the name of true reform. Otherwise, the final plan will be little more than a watered-down turkey.

Demonstrations will be taking place all day long, but we are asking people to make a particular effort to show up for one hour at lunch time. We are advising the local media that this is a “lunch time rally,” so if you can just stop by on your lunch break, that would be terrific! Thank you, and long live the public option!

TW October 3, 2009 · 4:56 pm

Without public option, the two primary goals of the meaningful health care reform, i.e, containing the cost as well as providing the coverage for people who don’t have the insurance, will not be reachable; we might as well not do this. As it is now, the insurance industry is the big winner of this bill; about half a trillion will be spent in buying the new insurance! This Baucus bill as it is now is made for helping the insurance industry, not for average people.

antonio.bklyn October 4, 2009 · 8:57 am

Mike Bacus lapdog of big insurance, has taken over $2.8 million dollars in contributions. He is a scondrel and a betrays the citizens of Montana, and America. Shame on him, and shame on you, and the democratic party, for allowing him to get away with his skullduggery.

nanvan January 15, 2010 · 4:33 pm

Between the Big Pharma and Pharma Plans offered to seniors…..these seniors, who have worked their rears off all of their lives, saved and been frugel so that we could live in some comfort in our retirement as Ernie says “Forgid abud it” ….as it seems that we just might end up on the ‘dole’, “Medicaid”, or whatever it is called. Our prescriptions and the premiums for the various plans for health care and prescriptions cost us way too much each year….now, every single drug plan has not only raised their premiums but also the ‘co-payment you must pay before you can buy your drugs is being increased ten fold….SOMETHING STINKS HERE….JUST WHAT ARE OUJR REPRESENTATIVES GOING TO DO ABOUT IT… WHAT LAWS/CHECKS/CONTROLS ARE GOING TO BE PLACED ON THESE GREEDY COMPANIES?