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House Democrats Unveil Plan to Overhaul Health Care

July 14, 2009 at 6:35 PM EDT
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House Democrats on Tuesday unveiled their proposal to overhaul the nation's health care system. The plan includes a government-run insurance option, and would be paid for in part by a tax increase on the wealthy. NPR's Julie Rovner explains the move.
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JIM LEHRER: And still to come on the NewsHour tonight: paying the bills in California.

That follows a health care reform update. Gwen Ifill reports for our Health Unit, a partnership with the Robert Wood Johnson Foundation.

GWEN IFILL: House Speaker Nancy Pelosi and other top Democrats introduced their health care bill this afternoon, all 1,000 pages of it.

REP. NANCY PELOSI (D-CA), Speaker of the House: This bill is a starting point and a path to success, to lower costs for consumers and businesses, to give greater choice for Americans, including keeping your plan, your doctor or plan if you like them, better quality of care, putting doctors, not insurance companies, back in charge, and to provide stability and peace of mind that you cannot be denied care or coverage for a pre-existing condition.

GWEN IFILL: The measure, a product of three separate House committees, would extend coverage to millions of the uninsured by requiring employers or individuals to purchase insurance; include a government-run health care plan to compete with private insurers, the so-called public option; prohibit insurance companies from denying coverage or charging higher premiums based on pre-existing conditions.

House Majority Leader Steny Hoyer said the bill would be paid for.

REP. STENY HOYER (D-MD), House Majority Leader: We’ll be on budget. We’re going to pay for this bill. We’re not going to add additional debt to the American people. And we will produce a product that will give to the American people a sense of security and well-being.

GWEN IFILL: Five hundred billion dollars of the costs would come from increasing new taxes on the wealthy, and hundreds of billions of dollars more would come from cuts in Medicare and Medicaid spending.

In a concession to conservative lawmakers from rural areas, businesses with a payroll of less than $250,000 would be exempt from the insurance mandate. But even before the announcement was made, House Republicans were critical.

Michigan Representative Dave Camp.

REP. DAVE CAMP (R), Michigan: As we approach this health care debate, I think anywhere you slice it, this is a trillion-dollar bill that is going to result in massive taxes on about half of small-business owners.

GWEN IFILL: The Democrats resisted putting an overall price tag on their plan. California’s Henry Waxman chairs the House Energy and Commerce Committee.

REP. HENRY WAXMAN (D), California: I wouldn’t want to speculate about exact amounts because CBO is going to come up with their official score, and that’s the score we abide by, so we should get that very soon, and we’ll share it with everybody.

GWEN IFILL: But Pelosi and other Democrats say they plan to meet the president’s White House-imposed deadline to win passage before the end of the summer.

President Obama, meanwhile, has turned over part of his schedule each day to a health care pitch. Before he left for Michigan today, he released a statement praising the House plan.

The House plan, he said, “would begin the process of fixing what’s broken about our health care system, reducing costs for all, building on what works, and covering an estimated 97 percent of all Americans.”

Lawmakers have pressed the president to become more actively involved in the details of getting the legislation passed. Today, some Democrats said they are satisfied that he is.

SEN. HARRY REID (D-NV), Senate Majority Leader: In the meeting we had yesterday, the president is engaged. He’s willing to be as helpful as anyone asks him to be. I think that role that they’ve played so far has been extremely positive. Any time that I’ve called down about a problem dealing with health care, I get an immediate response.

GWEN IFILL: But Senate Republicans weighed in, as well, saying the price tag the Democrats have in mind will be too steep.

SEN. MITCH MCCONNELL (R-KY), Senate Minority Leader: Most of us are scratching our heads wondering how you can design a plan in order to try to cover the uninsured, bring more people into the coverage, and still save money. In fact, that won’t happen. So what we need is real cost estimates that make sense.

GWEN IFILL: Senate committees are also working on their version of health care reform.

Catering to House moderates

Julie Rovner
National Public Radio
The first compromise is the idea of three House committees with lots of big egos and big turf battles coming together to do one bill. That's remarkable in and of itself.

GWEN IFILL: For more about where things are heading on Capitol Hill and at the White House, we're joined by Julie Rovner, who's covering health reform for National Public Radio.

So, Julie, when we see something like this, three House committees coming together with one big plan, we know compromises were made. What were they?

JULIE ROVNER, National Public Radio: Well, certainly, as you mentioned, the first compromise is the idea of three House committees with lots of big egos and big turf battles coming together to do one bill. That's remarkable in and of itself. That wouldn't have happened, you know, the last time we did this 15 years ago.

But as you mentioned in the piece, they've made some changes since a month ago when they first unveiled the draft, things like changing the threshold for small businesses that will be exempt from the mandate from $100,000 of payroll to $250,000.

You know, this is the curse of having a big majority. The Republicans found out that they had this when they had a big majority. When you have these big majorities, you've got members from these very marginal seats, and so it's hard for them to vote for a very liberal bill.

And so they've really had to cater to their more moderate members, and so this is not really the -- the big liberal bill that a lot of people expect it to be. It's a much more moderate bill than I think a lot of people expected.

GWEN IFILL: And we saw Henry Waxman, the last of the great liberals, really leaning away from putting a price tag on this. Is there anybody out there who has an idea about what this is going to cost and how many people it's going to really affect?

JULIE ROVNER: Actually, just in the last few minutes, we did get the Congressional Budget Office numbers. I think that was just a matter of the CBO is very backed up. They're working on this; they're working on the Senate bills.

It's going to cost, according to the CBO, a preliminary estimate, $1.042 trillion over 10 years. That's a whole lot less money than the numbers people were throwing around even a couple of weeks ago.

It's still a lot of money, but over 10 years, it's a real small percentage. Remember, we spend $2.5 trillion a year on health care, so a trillion dollars over 10 years is really not adding that much to it.

According to the CBO, it will cover 97 percent of the uninsured, if you don't count illegal immigrants. And, remember, no one is suggesting that they be covered in these plans.

GWEN IFILL: How do you, for instance, calculate savings or impose savings for Medicare and Medicaid? How do they know what they can save? And how would they do that?

JULIE ROVNER: Well, of course, they know what they're planning on spending. And in some cases, they can just say, "We're going to reduce payments."

For example, payments to Medicare Advantage plans, these are the HMOs and PPOs, the managed-care plans that take care of Medicare patients. In the 2003 Medicare drug bill, those plans were given extra payments and they were overpaid on purpose to try to entice them back into the program. A lot had left when their payments were cut.

So they're getting paid considerably more than it actually costs them to take care of these patients. The Democrats have been saying for years they would like to cut those additional payments to simply bring them back to parity with the rest of Medicare and what it costs. That's money that they know that they can cut out that they'll have that money to then spend on this effort.

Prospects in the Senate

Julie Rovner
National Public Radio
The Senate's a little bit more fractious, as the Senate tends to be.

GWEN IFILL: Now, of course, this was just the House side. On the Senate side, things aren't as Kumbaya as they seem to be on the House side. There's more than one bill percolating over there.

JULIE ROVNER: Yes, the Senate's a little bit more fractious, as the Senate tends to be. You've got the Health, Education, Labor and Pensions Committee working on the fourth week of a markup. And they've gone through hundreds, literally hundreds of amendments.

And they are, alas, wrapping up their markup even as we speak. They are expected to finish. This is Senator Kennedy's committee. We have not seen Senator Kennedy through this markup process. He's been participating mostly by phone.

So they're going to finish. They're going to have a product. Their bill, in fact, only costs about $600 billion over 10 years.

GWEN IFILL: But then there's the Senate Finance Committee's idea.

JULIE ROVNER: And then -- yes, I was going to say -- they don't have a lot of the expensive things in their bill, like adding people to the Medicaid rolls. Then we have the Senate Finance Committee. They're not nearly in quite as good shape, because they're trying to get a bipartisan bill.

Senator Max Baucus from Montana, Senator Grassley, Republican from Iowa, have been working together with several other Democrats and several other Republicans trying and trying. And, again, the Finance Committee has to come up with the mechanism to pay for this. They're having a little bit more trouble, and they hope to get something by the end of the week.

Senator Baucus was at the White House yesterday with President Obama, you know, giving him kind of a kick-start, but they're still working.

GWEN IFILL: And we're still thinking we're going to see something by August, by the August recess for real?

JULIE ROVNER: Well, the goal, remember, was not to get this finished by the August recess. The goal was to get it through the House and through the Senate. Probably the House could do that.

GWEN IFILL: It's still possible?

JULIE ROVNER: The Senate was always going to be a reach to get this through the Senate by the August recess. It's possible. It's looking a lot less likely in the Senate. Now maybe the goal is to get it through both Senate committees by the August recess.

GWEN IFILL: So much for your vacation, Julie. Thank you very much for joining us again.

JULIE ROVNER: You're welcome.