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Senate Gears Up for Showdown Over Health Reform Bill

November 19, 2009 at 12:00 AM EDT
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The Senate on Thursday inched closer to debating Majority Leader Harry Reid's $848 billion health care reform bill, despite stiff GOP resistance. After a report from Betty Ann Bowser, Susan Dentzer explains the details.

JIM LEHRER: The Senate geared up today for the real battle over health care reform. Democratic leaders hoped to get their new bill to the floor nearly 10 months after the process began.

“NewsHour” health correspondent Betty Ann Bowser has our lead story report.

SEN. HARRY REID, D-Nev.: No one can ever remember a bill that affects everybody in America, as this bill does.

BETTY ANN BOWSER: Senate Majority Leader Harry Reid and fellow Democrats edged closer today to moving a 2,000-page health care reform bill to the floor for debate.

SEN. HARRY REID: We all acknowledge this legislation is a tremendous step forward.

BETTY ANN BOWSER: Reid unveiled the legislation last night, with final cost estimates from the Congressional Budget Office. The CBO put the price tag at $848 billion over 10 years, and said 94 percent of Americans would be covered, starting in 2014. That includes 31 million who are currently uninsured.

SEN. HARRY REID: The finish line is in sight. I’m confident we will cross it soon. And I’m once again inviting my Republican colleagues to join us on the right side of history.

BETTY ANN BOWSER: But Senate Republicans remained opposed today to much of what the Democratic bill would do.

Minority Leader Mitch McConnell:

SEN. MITCH MCCONNELL, R-Ky.: Mr. President, for months, we have been warning the American people of the Democrats’ plans to raise premiums, raise taxes, and slash Medicare in order to fund more government. Americans know that is not reform. And, unfortunately, the majority hasn’t been listening.

While two committees have publicly reported legislation, the bill we’re being asked to consider was assembled behind closed doors, out of sight, without input from the public, for over six years — for over the last six weeks. We’re being told we must rush to pass this legislation.

BETTY ANN BOWSER: Unlike an earlier Senate Finance Committee plan, this bill includes a government-run health insurance option, but it also allows states to opt out, if they wish.

It mandates that most Americans buy health insurance, or pay a penalty, but there is no mandate for employers to provide insurance. And it allows those with no insurance to shop for coverage on a new exchange.

To take the bill to the floor, Reid needs 60 votes. He’s hoping new deficit reduction numbers from the nonpartisan Congressional Budget Office, $130 billion over 10 years, will sway party moderates worried about federal spending.

To get those deficit savings, the bill would cut hundreds of billions of dollars in future Medicare spending, and impose new taxes, including a levy on expensive insurance plans. There’s also a planned increase in the Medicare payroll tax on individuals who make more than $200,000 a year and couples earning more than $250,000.

In at least one case, the formula seemed be working today. Nebraska moderate Ben Nelson sounded more positive when we caught up with him at a hearing today.

SEN. BEN NELSON, D-Neb.: The impact on the deficit is improved. In other words, it shouldn’t add as much — it shouldn’t add anything to the deficit, but help the deficit over a 10-year period, if those numbers are accurate. That certainly is an improvement over the House bill.

BETTY ANN BOWSER: Connecticut independent Joe Lieberman’s vote is another one Reid wants. Today, Lieberman said he will no longer try to block the bill from going to the floor for debate, but he still opposes the public option.

SEN. JOSEPH LIEBERMAN, I-Conn.: I’m worried that it will raise taxes or send us even deeper into debt. That’s what history shows us about government-run insurance programs. So, we have got a lot of work to do. But I think Senator Reid got us off to a good start. It’s going to be an important debate.

BETTY ANN BOWSER: Republicans characterized the Reid bill as a government takeover of health care.

And Tennessee’s Bob Corker said, it shapes up as a colossal disaster.

SEN. BOB CORKER, R-Tenn.: And the building blocks of this bill are just fundamentally wrong. You have got unfunded mandates to states. You have got mandates in here that actually drive private insurance premiums up, not down — drive them up.

BETTY ANN BOWSER: The bill also limits the use of federal money to cover abortions, but it is not as restrictive as what the House approved. And, already, abortion opponents have condemned the Senate version.

Still, Reid appeared upbeat today.

SEN. HARRY REID: We reach out to our Republican colleagues, and we would like to work with them. But everyone should understand, we’re going to do a bill. We hope that we don’t have to do it with Democrats. But, if we have to, we will.

BETTY ANN BOWSER: The majority leader said a crucial procedural vote to allow debate to begin could come as early as Saturday.

Path to the finish line

Susan Dentzer
Health Affairs
There still are some significant differences to be transcended between both the House and the Senate bills.

JIM LEHRER: More now from Susan Dentzer, a health analyst for the "NewsHour." She's the editor in chief of the journal "Health Affairs."

Susan, welcome.

SUSAN DENTZER: Nice to be with you, Jim.

JIM LEHRER: As we saw, Senator Reid said today the finish line for health care reform is now in sight. Does that mean -- does it depend on what you mean by in sight at this point?

SUSAN DENTZER: I think that's right, Jim. I would use the phrase so near and yet so far, near in the sense that every procedural step that's taken gets closer to the finish line. There's no question about this. You don't want to liken this whole process to a football game, but you can't get to the fourth down until you get to the first, second, and third. And, so, when the process proceeds, that's good, and that does get closer.

On the other hand, there still are some significant differences to be transcended between both the House and the Senate bills. And, so, it suggests that the conference committee that will ultimately have to marry two bills together -- and that's assuming that we get over the hurdle of passing the Senate bill in the fist place -- that's going to be a process.

JIM LEHRER: Yes. How important to this process at this stage is this CBO number that came out last night, the, what is it, nearly $900 billion, rather than the $1 trillion that the Republicans were looking for, or expecting? But CBO came down lower, at least on Reid's bill.

SUSAN DENTZER: It's significant.

Eighty hundred and forty-nine billion dollars in gross cost is significant, because that's below the $900 billion maximum that President Obama set. So, that's for starters. It is, as you say, also less than the House bill.

But also very important is the notion that, over the course of the period from 2010 to 2019, the budget deficits collectively over that period would be driven down by $130 billion. So, this enables the president to keep his pledge that he would -- quote -- "not add one dime to the federal budget deficit," at least if something close to the Senate bill is ultimately enacted.

JIM LEHRER: Is there a simple way to explain, Susan, how they do that, I mean, how they -- they expand health care, and they still do not add to the federal deficit?

SUSAN DENTZER: Yes. The simple way is, they find a lot of other ways to pay for that expansion of coverage, some of which come out of the health care system. Lower fees paid under Medicare to a whole slew of providers, or at least lower than would have been expected, that's one big piece of it.

Another large piece, though, is new revenues. And, so, we have the -- at least in the Senate bill, the proposed tax on high -- 40 percent excise tax on high-cost health plans. We have the surtax on the -- or at least the additional tax on the Medicare payroll tax increase. All of those things effectively add up and enable this thing to be paid for.

JIM LEHRER: Is the umbrella issue that's between Republicans and Democrats government involvement in health care?

SUSAN DENTZER: That is certainly, rhetorically, the main issue.

You know, the government is deeply, deeply involved in health care now. Witness the Medicare program, the Medicaid program. Basically, half of the dollars expended in U.S. health care float through some sort of government program, either at the federal, state, or local level.

So, the government is deeply involved now. Would the government become somewhat more involved? No question about it. Also, the government would be very much more involved in sort of even structuring the private marketplace in health insurance by setting up new health insurance exchanges and so forth.

But I think, in the great balance of things, what's at work here is an attempt to make the insurance market work better for everybody, both people who get coverage through the public sector and people who get coverage through the private sector.

And, yes, as you say, there's some suggestion on the part of many that this is too much government control. Others say this is what we have to do, to have the government step in to make the markets function better than they do currently.

Reaching 60 votes

Susan Dentzer
Health Affairs
It means that they can begin the process of trying to get to something that 60 people could agree on, that is to say, for example, the public option provision.

JIM LEHRER: Now, the road here to passage, of course, the first -- now, Senator Reid has said, Saturday night, there's going to be a vote, a test vote on process. What -- how will that happen?

SUSAN DENTZER: It's a procedural vote. It essentially is a vote to cut off debate on whether we should move the bill on to the floor, in effect. So, it's a procedural vote, but it's significant. You need 60 votes to pass that, as well as to actually pass the final bill.

So, if he can get 60 votes, which it now looks like there's a very reasonable prospect that he will, Senator Lieberman having said he wasn't going to block it, others having said that -- indicated that they would support it, that's good. That means that, basically, there's 60 votes willing to move on to the -- move the bill on to the floor, begin the process of amending it -- and there will be many, many, many amendments offered on the floor -- and really start the final phase of debate on the Senate side, with the hope of leading up to passage after Thanksgiving.

JIM LEHRER: But it doesn't mean that they have 60 votes for passage or 60 votes for this bill?

SUSAN DENTZER: No, it doesn't yet. But it means that they can begin the process of trying to get to something that 60 people could agree on, that is to say, for example, the public option provision. Coming up with some kind of solution that can get Senator Lieberman on board, for example.

We will note that, in the new version of the Senate plan, the public option is called a community insurance provision. The Congressional Budget Office said, at the end of the day, it thought only about three or four million people nationwide would enroll in that, for various reasons, one being that states would opt out, another being that premiums in that plan could actually be higher than in the private insurance market.

But people sort of have to work their way through that and decide whether they could live with something that would draw on board three or four million people, or whether they can't live with any of that, and then come up with a solution that they can get 60 votes to agree on.

JIM LEHRER: Yes. And that's just one of the pieces of the debate that is still to come, yes.

SUSAN DENTZER: That's right.

JIM LEHRER: Thank you, Susan.

SUSAN DENTZER: Nice to be with you, Jim.

JIM LEHRER: Thank you.