Details Emerge on Senate Health Reform Compromise

BY Betty Ann Bowser  December 10, 2009 at 11:03 PM EST

Some Senate Democrats sounded confident about prospects for health care reform Thursday, in the wake of Democratic negotiators’ recent compromise deal on the public option — though details of the agreement were still hard to come by. The agreement puts Democrats “right on the doorstep” of the 60 votes they need to pass reform legislation, Sen. Charles Schumer, D-N.Y., said in a press conference. Details of the agreement have been slow to appear because everyone on Capitol Hill says they’re waiting for the Congressional Budget Office to tell them what it’s going to cost. The team of ten negotiators — five liberal and five moderate Democrats — sent the proposal to the CBO for a cost estimate Tuesday night, but may not hear back until next week. But several general themes have been made public. The first is the public option — which is almost history. Majority Leader Harry Reid couldn’t muster the votes he needs to pass the bill with a public option, so the negotiators he tasked with coming up with an alternative settled on something else.
Their compromise instead would establish of a selection of private, non-profit insurance plans that would be administered by a government agency called the Office of Personnel Management (OPM) — the same entity that manages insurance for federal workers, including members of Congress. Those plans would be run by private insurance companies and would be offered alongside other plans from private insurers in the new exchanges where uninsured Americans and small businesses would shop for coverage. There’s only one way a government-run public option could come back — it could be triggered if those private plans prove unacceptable. The trigger clause could cost Democrats support from Independent Sen. Joe Lieberman of Connecticut, who has said he would not cast a vote in support of an overhaul with a public option — even one with a trigger. Another idea on the table is allowing people between the ages of 55 and 64 to buy in to Medicare — there are nearly 4 million uninsured Americans in this group. Currently, you must be 65 to apply for the program. It’s not known how much it would cost younger people to buy in. If the plan charged the full cost of Medicare of about $8,000 a year per individual, some people wouldn’t be able to afford it. But the government might also offer subsidies to those people to make it affordable. Expanding Medicare has been met with a howl of protest from doctors and hospitals. The American Hospital Association President and CEO Richard Umbdenstock told me yesterday: “I am very concerned about the impact on hospitals. This is moving more people into a program that underpays hospitals.” According to the latest data, Medicare pays hospitals 91 cents for each dollar of care provided, he said. And Umbdenstock says providing care for more people while getting paid less could spell financial ruin for some already financially strained hospitals. The American Medical Association, which represents about 250,000 physicians and medical students nationwide, is also very much opposed to this idea. Doctors complain their Medicare reimbursements are too low already, and according to Dr. James Rohack, president and CEO of the group: “Twenty-two percent of Medicare patients looking for a new primary care physician are having trouble finding one.” So if this proposal makes its way into law, the AMA says more doctors will stop seeing Medicare patients. On Thursday, the Medicare expansion idea got a boost from House Speaker Nancy Pelosi, who told reporters: “That is something that people in the House have advocated for years.” She refrained from commenting on the rest of the deal, though, saying she was still waiting to see the details. Finally, one other idea seems to be under consideration. The deal would require insurance companies to spend 90 percent of all the money they get in premiums on medical care for policy holders. The insurance companies, obviously, oppose this.
Where all of this is going is up in the air. Most senators right now are mum when asked where they come down on this agreement. Virtually every Republican has lined up to criticize the latest Democratic proposal. Even moderate Sen. Olympia Snowe of Maine, the only Republican vote Democrats believe they have a chance of winning, today told Politico that could not support a reform bill with the Medicare buy-in proposal. However, she also told the NewsHour’s Kwame Holman that it’s still possible she could vote with the Democrats for the health care overhaul, if her concerns were addressed. Meanwhile, after debating an amendment that would allow U.S. pharmacies to import medications approved by the FDA, the Senate on Thursday temporarily suspended debate on the health bill to take up a spending bill — they’re expected to resume Monday. Stay tuned.