Post by jobs1stb4polarbear on Dec 19, 2009 21:56:08 GMT -5
Sen. Ben Nelson bought off for number 60. Democrats are now free to subvert the will of the American people
Deal on health bill is reached
By Shailagh Murray and Lori Montgomery
Washington Post Staff Writers
Sunday, December 20, 2009; A01
Senate Democrats said Saturday that they had closed ranks in support of legislation to reform the nation's health-care system, overcoming months of internal division and clearing a path for quick Senate passage of President Obama's top domestic policy priority.
Majority Leader Harry M. Reid (D-Nev.) secured the pivotal 60th vote after acceding to the demands of Sen. Ben Nelson (D-Neb.) for tighter restrictions on insurance coverage for abortions, along with money for his home state and breaks for favored health-care interests.
"Change is never easy, but change is what's necessary in America," Nelson said at a morning news conference, announcing his support as a snowstorm raged outside.
In remarks at the White House, Obama said it appears that a vote is certain on a bill that would provide coverage to more than 30 million uninsured Americans.
"After a nearly century-long struggle, we are on the cusp of making health-care reform a reality," said the president, who had dispatched senior administration officials to help lock down Nelson's support.
Republicans excoriated the Senate bill as a threat to Medicare -- cuts to the program for the elderly would offset much of the cost of the bill -- and the employer-based insurance system, which provides health coverage to most Americans. GOP leaders invoked a rarely used Senate rule to require that the entire 338-page package of amendments Reid introduced Saturday be read aloud on the floor, a process that consumed about seven hours on Saturday afternoon.
"This bill is a monstrosity," said Senate Minority Leader Mitch McConnell (R-Ky.). "This is not renaming the post office. Make no mistake -- this bill will reshape our nation and our lives."
But Republicans were running out of options in their quest to derail the overhaul. Unless the GOP yields, the bill is expected to pass in a final Senate vote at 7 p.m. on Christmas Eve. Negotiations to merge the bill with the House version would begin early next month.
Securing Nelson's support allows Reid to maneuver the legislation through a complex parliamentary minefield without obstruction. A 60-vote bloc chokes off the filibuster, the Senate minority's primary source of power, and the GOP's best hope of defeating the bill.
Many liberals, however, were bitterly disappointed with the bargains Reid struck to win support from moderates in his caucus, any member of which could seek alterations in exchange for his or her support. Democratic leaders dropped a government insurance option and the idea of expanding Medicare to younger Americans. Reid also omitted language that would have eliminated the federal antitrust exemption for health insurers -- another nonstarter for Nelson.
Congressional budget analysts reported Saturday that the revised package would not worsen the nation's fiscal situation, as GOP critics have warned. The analysts said the updated Senate bill would spend $871 billion over the next decade to extend coverage to more than 31 million Americans by dramatically expanding Medicaid, and by offering federal subsidies to those who lack affordable coverage through employers.
Those costs would be more than covered by nearly $400 billion in new taxes over the next decade and by nearly $500 billion in spending reductions, primarily cuts to Medicare, the federal health program for people 65 and older. All told, the package would reduce federal budget deficits by $132 billion by 2019, according to the nonpartisan Congressional Budget Office.
Over the long term, the analysts predicted, the package could reduce budget deficits even more sharply, slicing as much as $1.3 trillion from projected deficits between 2019 and 2029. That would represent a significant improvement in long-run savings compared with the bill approved by the House and a measure previously crafted by Reid.
Democratic leaders worked for days to hammer out a deal with Nelson. They reached a tentative agreement with him late Friday night on the abortion coverage provisions that had proven the major stumbling block.
Nelson also secured full federal funding for his state to expand Medicaid coverage to people below 133 percent of the federal poverty level. That bill would require all states to expand Medicaid eligibility, but all states except Nebraska would pay a portion of the additional cost of doing so after 2016. Nelson also won concessions for qualifying nonprofit insurers and for Medigap providers from a new insurance tax, and he was able to roll back cuts to health savings accounts.
"I know this is hard for some of my colleagues to accept and I appreciate their right to disagree," Nelson told reporters. "But I would not have voted for this bill without these provisions."
Other Democrats also won important changes. Reid added $10 billion for community health centers to provide services to low-income people. That funding had been a top priority for Sen. Bernard Sanders (I-Vt.), a liberal champion of the public option.
The revised Senate bill would require every American for the first time to obtain insurance or face a penalty of as much as $750 a year or 2 percent of income, whichever is greater, with a cap for families set at $2,250. Those without access to affordable coverage through an employer would be eligible to apply for federal subsidies and shop for coverage in new state-based exchanges, starting in 2014.
Instead of a public option, the legislation would allow private firms for the first time to offer insurance policies to all Americans across state lines on the exchanges. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress.
Starting immediately, insurers would be barred from denying coverage to children with pre-existing conditions. A total ban on the practice would take effect in 2014. Lifetime limits on coverage would be banned and annual limits would be restricted until 2014, when they, too, would be banned entirely.
Insurers would be required to justify rate increases, and patients would have the right to appeal denials of claims to an independent state board. All insurance companies would be required to spend at least 80 cents of every dollar they collect in premiums on delivering care to customers.
All but the smallest employers would face fines of as much as $750 per worker if even one employee sought federal help to buy a policy. But at the behest of other Democratic skeptics, including Sens. Mary Landrieu (La.) and Blanche Lincoln (Ark.), Reid made changes to offer additional assistance to small businesses.
To appease fiscal conservatives, Reid strengthened cost-containment provisions by expanding the scope of an independent Medicare advisory board, empowering it to implement cuts if costs grow faster than an inflation-based target after 2019.
The package would rely on nearly $400 billion in new taxes, including a new 10 percent tax on indoor tanning salons to be paid by the customer, and an increase in the Medicare payroll tax for people earning more than $200,000 a year and families earning more than $250,000.
The payroll tax increase was initially set at 0.5 percent, but Reid increased it to 0.9 percent. He scrapped an earlier provision that would have imposed a 5 percent tax on cosmetic surgery.
And Reid rewrote a proposed fee on insurance companies to exempt nonprofit firms that spend at least 92 percent of premiums on medical service, a change that would benefit firms in Michigan and Nebraska. That change, made at the request of Nelson and Sen. Carl M. Levin (D-Mich.), seeks to identify and reward "good actors," Senate aides said.
Deal on health bill is reached
By Shailagh Murray and Lori Montgomery
Washington Post Staff Writers
Sunday, December 20, 2009; A01
Senate Democrats said Saturday that they had closed ranks in support of legislation to reform the nation's health-care system, overcoming months of internal division and clearing a path for quick Senate passage of President Obama's top domestic policy priority.
Majority Leader Harry M. Reid (D-Nev.) secured the pivotal 60th vote after acceding to the demands of Sen. Ben Nelson (D-Neb.) for tighter restrictions on insurance coverage for abortions, along with money for his home state and breaks for favored health-care interests.
"Change is never easy, but change is what's necessary in America," Nelson said at a morning news conference, announcing his support as a snowstorm raged outside.
In remarks at the White House, Obama said it appears that a vote is certain on a bill that would provide coverage to more than 30 million uninsured Americans.
"After a nearly century-long struggle, we are on the cusp of making health-care reform a reality," said the president, who had dispatched senior administration officials to help lock down Nelson's support.
Republicans excoriated the Senate bill as a threat to Medicare -- cuts to the program for the elderly would offset much of the cost of the bill -- and the employer-based insurance system, which provides health coverage to most Americans. GOP leaders invoked a rarely used Senate rule to require that the entire 338-page package of amendments Reid introduced Saturday be read aloud on the floor, a process that consumed about seven hours on Saturday afternoon.
"This bill is a monstrosity," said Senate Minority Leader Mitch McConnell (R-Ky.). "This is not renaming the post office. Make no mistake -- this bill will reshape our nation and our lives."
But Republicans were running out of options in their quest to derail the overhaul. Unless the GOP yields, the bill is expected to pass in a final Senate vote at 7 p.m. on Christmas Eve. Negotiations to merge the bill with the House version would begin early next month.
Securing Nelson's support allows Reid to maneuver the legislation through a complex parliamentary minefield without obstruction. A 60-vote bloc chokes off the filibuster, the Senate minority's primary source of power, and the GOP's best hope of defeating the bill.
Many liberals, however, were bitterly disappointed with the bargains Reid struck to win support from moderates in his caucus, any member of which could seek alterations in exchange for his or her support. Democratic leaders dropped a government insurance option and the idea of expanding Medicare to younger Americans. Reid also omitted language that would have eliminated the federal antitrust exemption for health insurers -- another nonstarter for Nelson.
Congressional budget analysts reported Saturday that the revised package would not worsen the nation's fiscal situation, as GOP critics have warned. The analysts said the updated Senate bill would spend $871 billion over the next decade to extend coverage to more than 31 million Americans by dramatically expanding Medicaid, and by offering federal subsidies to those who lack affordable coverage through employers.
Those costs would be more than covered by nearly $400 billion in new taxes over the next decade and by nearly $500 billion in spending reductions, primarily cuts to Medicare, the federal health program for people 65 and older. All told, the package would reduce federal budget deficits by $132 billion by 2019, according to the nonpartisan Congressional Budget Office.
Over the long term, the analysts predicted, the package could reduce budget deficits even more sharply, slicing as much as $1.3 trillion from projected deficits between 2019 and 2029. That would represent a significant improvement in long-run savings compared with the bill approved by the House and a measure previously crafted by Reid.
Democratic leaders worked for days to hammer out a deal with Nelson. They reached a tentative agreement with him late Friday night on the abortion coverage provisions that had proven the major stumbling block.
Nelson also secured full federal funding for his state to expand Medicaid coverage to people below 133 percent of the federal poverty level. That bill would require all states to expand Medicaid eligibility, but all states except Nebraska would pay a portion of the additional cost of doing so after 2016. Nelson also won concessions for qualifying nonprofit insurers and for Medigap providers from a new insurance tax, and he was able to roll back cuts to health savings accounts.
"I know this is hard for some of my colleagues to accept and I appreciate their right to disagree," Nelson told reporters. "But I would not have voted for this bill without these provisions."
Other Democrats also won important changes. Reid added $10 billion for community health centers to provide services to low-income people. That funding had been a top priority for Sen. Bernard Sanders (I-Vt.), a liberal champion of the public option.
The revised Senate bill would require every American for the first time to obtain insurance or face a penalty of as much as $750 a year or 2 percent of income, whichever is greater, with a cap for families set at $2,250. Those without access to affordable coverage through an employer would be eligible to apply for federal subsidies and shop for coverage in new state-based exchanges, starting in 2014.
Instead of a public option, the legislation would allow private firms for the first time to offer insurance policies to all Americans across state lines on the exchanges. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress.
Starting immediately, insurers would be barred from denying coverage to children with pre-existing conditions. A total ban on the practice would take effect in 2014. Lifetime limits on coverage would be banned and annual limits would be restricted until 2014, when they, too, would be banned entirely.
Insurers would be required to justify rate increases, and patients would have the right to appeal denials of claims to an independent state board. All insurance companies would be required to spend at least 80 cents of every dollar they collect in premiums on delivering care to customers.
All but the smallest employers would face fines of as much as $750 per worker if even one employee sought federal help to buy a policy. But at the behest of other Democratic skeptics, including Sens. Mary Landrieu (La.) and Blanche Lincoln (Ark.), Reid made changes to offer additional assistance to small businesses.
To appease fiscal conservatives, Reid strengthened cost-containment provisions by expanding the scope of an independent Medicare advisory board, empowering it to implement cuts if costs grow faster than an inflation-based target after 2019.
The package would rely on nearly $400 billion in new taxes, including a new 10 percent tax on indoor tanning salons to be paid by the customer, and an increase in the Medicare payroll tax for people earning more than $200,000 a year and families earning more than $250,000.
The payroll tax increase was initially set at 0.5 percent, but Reid increased it to 0.9 percent. He scrapped an earlier provision that would have imposed a 5 percent tax on cosmetic surgery.
And Reid rewrote a proposed fee on insurance companies to exempt nonprofit firms that spend at least 92 percent of premiums on medical service, a change that would benefit firms in Michigan and Nebraska. That change, made at the request of Nelson and Sen. Carl M. Levin (D-Mich.), seeks to identify and reward "good actors," Senate aides said.
