Mon, 30 Nov 2009 07:11:5
Kris Alingod - AHN Contributor
Washington, D.C. (AHN) - The Senate returns to session on Monday to begin debate on the $849 billion healthcare bill Democrats successfully pushed through a key vote before the Thanksgiving recess, despite unanimous opposition of Republicans and continued concerns among centrist Democrats about provisions on abortion and a government insurance option.
The Patient Protection and Affordable Care Act will provide insurance to 94 percent of the nation, extending coverage to 31 million more Americans. It will reduce the deficit by $130 billion over the next decade. The Senate held a key test on Nov. 21, voting to begin debate on the measure with a 60-39 vote.
A number of Democratic and Republican amendments will be introduced and debate is expected to last weeks. Democrats are seeking to hold a final vote on the legislation before the year's end, a task made much more difficult because they will need the support of all 60 lawmakers in their caucus, including Sen. Ben Nelson (D-NE), who plans to oppose a final bill if no changes are made ensuring no public funding is allowed for abortions, and Sen. Mary Landrieu (D-LA), who wants a trigger type of public option.
Sen. Blanche Lincoln (D-AR) and an independent who caucuses with Democrats, Sen. Joe Lieberman (I-CT), have both pledged to vote against a government health plan.
"I support parts of the bill and oppose others I will work to fix," Nelson said last week. "If that's not possible, I will oppose the second cloture motion-needing 60 votes-to end debate, and oppose the final up or down vote on a Senate bill, and will do the same on motions to advance any subsequent House and Senate compromise bill."
"My vote should in no way be construed by the supporters of this current framework as an indication of how I might vote on the final bill," Landrieu also said. "I remain concerned that the current version of the public option included in this bill could shift significant risks to taxpayers over time unnecessarily...I have suggested that a freestanding, premium-supported, competitive community option that would trigger on a date certain, if our private market reforms fail to work, might be a possible compromise."
Landrieu has been working with Sen. Olympia Snowe (R-ME), the progenitor of the plan that would only be triggered if insurers in a state are unable to meet certain requirement on affordability -- the so-called "trigger" public option -- that failed to gain support from either Democrats or Republicans during committee debate.
If and when they Senate Democrats pass the bill on final vote, the measure still needs to be reconciled with the bill approved by the House. Upon approval by a bicameral conference committee, the House and Senate need to vote on the merged legislation, which is then sent to the White House for the President's signature.
The House early this month passed its own bill costing $894 billion, covers up to 96 percent of Americans and reduces the deficit by $30 billion over a decade. It includes an amendment from Rep. Bart Stupak (D-MI) that prohibits federal funding for abortion except in the case of rape, incest or when a mother's life is at risk.
Unlike the final measure from the House, the Senate bill has no such language on abortion and has a public option that will allow states to opt out of a federal program.
And while the House bill has a tax on the top 0.3 percent taxpayers or couples earning more than $1 million, the measure from Senate Majority Leader Harry Reid (D-NV) has a 40 percent tax on insurers for "Cadillac" insurance plans, or those costing more than $8,500 for individuals and $23,000 for families.
The tax previously had a lower cap -- $8,000 and $21,000 -- and the change was made amid strong opposition from Democrats and unions who said the cost would be passed on to consumers.
Moreover, in contrast to the House proposal, the Senate bill creates an independent commission that will provide Congress with recommendations on how to reduce growing costs of Medicare, which will be insolvent by 2017.
Republicans oppose the legislation in the House and Senate because both bills include rely on cuts to Medicare and include public option, which they say would harm small businesses, and would not reduce healthcare costs nor provide insurers with fair competition.
The GOP has proposed an alternative proposal that would cost $61 billion but would add expand coverage to only 3 million uninsured Americans.
The bill does not aim to directly expand coverage for the 47 million uninsured Americans, and seeks instead to achieve that goal by lowering costs of healthcare. The Congressional Budget Office says the bill meets this goal by lowering health care premiums by up to 10 percent. The proposal would reduce the deficit by $68 billion over 10 years.
The Republican measure does not require employers to provide insurance for workers. It explicitly bans the use of federal funds for abortions, makes no cuts to Medicare, and does not provide subsidies for low-income families to buy insurance.
It also does not explicitly prohibit insurers from declining coverage because of pre-existing conditions, but "creates Universal Access Programs that expand and reform high-risk pools and reinsurance programs to guarantee that all Americans, regardless of pre-existing conditions, have access to affordable care."
"We have plans to let small businesses pool their resources and let people buy insurance across state lines," Senate Republican Conference Chairman Lamar Alexander (R-TN) has said on FOX News Sunday. "I think people will be more comfortable with biting off what we can chew instead of arrogance that we can fix the system all at once."
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