Think Progress

by Faiz Shakir, Amanda Terkel, Matt Corley, Benjamin Armbruster, Igor Volsky, and Zaid Jilani

The Details Of Reform

On Thursday, House Speaker Nancy Pelosi (D-CA) unveiled the re-tooled Affordable Health Care for America Act (HR 3962). The $894 billion bill would extend coverage to 96 percent of Americans by 2019 and reduce the budget deficit by $104 billion over 10 years. "Leaders of all political parties, starting over a century ago with President Theodore Roosevelt, have called and fought for health-care reform and health-insurance reform," Pelosi said. "Today we are about to deliver on the promise." Democrats successfully lowered the price tag of the original House legislation from $1.04 trillion by expanding the Medicaid program to Americans with incomes 150 percent of the federal poverty line and removing the fix to  physicians'' Medicare reimbursements from the bill. (That measure will be introduced seperately.) The House bill will also "strip the health insurance industry of a long-standing  exemption from antitrust laws covering market allocation, price fixing and bid rigging" and "give the Federal Trade Commission authority to look into the health insurance industry at its own initiative." The bill allows the Secretary of Health and Human Services "to negotiate drug prices for Medicare" and "requires pharmaceutical companies to rebate the government for drug overcharges that arose after 2003 when low-income elderly people who got their drugs through Medicaid" were enrolled in Medicare Part D. Debate in the House is expected to begin this week, "and the Senate will soon take up its version."

A ROBUST HOUSE BILL: The House bill is "a better product than whatever's likely to emerge from the well-intentioned efforts of Senate Majority Leader Harry Reid," Slate's Timothy Noah concludes. Indeed, the legislation includes a national public plan that independently negotiates reimbursement rates with provideres, a robust individual mandate, higher subsidies and cost sharing protections, and requires large firms to offer coverage. Eighty-six percent of firms (companies with payrolls of less than $500,000) are exempt from the requirement, but large employers would have to "pay 72.5 percent of the costs of benefits for employees who are single, and 65 percent for employees with families. It would exact penalties for non-compliance on a sliding scale depending on the size of a company's payroll, going up to 8 percent for those with a payroll over $750,000." Like the Senate measure, the House bill is financed through a series of improvements in the Medicare and Medicaid programs and taxes on the health industry. But while "the Senate is expected to propose a series of annual fees on the health-care industry and a 40 percent tax on high-cost insurance policies; the House would raise the bulk of its new revenue -- $460 billion over the next decade -- through a 5.4 percent surtax on the richest 0.3 percent of tax filers."

REID OPTS FOR PUBLIC PLAN: On Tuesday, Reid announced that the merged Senate legislation would establish "a national insurance plan with government seed money and be run by a private, not-for-profit board." The plan would negotiate its own reimbursement rates with providers and allow state legislatures to opt out of the option by 2014 if they can provide comparable coverage in order to exit out of the federal plan." States may also choose to establish a consumer-driven cooperative, although "states that opt out of the public plan could not offer co-ops." Unlike the House legislation, the Senate bill will not require employers to provide coverage, but requires "companies with more than 50 employees that do not offer insurance to pay a fine for each of its workers who gets a government subsidy to buy health insurance." The bill, in effect, "could encourage employers to hire people who already make enough to afford health insurance or to dump low-wage workers who would qualify for the subsidy," the New York Times concludes. While details of the final legislation are still emerging, Senate aides are saying that Reid has increased the penalty for employers who fail to provide health insurance for their employees from $400 a person to more than $700, reduced a tax on medical-device makers to between $15 billion and $20 billion over a decade, and increased the threshold for high-cost insurance plans that would be subject to a 40 percent tax.

CONSERVATIVE DEMOCRATS RESIST: The House bill is similar to its Senate counterpart, although a handful of key differences and opposition from conservative Democrats "could make for protracted negotiations this year." Yesterday during an apperance on CBS' Face the Nation, Sen. Joe Lieberman (I-CT) -- who has previously threatened to filibuster any bill that included a national public option -- said he would prefer nothing to health care reform with a public option. "Well, the truth is that nothing is better than that because I think we ought to follow, if I may, the doctor's oath in Congress as we deal with health care reform, do no harm," Lieberman said. Sen. Blanche Lincoln (D-AR) is "not saying whether she'll vote to allow the Senate to begin debating a health care bill," and Sen. Ben Nelson (D-NE) -- who has gone back and forth on hints of support for the opt out provision -- said on CNN, "I can't decide about the procedural vote until I see the underlying bill." Meanwhile, Senate Republicans plan to use targeted amendments to attack the legislation issue by issue, offering detailed GOP alternatives in a concerted bid to turn the public against the measure and to try to set the table for electoral gains in 2010. According to GOP sources, Senate Republicans also are ready to use parliamentary tools to slow down the floor debate to ensure it lasts at least four weeks. "We're going to need a significant amount of time in order to evaluate it and offer amendments. So, I think this is going to go on for a while," Sen. John Cornyn (R-TX) said. In the House, Rep. Bart Stupak (D-MI) and 40 pro-life Democrats are potentially "considering teaming up with Republicans to block House health reform legislation unless Democratic leaders allow a floor vote on an amendment that would add new restrictions on the use of federal funding for health plans that cover abortion with private dollars." 
 

Self-fulfilling prophecies in international negotiation.

Progressives mobilize against health care obstructionists.

Fox News' Chris Wallace conducts a sycophantic, softball interview with Rush Limbaugh.

Chronicling the right wing's conspiracy theories.

Statistical analysis refutes "anti-Israel" charge against Human Rights Watch.

An alternative history of the 2008 electorate.

Is President Obama really too partisan?

Unpacking Frank Luntz's latest anti-health care reform strategy memo.
 

"I've told Sen. [Harry] Reid [D-NV] that if the [health care reform] bill stays as it is now I will vote against cloture."
-- Sen. Joe Lieberman (I-CT), 10/27/09

VERSUS

"The whole process of individual senators being able to hold up legislation, which in a sense is an extension of the filibuster because the hold has been understood in one way to be a threat to filibuster -- it's just unfair."
-- Lieberman, 11/24/94