By Jeffrey Young - 09/16/09 02:33 PM EDT
Sen. Max Baucus insisted the healthcare bill he unveiled Wednesday would win bipartisan support despite criticism across the political spectrum.
“At the end of the day, we will get bipartisan support and we're going to pass it,” Baucus said at a press conference. “I have worked very hard to get bipartisan support and I think we will get it.”
And while Baucus (D-Mont.) can seemingly count on the backing of the other two Democrats in the group, Sens. Jeff Bingaman (N.M.) and Kent Conrad (N.D.), liberals have responded to his bill with ambivalence or outright opposition.
Sen. Jay Rockefeller (D-W.Va.), a Finance panel member not included in the Gang of Six talks, asserted Tuesday he would vote against the measure in committee without substantial changes.
The bill includes significant concessions to Republicans on key
issues, which has drawn criticism from Democrats on the committee,
setting the stage for a potentially contentious markup when the process
kicks off next week.
Baucus faces a major challenge in getting the bill out of committee, let alone forming a grand coalition of senators to get the 60 votes needed to avoid a filibuster on the Senate floor. That would allow Democrats to avoid utilizing the politically contentious budget reconciliation maneuver, which would enable passage with a simply majority.
Repeating his comments from recent days, Baucus indicated that his legislation could undergo significant changes during the committee markup, which is scheduled to begin Tuesday.
“This is just really a stage,” he said.
“This is a good bill. This is a balanced bill. It can pass the Senate,” Baucus added. “This is our chance to reform healthcare in America and we cannot let this opportunity pass.”
Baucus said that his proposal mirrored the principles laid out by President Barack Obama during his address to a joint session of Congress this month. The bill seeks to extend coverage to millions of uninsured people, institute strict new insurance market reforms and change the healthcare delivery system to create financial incentives for medical providers to improve the quality of care.
Baucus will convene a closed-door meeting with Finance Committee members from both parties to go over the bill on Thursday morning. Senators have until 5 p.m. on Friday to submit amendments, all of which must include offsets if they require new spending.
Baucus’s measure would cost $856 billion over 10 years — far less than the $1 trillon-plus bills approved by four other congressional committees and less even than Baucus’s previous estimates. The price tag also falls below the $900 billion limit set by President Barack Obama.
The new costs would be fully offset by reductions in Medicare spending and by generating new revenue from an excise tax on health insurance companies that sell plans that cost more than $21,000 for families and more than $8,000 for individuals. Insurers, pharmaceutical companies, medical-device makers and clinical laboratories would also pay fees.
The basic structure of the bill closely resembles the measures already approved by four other congressional committees and the framework laid out by Obama in an address to a joint session of Congress this month.
Under the bill, most people would be required to obtain some form of insurance or face a penalty. The legislation would establish state-based health insurance exchanges through which individuals and small-business employees could purchase coverage. Tax credits would be available for low- and middle-income people up to 300 percent of the federal poverty level ($66,150 for a family of four) and to small-business owners to purchase insurance. Medicaid would be expanded to cover people up to 133 percent of poverty level, or $30,000 a year for a family of four.
According to Baucus, those who get their insurance coverage from their employers would continue to do so. Most employers that do not provide insurance would be required to contribute to the cost of their workers getting coverage elsewhere.
Insurance-market reforms make up a sizable part of the bill and include prohibitions against companies excluding people with pre-existing conditions or based on health status.
The measure also would beef up prevention and wellness services for people enrolled in Medicare and Medicaid. Underpinning the legislation is a set of healthcare delivery-system reforms designed to improve efficiency and quality in the system, such as linking pay rates under federal programs to demonstrate improvements in care.
But the differences between Baucus’s bill and those approved by three House committees and one other Senate committee are considerable and underscore the divisions among liberal and centrist Democrats over how to fulfill Obama’s campaign promise to overhaul the healthcare system during his first term.
Chief among liberal objections to Baucus’s approach is that his bill does not include a government-run public option insurance program that would compete against private companies. In its place is a proposal espoused by Sen. Kent Conrad (D-N.D.) to create member-owned, not-for-profit healthcare cooperatives as an alternative to traditional insurance.
Other Democrats have also grown increasingly vocal about their concerns that the tax credits Baucus would provide are too meager and do not apply to enough people. For those between 300 percent and 400 percent of poverty, the assistance is substantially less generous than under the other Democratic bills.
Baucus insisted Tuesday that the “gang of six” would keep working until the mark-up kicks off but statements from two of the three Republicans call into question whether more talk would produce a different result.
After Baucus released his bill, Enzi issued a statement clearing up any mystery about where he stood. “I cannot support the current proposal,” he said. “The proposal released today still spends too much, and it does too little to cut health care costs for those with health insurance.” Enzi suggested instead that Congress take an incremental approach to reforming healthcare.
Tuesday evening, Grassley issued a similar statement, saying the Baucus bill “does not meet the shared goals for affordable, accessible health coverage that we set forth when this process began. In addition to concerns about costs to taxpayers and affordability for individuals, there are still some serious outstanding issues that have yet to be resolved” related to abortion, illegal immigrants, medical malpractice reform, and federal spending.
Though Grassley and Snowe have indicated they have not given up hope of achieving a compromise before or during next week’s mark-up, any GOP senator who decides to support the Finance Committee’s bill would be defying his or her party.
Senate Minority Leader Mitch McConnell (R-Ky.) made it immediately apparent that he wants no more to do with Baucus’s bill that with the more liberal measure adopted on a party-line vote by the Health, Education, Labor and Pensions Committee in June.
“This partisan proposal cuts Medicare by nearly a half-trillion dollars, and puts massive new tax burdens on families and small businesses, to create yet another thousand-page, trillion-dollar government program. Only in Washington would anyone think that makes sense, especially in this economy,” McConnell said in a statement.
This story was updated at 2:10 p.m.