Baucus bill questions remain unanswered

A key Senate panel wrapped up the first week of its consideration of a sweeping healthcare reform bill with major questions unanswered.

The Senate Finance Committee began marking up legislation authored by Chairman Max Baucus (D-Mont.) Tuesday but called it a week at midday Friday and will not resume until Tuesday.

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“This was a good week. It was a productive week. And next week, our work will continue,” Baucus said in a statement. “We will continue to make this a better bill.”

Baucus entered the markup process with a $900 billion bill that is designed to expand coverage to about 94 percent of legal U.S. residents and reduce the federal budget deficit by more than $20 billion. The bill cuts Medicare spending by more than $300 billion and levies taxes and fees on healthcare companies to finance the new spending.

But what Baucus did not have Tuesday, and continues to lack, is a clear path to success.

“We have debated, we have questioned, we have prodded at times, and we have discussed — and discussed. Most important, we continue to move forward,” Baucus said.

In its current form, however, the bill does not address complaints about key issues, such as whether it would make health insurance affordable for lower- and middle-class people or whether it would adequately strengthen coverage in existing government programs like Medicare and Medicaid.

The committee met for an all-day session Monday and arduous 9:30 a.m.-to-11 p.m. sessions Tuesday and Wednesday, staged lengthy debates between Democrats and Republicans on the panel over the proper role of the government in the healthcare system, and held votes on numerous amendments.

Amendments that directly hit at the misgivings of the committee’s Democrats and key Republican swing-vote Sen. Olympia Snowe (Maine) have not come up yet, however.

Republicans on the committee have made clear they intend to oppose the bill outright and proposed hundreds of amendments to gut key provisions.

Ranking member Chuck Grassley (R-Iowa), who worked for months in bipartisan talks with Baucus, offered an amendment to strip the individual mandate to obtain health coverage. The amendment failed but Grassley’s repudiation of a policy he previously supported symbolized the partisan polarization of the committee.

With practically no hope of broad bipartisan support, Baucus must rely on near-unanimity among Democrats, who hold a 13-to-10 advantage on the panel, to move his legislation. To achieve a patina of bipartisanship and gain leverage for the eventual floor fight, Baucus wants to win over Snowe.

But the underlying bill has not yet undergone the kinds of modifications Democrats and Snowe say they need to see to support Baucus’s bill, which was drafted to attract bipartisan support but failed to win a single GOP endorsement.

Democrats on the panel including Sens. Jay Rockefeller (W.Va.) and Ron Wyden (Ore.), along with Snowe, continue to have concerns that Baucus’s bill does not go far enough in making health insurance affordable to people who would be subject to a legal mandate to obtain coverage. The bill would offer subsidies people could use to purchase private insurance but senators worry the subsidies would not be adequate, nor available to enough people.

Centrist Democrats on the panel such as Sen. Blanche Lincoln (Ark.) and Tom Carper (Del.), meanwhile, seem to have pegged their support for Baucus’s bill on its potential to reduce healthcare costs and trim the budget deficit. Any new spending added to the bill to please liberals risks unnerving these centrists.

And Democrats such as Sens. John Kerry (Mass.) and Debbie Stabenow (Mich.) take issue with the taxes in the Baucus bill. Baucus’s proposal, based on an idea conceived by Kerry, would levy a tax on insurance companies that sell costly “Cadillac” plans. But Democrats want insurance for retirees, people with high-risk jobs and others exempted from the tax, which blunts its revenue-raising potential.

Florida Sen. Bill Nelson (D) is adamant about preserving the current benefits his constituents receive from private Medicare Advantage plans, which are due a $113 billion cut under the bill, and making prescription drugs cheaper for everyone on Medicare.

But when Nelson’s amendment to tap drug makers for $106 billion to close the Medicare drug benefit’s annual coverage gap — the so-called donut hole — Baucus, Carper and Sen. Robert Menendez (D-N.J.) joined with Republicans to squash it, largely because it would violate a deal made between Baucus, the White House and the Pharamaceutical Research and Manufacturers of America to limit drug companies’ exposure to $80 billion in exchange for industry support of reform.

Baucus postponed an expected Friday committee vote on perhaps the most controversial aspect of healthcare reform: a proposal to create a government-run public option that would compete with private insurance companies.

Democratic Sens. Jay Rockefeller (W.Va.) and Charles Schumer (N.Y.) pledged to raise amendments on the public option, which Baucus’s bill left out, but the chairman pushed it back until next week. “I want to take that up soon. It’s a very important amendment,” Baucus said. “We don’t have time today to do it.”

The delay is largely due to senators' weekly rush to leave Washington, which was intensified Friday because of the three-day weekend around Yom Kippur.

But Baucus indicated he had not worked out how to handle the public option amendments and those related to Sen. Kent Conrad’s (D-N.D.) proposed compromise, which is part of the base bill, to create not-for-profit healthcare cooperatives as alternatives to traditional insurance. Democratic and Republican senators are gravely skeptical of the co-ops.