Finance committee health vote will require a leap of faith for senators

Several members of the Senate Finance Committee will have to make leaps of faith if the panel is to approve a healthcare reform bill on Tuesday.

Chairman Max Baucus (D-Mont.) got a big boost in the form of a favorable score from the Congressional Budget Office (CBO) last week, but it did very little to assuage the skeptics on his panel.

Baucus needs 12 votes, but two Democrats, Jay Rockefeller of West Virginia and Ron Wyden of Oregon, in particular remain disgruntled about his bill. The lone possible Republican supporter, Sen. Olympia Snowe (Maine), refuses to state her intentions.

If more than one of those three senators joins the panel’s Republicans and votes against the bill, healthcare reform would suffer a tough blow on Tuesday and might not recover.

It’s likely Baucus will have the votes. Committee chairmen generally don’t schedule a vote they won’t win, and at least two of the three senators are likely to make a leap Tuesday in the hope the bill will improve as it moves forward.

The fact that critics of the Baucus bill such as Sen. Charles Schumer (D-N.Y.) are already strategizing for the floor debate is a strong indication that Baucus will have the support he needs on Tuesday.

Outside the Senate, important lobbies have a huge stake in the Finance vote, as they hope the bill that lands on Obama’s desk will look much like the one Baucus’s panel will vote on Tuesday.

Many of those industries have already made the leap; they offered support for healthcare reform in exchange for concessions from President Barack Obama or Baucus, and now they hope those concessions aren’t watered down by the legislative process.

Rockefeller declared before the markup began that he was prepared to oppose Baucus’s bill for a long list of reasons, not the least of which is the concern — shared by most Democrats and by Snowe — that the legislation does too little to make health insurance affordable.

Despite winning some concessions from Baucus, and despite intense lobbying by Obama and Senate Majority Leader Harry Reid (D-Nev.), Rockefeller still has not confessed to a change of heart, though he said late last week that the CBO score was good.

CBO concluded the Baucus bill would cost $829 billion and reduce the deficit by $81 billion while expanding coverage to 29 million.

Wyden espouses similar misgivings about affordability but also strongly believes the Baucus bill is too timid and does practically nothing to expand the choice of insurance to consumers, especially those who get their coverage at work.

Critics unsatisfied with Baucus’s efforts to win them over have said they’ll press their case with Reid, who must meld the Finance bill with a more liberal measure approved by the Senate Health panel.

Reid’s efforts and pressure from Speaker Nancy Pelosi (D-Calif.) and the House could nudge the bill in the direction favored by Rockefeller and Wyden, at least to an extent.

But that could be a problem for Snowe and some industry groups.

Snowe has deep concerns about affordability and about the burden an individual mandate would place on those who don’t have the money to buy good insurance.

The healthcare industry groups that have gone to great lengths to maintain a positive front about reform have always seen the Finance Committee as their best hope. The hospital and pharmaceutical industries went so far as to strike deals with Baucus and the White House to limit their exposure to $155 billion and $80 billion, respectively.

Now those groups have seen their deals scotched, even before Reid melds the Senate measures and the House and Senate have a conference.

First, the Joint Committee on Taxation increased its estimate by roughly 30 percent for the fees Baucus would levy on drug makers, health insurers and medical device companies.

Because these companies would not be allowed to deduct the cost of those fees from their taxable income, the assessments rose from $17.2 billion to $22.2 billion for drug companies, from $40.5 billion to $60.4 billion for insurers, and from $29.9 billion to $38.6 billion for device makers.

All of the health groups are also highly concerned about the fact that Baucus’s bill would cover only 94 percent of legal U.S. residents and 91 percent overall, including illegal immigrants, and that the individual mandate to obtain health coverage was relaxed.

The result, they contend, is a level of coverage that would fail to produce the increase in business they need to offset the revenue they would lose. The bill would cut Medicare payments by $400 billion, and health insurance companies also would have added expenses from new federal regulations.

While lobbying feverishly to protect their interests, these lobbying groups face a tough decision about whether — or when — to start fighting against the entire healthcare reform enterprise. Meanwhile, they are biding their time.