By Jeffrey Young - 11/29/09 11:05 PM EST
Senators will be asked to cast their votes on numerous amendments as they begin a debate to reshape the country’s healthcare system.
Some amendments will be designed to improve the bill, some to satisfy a special interest or pet peeve. Still others will be presented as poison pills.
Public option: An issue that unites Republicans and divides Democrats on ideological grounds inevitably was bound to haunt the Senate Democratic leadership. The notion of creating a government-run health insurance plan to compete with private companies is seen as vital by liberal Democrats but centrists range from skeptical to deeply antagonistic, even though states could opt out.
The best hope for a positive outcome for the Democrats could rest on the chances that liberal Sen. Chuck Schumer (D-N.Y.) along with centrist public option supporter Sen. Tom Carper (D-Del.) can forge yet another compromise version of the program to satisfy centrists such as Sens. Ben Nelson (D-Neb.) and Joe Lieberman (I-Conn.), who have threatened to filibuster the bill over the public option. Sen. Olympia Snowe (R-Maine) is waiting in the wings with her “trigger” compromise.
Abortion: It wouldn’t be American politics if the forces on both sides of the abortion issue weren’t at loggerheads. The healthcare bill already includes language that is supposed to keep federal dollars away from abortion funding but the Catholic bishops, and Nelson, don’t think it goes far enough. Democratic Sens. Bob Casey Jr. (Pa.) and Kent Conrad (N.D.) each voted in committee to beef up the abortion restrictions so their actions on the floor will be key. Sen. Orrin Hatch (R-Utah) authored the failed committee amendments and is sure to raise objections to the bill on abortion.
Health insurance excise tax: The proposed tax on high-cost health insurance plans, a key to raising revenue and reducing long-term healthcare costs according to the Congressional Budget Office, may enjoy support in the White House but many Democrats and labor unions remain staunchly opposed to what they view as a middle-class tax hike. Already scaled down several times – the original idea was to tax the value of all workplace health benefits – Sen. Debbie Stabenow (D-Mich.) and others will look to shrink it further, if not eliminate it, but will need to raise additional taxes to make up the difference.
Prescription drugs: The pharmaceutical industry struck a grand bargain this summer with the White House and Senate Finance Committee Chairman Max Baucus (D-Mont.) to limit its financial exposure from healthcare reform to $85 billion and to support the Democrats’ efforts. That deal has held uneasily since and Democrats are eyeing the chance to take a bite out of a long-time nemesis. Like in the House, Democrats are eager to require larger rebates from pharmaceutical firms who sell drugs to state Medicaid programs and use the additional money to sweeten the Medicare prescription drug benefit. A handful of Republicans such as Sens. John McCain (Ariz.) and David Vitter (La.) would likely join, or even start, any effort to permit the import of medicines from abroad.
Affordability: Because almost everyone would be required to obtain health coverage, providing fair and adequate subsidies to low- and middle-income people has presented a challenge for lawmakers trying to keep the bill on budget. Liberal Democrats get more attention when they talk about the public option but they have complained about the subsidy levels almost as much, while Snowe has also been adamant that the bill does too little to ensure insurance is less expensive. Sen. Mary Landrieu (D-La.), a key swing vote, wants more help for small businesses and the self-employed. Trouble is, every dollar of assistance paid out has to come from somewhere.
Insurance exchanges: The concept of creating an online marketplace where consumers can comparison-shop for healthcare hasn’t been very controversial. But what types of plans people could buy and who will be allowed to buy them has been a point of contention. Democrats will be looking to provide access to the most generous but most affordable plans they can. Meanwhile, Sen. Ron Wyden (D-Ore.), under an agreement with Reid and Baucus, will offer an amendment to let more people beyond individuals and small-business employees buy insurance on the exchanges. The exchanges wouldn’t launch until 2014, either, so Landrieu and others want to move that date closer.
Medicare cuts: Republicans have railed about the hundreds of billions of dollars in cuts to Medicare contained in the bill though Democrats insist they are seeking to make the program more efficient and are not cutting anyone’s benefits. Because these cuts are essential to financing the rest of the bill, however, they’re here to stay – though some could be scaled back. The deep cuts to private Medicare Advantage plans, for instance, could be mitigated to assuage senators from states with large senior populations. Medical interests from physicians to home healthcare providers will also be seeking concessions.