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Final Bill Shaping Up

January 12, 2010 - by Donny Shaw

The Washington Post’s E.J. Dionne today runs down what he’s hearing on the Hill about the final health care bill. Since it’s the best information out right now on where things stand, I’ll just excerpt a big chunk of it here:

Over the past week, I’ve talked with key figures in the House, Senate and White House, and the outlines of a deal are becoming reasonably clear. The public option is, alas, dead. But the idea of setting up a national insurance exchange — alongside state exchanges — where the uninsured can buy coverage is very much alive. The House is demanding this as the price for giving up on the public plan, and a national exchange would provide for much more consumer-friendly regulation of health insurance policies.

Almost everyone in both houses wants to find ways of making insurance more affordable. Steps in this direction would include more generous subsidies for the purchase of insurance than those in the Senate bill and expanding its Medicaid provisions. The bill’s price tag will grow from the Senate’s $871 billion over a decade, probably to somewhere between $930 billion and $950 billion.

The tax on “Cadillac” insurance plans, opposed by both organized labor and the insurance industry, is likely to be scaled back but not eliminated. Currently, the Senate bill includes a 40 percent excise tax on high-end health insurance plans — those at or above $23,000 for families and $8,500 for individuals.

Many opponents would settle for raising that ceiling to $28,000 for families, with a comparable increase for individuals. That would reduce the number of policyholders covered by the levy. But because of fierce resistance to the tax from a large group of House Democrats, this could prove to be one of the most vexing issues in the negotiations.

In the meantime, negotiators are looking to extend to all states a version of the special deal that saved Sen. Ben Nelson’s home state of Nebraska from the bill’s increased Medicaid costs. Nelson himself is pushing for this change, which would cost $25 billion to $30 billion over 10 years. One solution: somewhat more modest across-the-board Medicaid relief to all states.

Since we already knew the public option was dead, a lot of this comes off as big victories for House Democrats who have been trying to push the Senate’s relatively conservative bill to the left. The bigger Medicaid expansion should lead to free care for millions more uninsured, low-income Americans than the Senate’s bill would. The national exchange will help bring down costs by facilitating the sale of federally regulated insurance plans across state lines. We’ll have to see the details and the CBO scores on all this, but it appears that the House Democrats are using the death of the public option to win concessions that will have major impacts on expanding health insurance coverage and making it more affordable.

Read the whole piece at WaPo.

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