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Pelosi Set to Unveil Final House Health Care Bill

October 28, 2009 - by Donny Shaw

Since March, members of Congress have been meeting on an almost daily basis to write health care legislation that meets President Obama’s goals of reducing costs, increasing choices for consumers and guaranteeing access to quality, affordable insurance for all Americans. Later this morning, we’ll see the final version of the legislation that Democratic leaders in the House of Representatives will bring to the full chamber for a vote.

UPDATE: Here’s a link to the bill:

H.R. 3962 – Affordable Health Care for America Act

In July, House Democrats released an initial version of the bill, H.R. 3200, that was sent to three committees for revisions. The bill would ban insurers from denying coverage based on pre-existing conditions, provide billions of dollars in new subsidies for low and middle-class people to buy insurance, require individual to have insurance, require employees to provide insurance and set up new exchanges for easier comparison shopping between different insurance plans, among other things.

By July 31st, all three committees had finished work on the bill, resulting in three different versions of it. Since then, Speaker of the House Rep. Nancy Pelosi [D, CA-8] has been working behind the scenes with the rest of the Democratic leadership and other key members to piece together the three versions ointo one bill that can get the 218 votes it will need to pass the full House.

That merger process is now finished and the resulting bill is what Speaker Pelosi will be unveiling today at a rally on the West Front of the Capitol at 10:30 a.m. ET. Democratic leaders in the House are planning to bring the bill to the House floor next week and hope to have a final vote on it next Thursday or Friday. According to Congress Daily, they have pledged to make the bill and any changes contained in a manager’s amendment publicly available at least 72 hours before any votes.

While it will be a few more hours before we know fully what’s in the bill, all the big news outlets have already started reporting some of the details. Below is a rundown, gathered from many different sources, of how some of the key elements of the bill that have been up for question are resolved in the bill Pelosi is announcing today:

  • Public Option with Negotiated Rates. Two of the three House committees that took up the original bill chose to approve a more liberal (a.k.a “robust”) version of the public option that would have used Medicare’s reimbursement rates for paying doctors and hospitals. One of the committees went with a toned-down version that would force the government to negotiate rates with providers just like the private companies. They feared that the lower Medicare rates wouldn’t be enough to sustain providers in rural areas where Medicare rates are lower.

    Pelosi went with this more conservative version in the final bill even though the Congressional Budget Office has repeatedly estimated that the more robust version tied to Medicare rates would save the government and premium payers more money in the long term. About $85 billion more. But because the moderate Democrats who hold the key votes for passing the bill are mostly from rural districts, Pelosi chose the negotiated rates version. This version is still stronger than what Senate Majority Leader Harry Reid [D, NV] is going to include in the Senate bill. Reid’s version also require reimbursement rates to be negotiated, but it would allow states to deny the public option to their residents. Pelosi’s version does not contain this “opt-out” provision.

  • Expansion of Medicaid to 150% of FPL. All three versions of the bill passed by the committees over the summer would have expanded Medicaid to 133% of the Federal Poverty Level. Pelosi’s bill goes a step further and expands it to 150% of FPL, which is $33,075 in annual income for a family of four. This is being added as a sweetener to progressives, some of who are going to feel burned by the decision to go with the weaker public option plan.

  • Quicker Enactment of Some Benefits. While most of the bill’s provisions won’t go into effect until 2013, according to Congress Daily ($) Pelosi has decided to push forward enactment of some of the more politically popular provisions in the bill to give Democrats who vote for it a boost going into the next election. It’s not totally clear yet what provisions are being moved forward, but they likely include a patch for helping people with pre-existing conditions get coverage, discounts on brand-name drugs for seniors, and some consumer protections.

  • Surtax on the Rich. This isn’t really a surprise. It was included in all three of the committee versions of the bill. But it’s significantly different than the Senate’s revenue plan, which is a tax on insurers’ most expensive (a.k.a “Cadillac”) insurance plans. The bill being announced today would levy a 5.4% surtax on all individuals earning more than $500,000 annually and couples earning more than $1 million. The tax, which would take effect in 2010, is estimated to bring in about $460 billion over the next 10 years to help provide subsidies for low and middle-income people to buy insurance.

  • Medical Device Tax. This comes from the Senate Finance Committee bill, not the House bill that went through the committee process. The House bill would impose a new $4 billion-per-year tax on medical device manufacturers who make things like pacemakers and hip replacements to help defray the bill’s costs. The tax’s proponents generally argue that it’s fair because the bill will expand insurance to more people, giving device manufacturers more opportunities to sell devices.

We’ll know a lot more about the bill shortly. Stay tuned to this blog (RSS here) where I’ll be posting links about the bill as soon as it’s available and going through important parts of the bill text all day.

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