by Julie Rovner
March 9, 2010
Since the Senate passed its version of a health overhaul on Christmas Eve, most of the debate has focused on the politics of the effort. By now, many people have forgotten — if they ever knew — what the bill would actually do.
So here’s a short refresher.
According to the Congressional Budget Office, the Senate-passed bill would expand coverage to roughly 30 million of the 46 million people in the U.S. who lack health insurance. Most of the remaining uninsured would be undocumented immigrants, who would be ineligible for benefits under the bill.
One of the most popular things the bill would do is ban insurance companies from excluding people or raising their rates, because they have what’s known as a pre-existing medical condition.
What’s that? Here’s how California Democratic Rep. George Miller described his: “I sit here with two artificial hips, a little bit of arthritis, and I have a kidney stone. I’m dead in that insurance market if I have to switch policies or switch companies.”
But in exchange for getting insurance companies to agree to accept everyone, the insurance companies need more healthy people to be covered to help spread the risk. So the bill does something that’s a lot more controversial: It requires everyone to have insurance.
That’s something many Republicans used to support, but don’t now. “Never has the federal government said any American had to buy anything. Now, [you] have to buy insurance. If you don’t buy insurance, pay the IRS more money,” said Sen. Charles Grassley (R-IA) during the Senate’s floor debate in November.
Grassley is correct in that the mandate would be enforced at tax time. If you can’t prove you’re covered, you’ll pay a penalty.
But help will be available. If you’re poor, you’ll get health insurance for free through the Medicaid program. For the first time, able-bodied adults who are simply low-income would become eligible for Medicaid.
Middle-class people who have to buy their own policies would get government subsidies. And small businesses would get tax credits to encourage them to help pay for insurance for their workers.
Those who have to buy their own health insurance get another leg up — a new marketplace called an exchange. There they could pool their buying power and compare their options.
At the same time, said Senate Finance Committee Chairman Max Baucus (D-MT), “exchanges will make it easier for consumers to choose the most efficient plans. And that will reduce their costs and put pressure on insurance companies to offer lower-cost, higher-quality plans.”
Another cost-cutting aspect of the bill is a new focus on paying doctors, hospitals and other health care professionals.
“We … believe that there should be incentives to provide care based upon best practices, not based upon simply procedures being reimbursed,” House Majority Leader Steny Hoyer (D-MD) said at the White House health meeting last month. In other words, the new payment system would be based on how health care professionals do their jobs, rather than just how many tests they order or exams they perform.
But politics has had a lot to do with getting the bill this far. Now House Democrats are being asked to cast a vote for the bill the Senate passed Christmas Eve. And, at least initially, they’ll have to approve that Senate bill with no changes.
That means, as Sen. Lamar Alexander (R-TN) reminded everyone at last month’s meeting, “It still has the sweetheart deals in it. … I mean, what’s fair about taxpayers in Louisiana paying less than taxpayers in Tennessee? And what’s fair about protecting seniors in Florida and not protecting seniors in California and Illinois and Wyoming?”
Alexander was referring to several deals cut by Senate Majority Leader Harry Reid to win the 60 Democratic votes needed to get the bill passed by the Senate.
Of course, here’s where this process gets even more complicated. Those so-called sweetheart deals are expected to be cancelled in a second bill. That so-called fix bill will carry the compromises now being made between the Senate and the House. That bill is also likely to alter the way the health care program is paid for.
But that second bill is still being drafted, and House Democrats are skittish about its ultimate prospects. Don’t expect a House vote on the Senate bill until they get some assurances about what that second bill will do — and that the Senate can actually pass it.