Monday, November 2, 2009

Health Care Progress Report: November 2

health insurance

Congress is indeed "closer than ever before" to passing comprehensive health care legislation, as President Obama has often remarked. House Speaker Nancy Pelosi has introduced her massive, comprehensive health care reform bill on the House floor. The Senate inches closer to introducing a bill on the floor as well.

Whether Congress will meet the president's year-end deadline for passing legislation is far from certain, however. Special Report: Health Care

As Congress methodically -- and sometimes clumsily-- cobbles together a health care bill, has been tracking its progress for you. Below is a chart to track the six major steps Washington needs to take to accomplish health care reform. The House has cleared step two, and this week the Senate may as well.

More on the progress of health care legislation in each chamber of Congress.

SENATE: Last week, Senate Majority Leader Harry Reid (D-Nev.) announced he had drafted a health care bill to bring up for debate before the full Senate. It will include a government-run health insurance plan, or "public option," from which states can choose to opt out.

Reid has yet to clear step two of our progress report, however, because he has not publicly unveiled the bill. He is waiting to receive a cost estimate for it from the Congressional Budget Office. The generalities of the bill are known, since it combines the provisions of the two bills that came out of two separate Senate Committees (the bills written in step one).

The legislation would establish consumer protections in the health insurance industry, set up a health insurance exchange system that would serve as a "marketplace" for different insurance plans, require nearly all Americans to acquire health insurance, provide assistance for lower-income Americans to get insurance, and require some kind of employer participation in providing health insurance to their employees, among other things.

There are some significant details the public has yet to learn, however, such as the size of the subsidies the bill will offer to lower-income Americans for health care, and the structure of the individual mandate.

In addition, the bill's fate is uncertain even once it hits the Senate floor.

For one thing, it is unclear whether the public option will be able to survive the Senate, or whether moderates and conservatives would approve an amendment to strip the provision from the legislation. At least one member of the Democratic caucus, Sen. Joe Lieberman (I-Conn.) said last week and again on CBS News' "Face the Nation" that he would support a Republican filibuster of any bill with a public option. However, Sen. Evan Bayh (D-Ind.) pointed out on's Washington Unplugged that the Senate could always pass a public option through the procedural process called reconciliation.

Senate Republicans are plotting a strategy to ensure floor debate lasts at least four weeks, Roll Call reports.

HOUSE: House Speaker Nancy Pelosi (D-Calif.) last week introduced her health care reform bill. The bill represents the combined work of three different House committees that passed slightly different versions of health care reform.

House Majority Leader Steny Hoyer said the bill could come up for debate as early as Thursday.

The House bill is similar to the Senate bill, but it gives less responsibility to the states. For instance, the House bill includes a public option, but it does not allow states to opt out of the program, like the Senate bill would. Also, the House bill would establish a national health insurance exchange, or "marketplace" for different insurance plans. By contrast, health care bills passed in Senate committees would permit states to establish their own exchanges.

Pelosi included in her bill a public option that would negotiate its payment rates with medical providers; this was seen as a concession to moderate lawmakers concerned that tying public option payment rates to Medicare would leave doctors in rural areas -- where Medicare rates are sometimes below average -- underpaid. The CBO, however, has shown that a public option with negotiated rates may have higher premiums than private insurance plans.

Even though a public option tied to Medicare would mean lower premiums for consumers, Pelosi is not interested in debating the difference on the House floor because she does not think there is enough support for a Medicare-based public option. This could prove to be a point of contention between liberals and other House Democrats. Pelosi will have to overcome other issues to advance her billl, such as questions about abortion coverage.