Health care reform bill gets boost in Senate

WASHINGTON - Sweeping health care legislation last night cleared its first hurdle in the Senate on a party-line vote.

The 60-39 vote clears the way for a historic debate after Thanksgiving on the legislation. The measure is designed to extend coverage to an estimated 31 million Americans who lack it and crack down on insurance industry practices that deny benefits.

The vote came in a rare Saturday session in the Senate.

Democrats posted precisely the number of votes needed to overcome delaying tactics by Republicans seeking to doom the bill and inflict a punishing defeat on President Barack Obama.

Two final holdouts, Sens. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas, announced in speeches a few hours apart on the Senate floor that they would vote to clear the way for what is expected to be a bruising, full-scale health care debate after Thanksgiving.

At a 10-year cost approaching $1 trillion, the measure is designed to extend coverage to roughly 31 million uninsured people, crack down on insurance company practices that deny benefits, and curtail the growth of spending on medical care nationally.

New Hampshire's two senators stood on opposite sides of the partisan divide over the vote.

Sen. Jeanne Shaheen, D-N.H., last night told the New Hampshire Sunday News she was pleased that Democrats unified to advance the bill.

"I think that's very positive that we're going to keep the effort to change our health-care system moving forward in a way that I believe is important for middle-class families, is important for business, and is important for the economy of this country," she said.

Sen. Judd Gregg, R-N.H., had a different take on the bill.

"We can't afford it as a country," Gregg said in an interview last night with the Sunday News. "What you end up with is a bill that will increase the country's debt, and down the road government taking control of the system."

Cost debate

Shaheen noted the health-care debate in the Senate is just beginning and the bill will change. But she said last night's vote bodes well for future progress on the contentious issue.

"I hope it means that there's a real coalescing of support for getting something done that's going to reform health care in this country," she said.

"I think it's unfortunate that the opposition has been so obstructionist that they're not even willing to debate the issue on the floor of the Senate," she added.

In hours of debate before last evening's vote, Republicans attacked the legislation as a government takeover of health care and worse.

Sen. Gregg had spent the last few days speaking out about true cost of the bill, accusing Senate Majority Leader Harry Reid, D-Nev., of playing what he termed a 'shell game' to make the numbers appear more palatable.

"It will have dire fiscal consequences for future generations," said Gregg. "When Reid first filed the bill, the CBO (Congressional Budget Office) scored it at over a trillion dollars, and what they did, and I feel it was done in a very cynical way, was spread it out over 10 years, which hides some of the true costs."

Gregg said the bill is front-loaded with tax hikes and spending cuts in the first few years, with much of the new spending scheduled to begin after 2014. He put the actual cost of the bill at closer to $1.2 trillion between today and 2019.

Shaheen disagreed, contending the Senate bill would reduce the deficit by $130 billion, compared to where it would be if nothing is done.

She noted that the Medicare Trust Fund is projected to "go broke" in 2017 if the current system continues. "For those people who say we can't afford this, we can't afford not to do this," she said.

Victory for Reid

The vote marked a major victory for Sen. Reid and the White House in a year-end drive to enact the most sweeping changes to the nation's health care system in a half-century or more.

The legislation would require most Americans to carry insurance, and large firms would incur large costs if they did not provide it to their workforce.

Congressional budget analysts put the legislation's cost at $979 billion over a decade and said it would reduce deficits over the same period while extending coverage to 94 percent of the eligible population.

The House approved its version of the bill earlier this month on a near party line vote of 220-215.

Reid worked for weeks drafting the legislation, a blend of bills approved earlier by two committees with new provisions designed to straddle the ideological divide among Senate Democrats.

Among the most controversial is a requirement for the government to sell insurance in competition with private industry, unless individual states opt out.

Landrieu, Lincoln and other Democrats have expressed unease about it, and attempts to modify the so-called public option are certain once debate begins in earnest. One possibility would require the federal government stay out of the insurance business unless there was a shortage of competition or affordable coverage offered by private companies.

What's in the bill

At its core, the legislation would create insurance exchanges beginning in 2014 where individuals, most of them lower income and uninsured, would shop for coverage. The bill sets aside hundreds of billions of dollars in tax credits to help those earning up to 400 percent of poverty, $88,200 for a family of four.

Additional funds would be available to help small businesses defray the cost of providing coverage to their employees.

The insurance industry would come under significant new regulation under the bill, which would first ease and then ban the practice of denying coverage on the basis of pre-existing medical conditions. Beginning in 2014, there would be no limits on lifetime coverage. Effective immediately, children could remain on their parents' insurance policies until age 26, three years longer than under current law, another attempt to cut into the ranks of the uninsured.

Individuals would be required to purchase coverage or pay a fine, unless affordable coverage was not available. Larger employers would not be required to provide coverage, but would face penalties if they did not and any of their workers received federal subsidies to buy individual coverage.

Gregg told the Sunday News that as of Nov. 30 he and other Republicans will have an opportunity to offer amendments to the bill. He plans to submit amendments that include language to reduce abusive lawsuits, provisions that would allow employers to reward employees for living healthy lifestyles, ones that target specific disease groups, such as Alzheimer's disease and obesity, as well as provisions that would benefit small-business associations.

"Hopefully some of these will be agreed to," said Gregg.

Financing coverage

To finance the expanded coverage, Reid proposed higher taxes as well as cuts totaling hundreds of billions of dollars in projected Medicare payments. Hardest hit would be the private-insurance Medicare plans, although providers such as home health agencies would also receive significantly less in future years than now estimated.

The bill raises payroll taxes on incomes over $200,000 for individuals and $250,000 for couples. Reid eased the impact of an earlier proposal to tax high-value insurance plans, which has emerged as one of the principal methods for restraining the growth in health costs.

The bill includes tax increases on insurance companies, medical device makers, patients electing to undergo cosmetic surgery and drugmakers.