Senate unveils health-care bill
PACKAGE COSTS $848 BILLION
Reid hopes to bring it to floor by next week
By Shailagh Murray and Lori Montgomery
Washington Post Staff Writer
Thursday, November 19, 2009
Senate Majority Leader Harry M. Reid presented an $848 billion health-care overhaul package on
Wednesday that would extend coverage to 31 million Americans and reform insurance practices while
adding an array of tax increases, including a rise in payroll taxes for high earners.
Democratic leaders were jubilant that the nonpartisan Congressional Budget Office determined that the
Senate bill would cut federal deficits by $130 billion over the next decade. That projection, released shortly
before midnight Wednesday, represents the biggest cost savings of any legislation to come before the
House or Senate this year, but the measure's effective date also was pushed back by one year, to 2014.
Democrats said the savings could prove more significant in the long run, though the CBO said they "would
probably be small," amounting to around 0.25 percent of the overall economy, or no more than $650 billion
between 2019 and 2029.
Those projected reductions could prove critical in winning the support of three wavering moderate
Democrats whose votes Reid (D-Nev.) must secure to bring the legislation to the floor before the Senate
breaks for Thanksgiving. But Reid also stacked the bill with provisions sought by liberals, including a
public insurance option, albeit a version with an opt-out clause for states.
The legislation received a positive response from across the Democratic spectrum. "This is the bill that
we've been fighting for," said Sen. Sherrod Brown (Ohio), a liberal who pressed Reid to revive the public
option. Sen. Kent Conrad (N.D.), the budget chairman and a leading Democratic fiscal hawk, said after a
briefing on the bill, "I was very impressed by what Senator Reid has done."
But Republicans dismissed it as "another trillion-dollar experiment," in the words of Senate Minority
Leader Mitch McConnell (Ky.). Sen. Judd Gregg (N.H.) said the bill "may claim to be deficit-neutral, [but]
it uses sleight-of-hand budgetary tricks by assuming unrealistic tax increases and Medicare cuts that
members of Congress will not be willing to follow through on."
The Senate measure is similar in scope to legislation the House approved earlier this month. It would
require most people to buy insurance, and if their employers did not offer affordable coverage, they would
be able to shop for policies on new state-based "exchanges" that would function as marketplaces for
individual coverage. Insurance companies would have to abide by broad new rules that would ban practices
such as denying coverage based on preexisting conditions.
But the bills diverge on other key provisions. The House version would require all but the smallest
businesses to offer insurance, while the Senate measure would merely fine companies for not offering
affordable coverage. The Senate bill would bar illegal immigrants from buying insurance through the
exchanges, while the House would restrict access only to subsidies and federal programs such as Medicaid,
which would be vastly expanded under both bills.
Another potential flashpoint is abortion coverage. The issue sparked a major battle in the House, forcing
Speaker Nancy Pelosi (D-Calif.) to agree to an amendment that would bar people who receive federal
subsidies for insurance coverage from using that money to purchase policies that pay for abortion.
Reid took a different approach that may or may not pass muster with abortion opponents, proposing to
establish a "firewall" that would segregate private premiums from federal funding if abortion coverage
were offered in the public insurance plan.
Few details were available Wednesday, but Sen. Barbara Boxer (D-Calif.), an abortion rights advocate who
was working to forge a compromise on the issue, said, "I couldn't be happier. For those who want to keep
abortion out of this bill, Senator Reid did it the right way."
The National Right to Life Committee, however, called the firewall "completely unacceptable" and said it
utilizes "layers of contrived definitions and hollow bookkeeping requirements" to permit federal funding of
abortion.
Like the House bill, Reid's proposal would be financed through billions of dollars in Medicare cuts, as well
as new taxes. But while the House would impose a 5.4 percent surtax on income over $500,000 for
individuals and $1 million for families, the Senate would rely primarily on a new tax on high-cost
insurance policies that has been hugely unpopular among House members.
To blunt opposition, Reid would impose the 40 percent tax on fewer policies, raising the threshold to
$8,500 for individuals and $23,000 for family coverage. That change required him to come up with about
$60 billion in additional revenue, most of which would come from raising the Medicare payroll tax from
1.45 percent to 1.95 percent on individual income over $200,000 and household income over $250,000.
Reid is also proposing a new 5 percent tax on elective cosmetic surgery.
The bill's first test is expected on Friday or Saturday, with a procedural vote required to start debate.
Republicans are expected to rally all 40 of their senators to block the legislation from advancing, requiring
Reid to keep all 60 members of his Democratic caucus in line.
GOP leaders pledged to use all their parliamentary powers to delay a final vote. "This will not be a short
debate," McConnell said.
But Reid said Wednesday night that he was "cautiously optimistic" that he could move the bill to the floor,
and one of the three undecided Democrats -- Sen. Ben Nelson (Neb.) -- suggested in a statement that he
would support Reid's effort.
"It is a motion to start debate on a bill and to try to improve it," Nelson said of the upcoming vote. "If you
don't like the bill, then why would you block your own opportunity to amend it?"
The package the House approved on Nov. 7 would spend $1.05 trillion to extend coverage to about 36
million Americans and reduce deficits by about $109 billion by 2019, according to the most recent
Congressional Budget Office estimate. Pelosi called the Senate bill "an encouraging development" in a
quest that started decades ago and that probably will extend at least into January if Reid can meet his goal
of a Senate vote before Christmas.
Said Pelosi: "House Democrats look forward to a constructive debate in the Senate and to working together
to achieve historic reforms that will make health care more affordable and strengthen our economy."
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