Thread: Obama outlines health care plan for all

Who wins, who loses in Senate health bill
By Erica Werner, Associated Press Writer Mon Dec 21, 12:44 am ET

WASHINGTON – The little town of Libby, Mont., isn't mentioned by name in the Senate's mammoth health care bill, but its 2,900 citizens are big winners in the legislation, thanks to the influence of Finance Committee Chairman Max Baucus, D-Mont.

After pushing for years for help for residents, many of whom suffer from asbestos-related illnesses from a now-closed mineral mining operation, Baucus inserted language in a package of last-minute amendments that grants them access to Medicare benefits.

He didn't advertise the change, and it takes a close read of the bill to find it. It's just one example of how the sweeping legislation designed to remake the U.S. health care system and extend coverage to 30 million uninsured Americans also helps and hurts more narrow interests, often thanks to one lawmaker with influence or bargaining power.

Here's a look at some other winners and losers in the latest version of the legislation, which was expected to survive an initial test vote in the Senate around 1 a.m. Monday.

WINNERS

_ Cosmetic surgeons, who fended off a 5 percent tax on their procedures.

_ Nebraska, Louisiana, Vermont and Massachusetts. These states are getting more federal help with Medicaid than other states. In the case of Nebraska — represented by Sen. Ben Nelson, who's providing the critical 60th vote for the legislation to pass — the federal government is picking up 100 percent of the tab of a planned expansion of the program, in perpetuity. Vermont and Massachusetts get temporary increases in the federal share of their Medicaid tabs. In Louisiana, moderate Democratic Sen. Mary Landrieu negotiated $100 million for 2011 before announcing her support for the legislation.

_ Beneficiaries of Medicare Advantage plans — the private managed-care plans within Medicare — in Florida. Hundreds of thousands of them will have their benefits grandfathered in thanks to a provision tailored by Sen. Bill Nelson, D-Fla., that also affects a much smaller number of seniors in a few other states.

_ Longshoremen. They were added to the list of workers in high-risk professions who are shielded from the full impact of a proposed new tax on high-value insurance plans. (Electrical linemen were already included, along with policemen, firefighters, emergency first responders and workers in construction, mining, forestry, fishing and certain agriculture jobs.)

_ Community health centers. They got $10 billion more in the revised bill, thanks to advocacy by Sen. Bernie Sanders, I-Vt.

_ A handful of physician-owned hospitals being built around the country — including one in Bellevue, Neb. — which would be permitted to get referrals from the doctors who own them, avoiding a new ban in the Senate bill that will apply to hospitals built in the future. Without mentioning Nebraska or other states by name, the Senate bill pushes back some legal deadlines by several months, in effect making a few hospitals that are near completion eligible to continue receiving referrals from the doctors who own them. The provision was described by a pair of health industry lobbyists who spoke on condition of anonymity in order to speak freely. Chalk up another win for Nelson.

_ AARP, the lobby for elderly people. The new Democratic bill has about $1 billion in extra Medicaid payments to states that provide visiting nurses and other in-home or community services to prevent low-income people from needing to be admitted to hospitals. In House-Senate bargaining, AARP also is expected to win one of their top priorities: a full closing of the so-called "doughnut hole," the gap in Medicare's coverage of prescription drugs.

_ Doctors and hospitals in Montana, North Dakota, South Dakota, Utah and Wyoming, who will get paid more than providers elsewhere under formulas in the bill.

_ The University of Connecticut, which could be the beneficiary of $100 million for construction of a hospital inserted at the behest of Sen. Christopher Dodd, D-Conn., who faces a difficult re-election next year. The legislation leaves it up to the Health and Human Services Department to decide where the money should be spent, but spokesman Bryan DeAngelis said Dodd hopes to claim it for his state's university.

LOSERS

_ Tanning salons, which are getting hit with a 10 percent tax on indoor tanning services, replacing the cosmetic surgery tax.

_ Progressives. They had to give up on their long-held dream of a new government-run insurance plan so that Democratic leaders could lock down the necessary votes from moderates.

_ People making over $200,000 a year. A proposed 0.5 percent increase in the Medicare payroll tax was bumped up to 0.9 percent in the latest version, putting the tax at 2.35 percent on income over $200,000 a year for individuals, $250,000 for couples.

_ Generic drug makers. They fought unsuccessfully to block 12 years of protection that makers of brand-name biotech drugs — expensive pharmaceuticals made from living cells — will get against generic would-be competitors.


http://news.yahoo.com/s/ap/20091221/...ers_and_losers

What's in health care proposals for these 5 Americans
By Carla K. Johnson, Ap Medical Writer Sun Dec 20, 12:20 am ET

As Congress gets closer to a final health care bill, many Americans want to know: What's in it for me?

The answer is: It depends.

On your age and household income. Whether you own a business and whether it's big or small. Whether you're insured now and who provides that insurance. In the end, it will depend on how House and Senate negotiators will merge the proposals, and how their vision gets translated into regulations.

Five Americans shared their stories with The Associated Press. Here's an educated guess on how the health care package taking shape in Congress might affect them.

___

Name: Holly Brown

Home: Round Lake, Ill.

Age: 28

Employment: Student, working part time, receiving unemployment benefits.

Household income: about $15,000.

Coverage: Insured, but struggling to afford it.

Brown was laid off last year from a job she'd held for four years. She's stayed insured because of the government COBRA program, which allows workers to remain on a health plan for 18 months after they leave their jobs, if they pay the premiums.

Brown works part time and studies medical imaging at College of Lake County. She has a chronic lung condition and was in the emergency room in November with flu and pneumonia. She's paid about $1,000 in medical bills this year that her insurance didn't cover.

She doesn't know how she'll pay her $500 premium this month because a government subsidy that helped her afford the premium has expired.

"It's scary to think about what's going to happen if I can't make the payment by the end of the month," Brown said.

The health care overhaul taking shape in Congress would require her to buy health insurance or pay a penalty. She could pick a plan offered through new state-based insurance exchanges and she would qualify for a subsidy to help pay her premiums because she makes less than 400 percent of the poverty level ($43,320 for an individual in 2009). But all those benefits wouldn't kick in until 2013 in the House bill (2014 in the Senate legislation). Because of her medical problem, she may be able to qualify for coverage during the transition period by going through high-risk insurance pools called for in the legislation.

___

Name: Glenn Nishimura

Home: Little Rock, Ark.

Age: 60

Employment: Consultant to nonprofit groups.

Household income: $55,000, including wife's earnings.

Coverage: Uninsured since COBRA expired in May.

Nishimura left a full-time job with benefits in October 2007 thinking he'd be able to find another good position.

Then the recession hit.

He's now a self-employed consultant. Since May, he's been without health insurance. For 18 months, he bought insurance through the COBRA program. When that ran out, he tried to find other coverage. He's been turned down by five insurance companies because he has high blood pressure and high blood sugar levels, even though he's otherwise healthy, has never been hospitalized and controls his conditions through diet and exercise.

"I could get H1N1 or get into an accident and I would be potentially bankrupt," Nishimura said. "It's an untenable situation."

The Medicare buy-in proposal considered in the Senate could have helped Nishimura get insurance, as would portions of both the House and Senate bills that would ban denials for pre-existing conditions. But opposition from moderates and a few liberals is forcing Senate Democratic leaders to scrap the idea of a buy-in to get a bill completed.

Nishimura said he e-mailed President Barack Obama suggesting that lowering the Medicare eligibility age to 55 or 60 would create jobs. "I know a lot of people who would like to retire early, but can't because of health care," he said.

____

Name: David W. Brown

Home: Philadelphia

Age: 47

Employment: Owner of BrownPartners, an advertising and marketing agency. Seven employees. $336,000 in annual wages paid.

Household income: $150,000, including wife's earnings.

Coverage: Provides health, dental and vision coverage to employees.

An ad agency owner, Brown has been able to offer health insurance to his seven employees, but has had to cut benefits because of rising costs. Like other business owners, Brown is trying to figure out what will emerge from Congress and how it will affect him.

"We haven't been able to be as generous as we have in the past," Brown said of the insurance plan he offers his workers. "The good thing is, not a lot of folks are leaving because somebody else has a better plan."

Health care overhaul might help Brown and his wife with coverage for their daughters, now age 17 and 20. The proposals would allow young adults to stay on their parents' insurance plans as dependents into their mid-20s.

Brown would be able to shop for insurance for his workers through a health insurance exchange. Neither of the bills would require him to provide coverage. Both bills provide tax credits to help small companies with average wages of less than $40,000 provide health insurance. But pay levels in Brown's agency are above that cutoff.

___

Name: Robert Hansen

Home: Seattle homeless shelter

Age: 58

Employment: vendor, Real Change street newspaper.

Household income: $12,000, including tips.

Coverage: Uninsured.

Hansen used to work selling beer and peanuts at Seattle's now-demolished Kingdome. "Age caught up to me, running up and down the stairs, the physical labor," said the 58-year-old Seattle native.

Hansen has been homeless since 1994. A top-selling vendor of a weekly newspaper called Real Change, he makes about $1,000 a month. He eats his evening meal and finds a bed at a Catholic Community Services shelter.

The tingling in his feet and the occasional purplish color of his hands worry him. It's been so long since he's had a thorough physical exam that he's not sure if his symptoms could mean a serious health problem such as diabetes. He's uninsured and finds care in community clinics and emergency rooms.

Hansen and most other poor adults without young children don't qualify for Medicaid, the state-federal program that helps low-income families with health care. The proposals in Congress would expand Medicaid coverage to people such as Hansen.

In the leading Senate proposal, people with incomes up to 133 percent of the federal poverty level ($14,404 for an individual in 2009) could enroll in Medicaid. The House bill makes the cutoff 150 percent of the poverty level ($16,245 for an individual in 2009).

___

Name: Carol McKenna

Home: Pembroke Pines, Fla.

Age: 68

Employment: Retired payroll coordinator

Household income: About $39,000 from Social Security and some earnings by husband as mattress salesman.

Coverage: Medicare Advantage policy administered by AvMed Health Plans.

If McKenna believes the claims of the insurance industry and many Republicans, she and her husband are among the most at risk to be hurt by Congress' health proposals. If Democrats are telling the truth, they will be among those with the most to gain.

The 68-year-old retiree refrains from any worry, or any premature celebration. She simply believes, "It'll work out."

McKenna and her husband, Morty, who turns 78 on Sunday, are in private Medicare Advantage plans, which many Democrats have called wasteful and which have been made a prime target for major cuts. But Morty McKenna also falls in the coverage gap in Medicare's prescription drug program — the "doughnut hole" — that the health bills have promised to close. More than 3 million Medicare beneficiaries a year hit this gap and start paying the full cost of their drugs until they qualify for catastrophic coverage.

She said the government must "get rid of the abuses" and that pharmaceutical companies "need to step up and be accountable." For now, though, she's just waiting to see what actually happens.

http://news.yahoo.com/s/ap/20091220/...five_americans

Originally Posted by Bahet

If 15,000 cancer patients die prematurely in the UK I wonder how many hundreds of thousands must die prematurely in the US to make up for the fact that the Brits have a considerably longer life span than Americans.

How did they arrive at their figures - per capita or just a statistical average ? The population of the United Kingdom is 61,113,205 (July 2009 est.), the USA has 307,212,123.

The Age Of Entitlement!

Makes me pine for the Age Of Aquarius!


Mandating insurance for adult “children”
December 21, 2009 12:25 PM

Several times during the cloture debate on Sunday, Democrats hailed a provision requiring insurance plans that cover dependents to provide benefits to children up to age 26. Democrat Sens. Ben Cardin and Tom Harkin both championed the unfunded mandate in ther floor statements.

This manifestation of the Nanny State is especially galling given the massive levels of generational theft that the Democrat majority has presided over the last year.

I can tell you what most fiscally responsible parents are thinking when they hear the feds “taking care” of everyone else’s adult “children” for them by confiscating their tax dollars and forcing private companies to comply:

What. The. Hell.

There are an estimated 20 states that have already passed legislation requiring insurers to cover adult children. And it’s these very government health care mandates that are driving the cost of insurance up:

“Whenever you insure somebody whom you didn’t insure before there’s some additional risk,” said Mueller, executive vice president of the Wisconsin unit of Willis Group Holdings Ltd., one of the world’s largest insurance brokers. A state requirement that insurers cover autism and mental health has added 3% to the premium rates of employer-sponsored plans that renew on Jan. 1, when those mandates also take effect, Mueller said. Extending coverage is good, he said, but doesn’t come free. “The problem with all these good ideas is there’s funding necessary,” Mueller said.

About 20 states require insurers to offer parents coverage of adult children through what are sometimes called “slacker plans,” according to the Council for Affordable Health Insurance, an advocacy group whose membership includes insurers, health-care providers, actuaries and insurance brokers. About 10 states have enacted such laws in the past few years, said J.P. Wieske, the organization’s director of state affairs.

…”Employers do not have the appetite right now or the means to take on additional risk, no matter how noble. . . . People are stretched to the max,” Mueller said.

In New Jersey, the slacker mandate covers “children” up to the age of 30.

30!!!

To date, 17 states have passed slacker mandates, with ages ranging from 24 to 30. New Jersey passed its slacker mandate in 2006, extending coverage for adult children up to age 30. Proponents claimed it would benefit 100,000 uninsured young adults. Yet in two years, only 6% of that estimate has been realized. The primary reason—health insurance is still too expensive…Placing mandates on insurance providers forces everyone to pay more for insurance—even those who do not want and will never use the additional coverage.

Demcare: Creating a permanent culture of dependency and bottomless debt in the name of the “children” from birth through quarterlife — and beyond

http://michellemalkin.com/2009/12/21...dult-children/

Exclusive: ACORN Qualifies for Funding in Senate Health Care Bill

Senator Roland Burris is claiming credit for a provision in Harry Reid's "manager's amendment," unveiled Saturday morning, that could funnel money to ACORN through the health care bill.

On December 9, Burris, an Illinois Democrat, pledged that he would filibuster a health care bill without a public option. "If we have to get 60 and it comes back and it does not have a public option in it, I will not vote for it," he said. Then early last week he said he could vote for the bill if there were changes made to achieve the goals of the public option: "until this bill addresses cost, competition, and accountability in a meaningful way—it will not win [my vote]."

Asked last night before the Senate voted why he was planning to support a bill without a public option, Burris said: "We have a great bill--the best we could get. And it also covers most of our concerns: competition, cost, and accountability." But had anything specifically changed in the text of the bill that helped him change his mind? Burris told THE WEEKLY STANDARD: "It was the disparity provision that was put in, which we had something to do with, in terms of making sure that diabetes and the other diseases that are affecting minorities are really studied by HHS in all of these pilot programs."

The provision he cites, found on pages 240 through 248 of the manager's amendment, requires that six different agencies each establish an “Office of Minority Health.” The agencies are the “Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the Agency for Healthcare Research and Quality, the Food and Drug Administration, and the Centers for Medicare & Medicaid Services.”

According to page 241 of the amendment:

In carrying out this subsection, the Secretary, acting through the Deputy Assistant Secretary, shall award grants, contracts, enter into memoranda of understanding, cooperative, interagency, intra-agency and other agreements with public and nonprofit private entities, agencies, as well as Departmental and Cabinet agencies and organizations, and with organizations that are indigenous human resource providers in communities of color to assure improved health status of racial and ethnic minorities, and shall develop measures to evaluate the effectiveness of activities aimed at reducing health disparities and supporting the local community. Such measures shall evaluate community outreach activities, language services, workforce cultural competence, and other areas as determined by the Secretary.’’

According to a Senate legislative aide, the scandal-plagued Association of Community Organizations for Reform Now could qualify for grants under this provision. ACORN would also qualify for funding on page 150 of the underlying Reid bill, which says that "community and consumer-focused nonprofit groups" may receive grants to "conduct public education activities to raise awareness of the availability of qualified health plans."

Earlier this year, Congress passed and the president signed into law a ban on federal funding for ACORN, but a judge ruled that that law was unconstitutional. If a higher court reverses that ruling, ACORN may be prohibited from receiving funds through the Office of Minority Health earmark. But according to the Senate legislative aide, ACORN would still "absolutely" qualify for federal funding through the provision in the underlying Reid bill because the anti-ACORN appropriations amendment would not apply to funds provided through the health care exchanges.

A spokesman for Sen. Harkin, chairman of the HELP committee, wrote in an email that he "will look into" which organizations qualify for funding under these provisions. Spokesmen for Senators Reid and Dodd did not immediately reply to emails.

Posted by John McCormack on December 21, 2009 06:59 PM


http://www.weeklystandard.com/weblog...fies_for_1.asp

Senate OK's health care bill in victory for Obama
By David Espo, Ap Special Correspondent
48 mins ago

WASHINGTON – In an epic struggle settled at dawn, the Democratic-controlled Senate passed health care legislation Thursday, a triumph for President Barack Obama that clears the way for compromise talks with the House on a bill to reduce the ranks of the uninsured and rein in the insurance industry.

The vote was 60-39, strictly along party lines, one day after Democrats succeeded in crushing a filibuster by Republicans eager — yet unable — to inflict a year-end political defeat on the White House.

At the White House, Obama called the vote historic, and said because of it, "we are incredibly close to making health insurance reform a reality in this country. Our challenge now is to finish the job."

Democrats, led by Majority Leader Harry Reid of Nevada, said they would, by early in the new year. Even before they held a celebratory news conference, Speaker Nancy Pelosi issued a statement pledging, "We will soon produce a final bill that is founded on the core principles of health insurance reform: affordability for the middle class, security for our seniors, responsibility to our children by reducing the deficit, and accountability for the insurance industry."

The House passed its bill in November, and officials said it was likely to be February before the two sides can sort out their differences over issues as diverse as government's role in a remade health care system, coverage for abortion and federal subsidies for lower and middle-income families who would be required to purchase insurance.

Senate Republican attacked the bill to the end, and citing public opinion polls, said they would use it as an issue in the 2010 congressional elections. "This debate was supposed to produce a bill that reformed health care in America. Instead, we're left with party-line votes in the middle of the night, a couple of sweetheart deals to get it over the finish line, and a public that's outraged," said the Republican leader, Sen. Mitch McConnell, R-Ky.

The Senate vote unfolded as the sun rose over the Capitol on the day before Christmas, and marked the culmination of a battle that lasted months and included failed bipartisan negotiations, a last-minute flurry of Democratic dealmaking to lock in 60 votes and a highly partisan debate that held lawmakers in session a near-record 25 consecutive days.

For the third time since Sunday night, Sen. Robert C. Byrd of West Virginia, 92, was wheeled into the Senate so he could cast a vote Democrats could not do without.

For Democrats there was an air of bittersweet celebration, underscored by the presence of Vicki Kennedy in the visitor's gallery that overlooks the Senate floor. Her husband, the late Sen. Edward M. Kennedy of Massachusetts, died in August after a career spent working relentlessly for universal health care.

"With Sen. Ted Kennedy's booming voice in our ears, with his passion in our hearts, we say, as he said: The work goes on, the cause endures," said Reid, echoing words Kennedy uttered in his most famous speech.

Beginning in 2014, the Senate bill would establish insurance exchanges where consumers could shop for private coverage sold under federal guidelines. Most Americans would be required to purchase insurance or face penalties, and hundreds of billions of dollars in federal subsidies would be available to families up to incomes of about $88,000 a year. Insurance companies would be banned from denying benefits or charging higher fees on the basis of pre-existing medical conditions. That provision would take effect in 2013 in the House version.

The Congressional Budget Office estimates the Senate measure would extend coverage to about 31 million Americans who lack it, while cutting federal deficits by $130 billion over a decade and possibly much more in the following 10 years. Premiums would rise for some, but fall for many others, particularly when the effects of federal subsidies are factored in, the agency says.

Literally hundreds of issues remain to be settled in the two bills, a House measure that ran to 1,990 pages and a Senate version of 2,074, not counting 383 pages of revisions that Reid unveiled over the weekend.

To finance extended coverage, the House bill relies on an income tax surcharge on incomes over $500,000 for individuals and $1 million for couples, a provision the Senate omitted. Its bill includes higher Medicare payroll taxes on high wage-earners and a new tax on high-cost insurance policies that labor unions generally oppose.

Medicaid, the federal-state health care program for the poor, is expanded in both bills, but the House provision includes many more people. The House legislation also requires large employers to provide insurance to their workers or pay a fine. There is no such mandate in the Senate bill, although companies would face penalties if any of their uninsured employees qualified for federal subsidies to purchase their own insurance.

The House-passed bill is estimated to extend coverage to more individuals than the Senate measure, 36 million over a decade as opposed to 31 million.

It also provides more generous subsidies, on average, according to calculations by the Congressional Budget Office. The agency says the approximate average subsidy in 2019 under the House will would be $6,800 a year; for the Senate bill, it is $5,600. Those differences reflect one of the biggest contrasts between the two bills — the $574 billion the House bill provides for subsidies over a decade, as opposed to $336 billion under the Senate measure.

Both bills also rely on hundreds of billions of dollars in cuts in future payments to doctors, hospitals and others who care for Medicare patients, with the largest reduction falling on insurance companies who provide a private alternative to traditional Medicare.

Over 10 years, the House bill closes a gap in coverage under Medicare prescription drug benefits popularly known as the doughnut hole. The Senate bill reduces but does not eliminate that interruption in coverage, although Reid has pledged to defer to the House, a pledge made to secure AARP's endorsement for the bill.

Already, the liberals who dominate the Democratic caucuses in the House and Senate have shown a willingness to yield on key issues to moderates whose votes are essential to passage of legislation, and more of the same will be needed for a final compromise to emerge.

For her part, Pelosi, D-Calif., has already signaled she will not insist on a government-run insurance option in a final bill. The House bill has one, a provision its liberal supporters said was designed to put pressure on the insurance companies to hold down premium prices.

Democratic moderates insisted no such plan make it into the Senate bill, which calls instead for national plans overseen by the same office that manages health coverage for federal employees and members of Congress. Those plans would be privately owned, but one of them would have to be operated on a nonprofit basis, as many Blue Cross Blue Shield plans are now.

A dispute over abortion clouded the final days of debate in the House, and again in the Senate.

In both cases, liberals were forced to yield more than they wanted to opponents of the procedures who insist that no federal funds be allowed to pay for abortion services. The two bills have different approaches to the subject, and that issue, once again, is likely to be one of the last resolved.

___

The bill is H.R. 3590


http://news.yahoo.com/s/ap/us_health...VuYXRlb2tzaGVh

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Late night, closed-door deals will shape final health bill
By David Lightman and William Douglas, McClatchy Newspapers David Lightman And William Douglas, Mcclatchy Newspapers Tue Dec 22, 6:20 pm ET
WASHINGTON — With Senate passage of health-care legislation now virtually certain, Washington lawmakers and interest groups are scrambling to influence one of Congress' most mysterious but most powerful institutions — the conference committee.

The Senate is expected to pass its version of the $871 billion health-care overhaul early Thursday, after 58 Democrats and two independents agreed Tuesday to cut off another Republican-led debate.

If the bill passes, it will need to be reconciled with the version the House of Representatives passed on Nov. 7 . That job falls to a House-Senate conference committee, a group that likely will consist of a handful of senior lawmakers loyal to party congressional leaders, and working behind closed doors.

To most Americans, the conference process is an enigma, rarely taught in history or civics lessons. Even the "School House Rock" classic animated step-by-step primer, "I'm Just a Bill,'' skipped over the conference committee's role.

On Capitol Hill , however, it's a tradition steeped in late-night, closed-door deals and howls of protest from the frozen-out minority party.

"Probably the best part of the sausage-making process is the least understood and the most important," said former House Budget Committee Chairman Jim Nussle .

Nussle, an Iowa Republican and a former director of the White House Office of Management and Budget , said it isn't unusual for a chairman to call one official, open a conference meeting with all Democratic and Republican appointees present and then quickly adjourn the session.

The conference then usually goes behind closed doors, oftentimes without telling the minority conferees — in health care's case, Republicans — when or where the meetings are being held, Nussle said.

While health-care committee members haven't been named yet, it's widely expected that they'll include Sen. Christopher Dodd , D- Conn. , one of the Senate bill's architects, as well as: Majority Leader Harry Reid , D- Nev. ; Senate committee chairmen Max Baucus , D- Mont. , and Tom Harkin , D- Iowa ; and House committee chairmen Charles Rangel of New York , and George Miller and Henry Waxman of California , according to Harkin.

The Senate version is likely to dominate, because the conference needs the support of party moderates to get the 60 Senate votes it eventually will need to overcome procedural hurdles.

"Anybody who understands this process knows how hard it is to get 60 votes," said Sen. Kent Conrad , D- N.D. , the chairman of the Budget Committee. "So it's clear the bill will need to be close to the Senate version."

Former Rep. Barbara Kennelly of Connecticut , now the president of the National Committee to Preserve Social Security and Medicare , agreed.

"The Senate has taken the House hostage, that's all there is to it," she said. "Do we have health-care reform in the bill the way we like it? No. I have to be for the bill because it's a starting point.''

Conferees are considered loyal to their party leaders, and in the Democrats' case, to the White House . While administration officials aren't part of the health-care conference, Chief of Staff Rahm Emanuel, health care expert Nancy Ann Deparle and others are expected to be in close touch.

"Every conference I've been on for 30-plus years has had White House involvement," Harkin said.

At the White House , press secretary Robert Gibbs Tuesday wouldn't get specific about President Barack Obama's role, saying, "I am not going to get into from here . . . what those negotiations may look like."

However, he said, "Health-care reform is not a matter of 'if.' Health care reform now is a matter of 'when.'"

The major flashpoints are well known: The House version has tough limits on federal abortion funding; the Senate bill is less restrictive. The House includes a public option; the Senate doesn't, and while the House would impose an income tax surcharge on the wealthy, the Senate opts for a higher Medicare payroll tax for higher-income wage earners and an excise tax on expensive insurance policies.

This much is likely: Whatever happens will unfold in secrecy after some tough bargaining.

Paul Ginsburg , the president of the Center for Studying Health System Change , a nonpartisan research group, predicted that fights would go well beyond those that are now obvious.

For instance, the insurance exchanges, or marketplaces where consumers could shop for coverage, are structured differently in the two bills. Also likely are differences over how to create savings in Medicare . The two bills approach the problem differently.

The internal dynamics of a conference can sometimes be reminiscent of Reginald Rose's "12 Angry Men," a play about tension in a deadlocked jury, where stamina, personality, ego and sometimes stubbornness can play major roles, said former Sen. Bob Kerrey of Nebraska .

"People like myself who have run for office before, we have 25 percent more capacity for self-delusion than most people," said Kerrey, now the president of the New School in New York . "In conference, it comes down to, 'If they get to know me, they'll support me.' "

Fatigue could also become a factor, Kerrey said, particularly among Senate conferees. The House adjourned last week for a lengthy holiday break, but the Senate has worked almost nonstop since Thanksgiving and is poised to work up to Christmas Eve .

The average age of the 100-member Senate is 61.7 years old, according to the Center on Congress at Indiana University . The average age of the 435-member House is 56.

"Fatigue is a factor," Kerrey said. "I have trouble staying awake after 10 p.m. "

( Margaret Talev contributed to this article.)

ON THE WEB

Joint Committee on Taxation analysis of Senate amendment us.rd.yahoo.com/dailynews/mcclatchy/pl_mcclatchy/storytext/3383661/34513828/SIG=10sj5icsa;_ylt=Apfpv1D.B5LQEd7PmFeeYfNYRJ54;_y lu=X3oDMTFob3A1NmxvBHBvcwM0BHNlYwN5bl9zdG9yeV9wcml udF9jb250ZW50BHNsawNqb2ludGNvbW1pdHQ-/*http://*******.com/yby22fz

CNN/Opinion Research Corp. health care poll http://us.rd.yahoo.com/dailynews/mcc.../21/rel19a.pdf

Congressional Budget Office analysis of Senate Democrats' health care bill http://us.rd.yahoo.com/dailynews/mcc...**.com/yb3sdxk

Text of Senate Democratic health care bill http://us.rd.yahoo.com/dailynews/mcc...e-care-act.pdf

Congressional Budget Office analysis of House health bill http://us.rd.yahoo.com/dailynews/mcc...**.com/y8l3jbl

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Senate Democrats reach tentative deal on public option http://us.rd.yahoo.com/dailynews/mcc...ory/80290.html




http://news.yahoo.com/s/mcclatchy/3383661

Health bills would raise taxes well before changes roll out

http://www.mcclatchydc.com/251/story/79427.html

Health bills would raise taxes well before changes roll out
David Lightman | McClatchy Newspapers
last updated: November 24, 2009 05:07:40 PM

WASHINGTON — Americans could pay billions of dollars more in new taxes for a few years before they're likely to see significant change in the nation's health care system under legislation that Congress is considering.

Some analysts said that's not necessarily bad. Delaying major health care changes until at least 2013, as the pending Senate and House of Representatives bills would do, would give the government sufficient money and time to get things right.

"You want to fully finance these reforms, so there's no reason not to start raising money," said Linda Blumberg, senior fellow at Washington's Urban Institute Health Policy Center, a center-left research group.

Critics counter that there's no guarantee that the money will be enough, and in the meantime, higher taxes could stifle an ailing economy.

"This is a layaway plan," said Sen. Richard Burr, R-N.C., referring to the pending Democratic legislation before the Senate as well as to the arrangement in which retail customers pay small amounts over time for merchandise and receive it only when they've paid in full. "In four years you'll find out exactly how expensive this plan was."

The bill the House passed on Nov. 7 would impose a 5.4 percent surcharge on adjusted gross incomes of more than $500,000 for singles and $1 million for joint filers beginning in 2011.

Congress' nonpartisan Joint Committee on Taxation estimates that tax would raise $30.9 billion that year, $31.7 billion the next year and $45 billion in 2013. The government-run health insurance plan, or public option, and well as the new health insurance exchange, would begin in 2013, and the joint committee estimates a total of $138.9 billion from all taxes would be available by the end of that year.

For the bill the Senate is scheduled to begin considering next week, the joint committee estimates that the government would raise a total of $108.5 billion through 2014, when its public option, insurance exchanges and most other major changes would take effect.

Among the bigger taxes in that legislation are a 40 percent excise tax on insurance policies costing more than $8,500 for singles and $23,000 for families, starting in 2013. In addition, a 0.5 percentage point increase in the Medicare payroll tax would start that year. Single wage earners making more than $200,000 a year and couples earning more than $250,000 annually would see the tax increase to 1.95 percent.

Starting next year, some smaller tax increases also could be imposed, notably a 5 percent tax on elective cosmetic surgery performed after Jan. 1, and a fee on manufacturers and importers of certain medical devices.

Some experts said that collecting funds in advance is not only responsible but also has been done before.

Veteran budget analyst Stan Collender argued "this isn't unlike what happened with Social Security in 1983," when lawmakers increased payroll tax rates over the next seven years with an eye toward keeping the system solvent well into the future.

While most health care revenues wouldn't be targeted specifically for that purpose, the House legislation says that the public plan would be self-sustaining and money collected from employer penalties would be used to help lower and middle income people obtain coverage.

House and Senate Democratic leaders also point to another benefit: The revenue would help fund a series of steps that could take effect in 2010.

The Senate bill, for instance, includes $5 billion for a new program to help uninsured people with pre-existing conditions afford policies. The House version has a similar initiative. Both bills also would boost benefits right away to Medicare prescription drug plan participants. None of those provisions, though, are major pieces of the bills.

Maya MacGuineas, the president of the Committee for a Responsible Federal Budget, a group devoted to fiscal discipline, accepts that revenue needs to be collected slowly. "You can't build a huge program overnight," she said.

At the same time, however, she favors more savings, perhaps different kinds of taxes and more specific ways of cutting spending. She also knows that the current tax proposals are about as bold as Democrats are likely to get.

"Given the political system's aversion to tax increases and spending cuts," she said, "I worry about what the final bill will look like."

What was that you said Senator Reid?
Thu Dec 24, 10:05 am ET

WASHINGTON (Reuters) – For months, Senate Democratic leader Harry Reid exhorted his fellow senators to vote yes on healthcare reform. But when the big moment came on Thursday, he momentarily voted no -- by mistake.

Reid, who has spent weeks in round-the-clock negotiations over the massive legislation, threw up his arms, bowed his head and quickly corrected his mistake, voting yes for the overhaul that is a top priority for President Barack Obama.

"I spent a very restless night last night trying to figure out how I could show some bipartisanship. And I think I was able to accomplish that for a few minutes today," Reid quipped at a news conference after majority Democrats passed the bill over solid Republican opposition. The vote was 60-39, along strict party lines.

No Republicans voted for the bill and all Democrats and independents supported the measure. Republican Senator Jim Bunning missed the vote.

It wasn't the only moment of drama during the early morning Senate vote on Christmas Eve after four weeks of nonstop debate.

Senator Robert Byrd, the 92-year-old Democrat from West Virginia, cast his vote in favor of the bill, invoking the name of the late Senator Edward Kennedy who championed healthcare coverage for every American during his nearly half century of service in Congress.

"This is for my friend Ted Kennedy," Byrd said. Kennedy died in August of brain cancer.

Although Kennedy did not live to witness Senate passage of healthcare reform, his memory was very much alive.

"I wish Ted Kennedy were here with us today to enjoy this," Senator Christopher Dodd said following the vote.

Kennedy's widow, Vicki Kennedy, was present in the Senate chamber for the vote. So was Representative John Dingell, a Michigan Democrat who has worked for decades for universal healthcare coverage, carrying on the legacy of his father who first introduced healthcare reform legislation in the U.S. House of Representatives in 1943.

http://news.yahoo.com/s/nm/20091224/...lthcare_senate

Health Interests Spend $600 Million to Sway Congress
Jonathan D. Salant And Alex Nussbaum Tue Dec 22, 7:18 pm ET

Dec. 22 (Bloomberg) -- More than $600 million has been spent so far this year trying to influence U.S. lawmakers working to overhaul the health-care system, reports show.

The health industry spent $396 million through Sept. 30, more than any other industry and up 9 percent over the same period a year ago, according to the Center for Responsive Politics, a Washington-based research group.

Those numbers don’t include spending on lobbying by insurers such as the Blue Cross and Blue Shield Association and its member companies, which spent $16.7 million in the first nine months of 2009, compared with $16.2 million in all of 2008.

“The health-care industry has a full-court press on members of Congress,” said Representative Dennis Kucinich, an Ohio Democrat.

Another $200 million has been spent on television advertising for and against overhauling health care, according to TNS Media Intelligence/Campaign Media Analysis Group, an Arlington, Virginia-based company that tracks political advertising.

The U.S. House passed health-care legislation last month. The Senate has overcome procedural hurdles to pave the way for approval of its version by Dec. 24.

Working With Lawmakers

“The Blue Cross and Blue Shield companies represent 100 million people across the country in every zip code and have 80 years of experience in health care,” said Brett Lieberman, a spokesman for the Blue Cross and Blue Shield Association in Washington. “We’ve been working with members of Congress sharing that experience.”

The Senate health legislation exempts some nonprofit health plans from a $70 billion tax on the insurance industry, including some Blue Cross plans in Alabama, Michigan and Pennsylvania.

Health-industry shares have risen 18 percent this year, as measured by the Standard & Poor’s 500 Health-Care Index. Tenet Healthcare Corp., the Dallas-based hospital chain, led the index with an almost fivefold gain, followed by Intuitive Surgical Inc. of Sunnyvale, California, a maker of robotic surgical systems, which has more than doubled.

The S&P index of six managed-care insurers has risen 34 percent this year. Cigna Corp. of Philadelphia, up 120 percent, and Coventry Health Care Inc. of Bethesda, Maryland, up 69 percent, have led the advance. The index has jumped 12 percent since Dec. 9, when Senate Democrats dropped a proposal for a government-run plan to compete with private insurers.

Drugmaker Gains

Drug companies have gained 16 percent this year, as measured by the by S&P Pharmaceutical Index. New York-based Pfizer Inc., the world’s largest drugmaker, rose 5.5 percent.

The Senate on Dec. 15 rejected an amendment to allow imports of cheaper drugs from Canada, a provision opposed by the pharmaceutical industry. Drugmakers earlier agreed to contribute $80 billion over 10 years in return for blocking other profit- endangering proposals.

Pfizer’s trade group, the Pharmaceutical Research and Manufacturers Association, spent $19.9 million through September. That’s the third-highest amount behind the U.S. Chamber of Commerce and Irving, Texas-based Exxon Mobil Corp., and almost as much as the $20.2 million the group spent in 2008.

Lobbyists

There are 3,300 lobbyists registered to lobby on health care, Senate records show, six for each of the 535 members of the House and Senate. More than 1,400 of those lobbying on health care formerly worked for Congress, the White House or federal agencies, including 55 former lawmakers.

“This is the way the political system works,” said Representative Patrick Kennedy, a Rhode Island Democrat. “People curry favor in all kinds of different ways.”

Many of those lobbyists visited the White House to meet with President Barack Obama and top administration officials, according to visitor logs. Health-care visitors included Karen Ignagni, president of America’s Health Insurance Plans, the trade group for private insurers; Phrma President Billy Tauzin, a former U.S. representative; and Richard Kirsch, national campaign manager of Health Care for America Now, a coalition of labor and advocacy groups such as the AFL-CIO.

http://news.yahoo.com/s/bloomberg/20...g/aflbcmedobbk

Texas AG outraged by Senate health care provision
By Jay Root, Associated Press Writer
Thu Dec 24, 9:28 am ET

AUSTIN, Texas – Texas Attorney General Greg Abbott is vowing to fight what he called an "outrageous" decision to give Nebraska multimillion-dollar tax breaks as part of a deal to get enough votes for the health care overhaul working its way through Congress.

Abbott, a Republican, said Wednesday that he and several other attorneys general will explore legal options in telephone meetings planned for next week. The coordinated attack from several Republican attorneys general, initiated in South Carolina, now includes officials in 10 states, Abbott said.

According to a list released by Abbott's office, the attorneys general in Alabama, Colorado, Michigan, North Dakota, Pennsylvania, South Carolina, Utah and Washington state, along with the attorney general-elect in Virginia, are also involved in the discussions.

In addition, high-ranking Republicans in Georgia, New York and Tennessee — grabbing hold of a hot new political issue — have begun advocating that their states participate in a possible lawsuit.

Abbott said the provision, which helped win Nebraska Sen. Ben Nelson's vote on the massive health care bill, was unfair and possibly unconstitutional. It's part of a Senate bill that was approved Thursday morning.

"From a fundamental fairness perspective this is both wrong and outrageous," Abbott told The Associated Press in a telephone interview. "Usually when that is the case you can either find law that will support your position or a court who will agree with you."

Abbott said he and other attorneys general are preparing a legal analysis and plan to hold more telephone meetings early next week. He said the legal analysis was still in its "early stages" but characterized his fight against the measure as being on the "top of our list" of priorities heading into 2010.

"If it is upheld, then there really are no limitations in actions that Congress can take where literally they're taking taxpayer dollars from one state and giving it to another," Abbott said.

Republican critics of the measure are calling it the "Nebraska Compromise" and the "Cornhusker Kickback," a reference to the state's nickname. Nelson, Nebraska's lone Democrat in Congress, held out as fellow Democrats worked to get 60 votes to cut off a GOP filibuster and the bill was amended to shield Nebraska from the cost tied to expanding Medicaid programs.

Nelson has vigorously defended himself, saying he sought no special deal for Nebraska while chalking up the criticism to political opportunism and distortion. A call to his Washington office Wednesday landed into a voicemail box that was too full to receive messages.

The Nebraska provision has been estimated to cost between $45 million and $100 million in published reports.

http://news.yahoo.com/s/ap/20091224/...lth_care_texas