It's an historic day as the Senate begins debating health care reform and www.NewAmerica.net gets a facelift (before we start taxing botox...).
Since the keeper of New America's internets requested we try not to break anything while we migrate to a new website, it will be a light blogging day. Fear not however, as you'll be able to follow the Senate floor debate with us on Twitter starting at 3 p.m. (hashtag: #Senate) and be sure to check back Tuesday for a wrap up of the action and some excellent posts on quality improvements and cost control that made us thankful over the holiday break.
In the meantime check out this excellent piece from Kaiser Health News on the some of the lesser known provisions of the Senate bill and this report from MIT's Jonathan Gruber showing "the House bill will deliver savings ranging from $200 for singles to $500 for families in today's dollars -- even without subsidies."
After weeks of anticipation and speculation, Senate Majority Leader Harry Reid has unveiled the legislation that will bring health reform to the Senate floor in the coming weeks.
While waiting for the details of the bill to come out Wednesday, we created a little office pool, called the Price is Right for Health Reform. In an office-wide email, we asked our peers to guess the CBO's estimates of the gross costs of the bill. Showcase Showdown rules (closest without going over) applied. We were intentionally vague in our question because estimating the true costs of the bill is inherently a difficult process.
The number we were looking for was $848 billion. The CBO's estimate of the gross cost of the bill is essentially the total cost of coverage provisions over the next 10-years. This is the number most frequently reported in the media as the "cost" of the various health reform bills being discussed. But is this really the best indicator of the true costs of health reform? Maybe not. First, timing matters: $848 billion over ten years is a lot different than a $787 stimulus bill where 90 percent of the money is spent within the first 3 years. So do deficits. How much does a bill cost if it's fully paid for and in fact reduces the deficit as is the case for both the House ($109 billion) and Senate ($130 billion) bills?
We received plenty of calls from our co-workers asking just these questions. We tried to stay quiet, because we were interested in what the educated, non-health policy wonks think about the cost of reform. True to our think tank's "post-partisan roots" we got a range of answers from "too little" to "$600 trillion, Obama lies." We got a couple of "$1" which we assume was a reference to the bill's deficit neutrality, and $90 billion which seems like a reasonable estimate of yearly costs. But the majority of the answers clustered within the $800-$900 billion range, surprisingly close to the final answer. Few people seemed willing to go above $900 billion, suggesting the power of the official price tag President Obama put on reform during his September address to a Joint Session of Congress. So who won? The answer after this non-commercial break:
The latest version of Senate health care legislation (pdf available here) crafted by Majority Leader Harry Reid is making its rounds. There is a lot to review, but an initial read shows the bill is close to the legislation approved by the Senate Finance Committee in early October with a few notable changes: more generous subsidies, a higher threshold for the excise tax on insurers who offer high-cost plans, an increase in the Medicare payroll tax for Americans making over $250,000, and the addition of a long-term care insurance program for people with disabilities.
While this legislation also delays the implementation of insurance market reforms and subsidies (when compared to the Senate Finance legislation) there are a number of provisions that would start helping Americans immediately. In particular, the legislation:
It's Monday, the day after Sunday, which in America means a surprisingly large number of Americans are talking trash about their fantasy football teams. (Good hustle Ben, but the Cleveland Steamers are on a roll.) So forgive us for the gridiron gab, as we reset the play clock on health reform.
As you know, the passage of H.R. 3962 in the House two Saturdays ago pushed health reform into the red zone and brought us closer to the goal line than we've ever been before. The problem, as the Senate prepares to take the field, is that the goal posts keep getting pushed back. A slow handoff between Senate Majority Leader Harry Reid (D-NV) and the CBO has delayed the bill's release, but Reid seems determined to keep the ball moving. Roll Call's Emily Pierce lays out the potential Democratic gameplan going forward:
First, thank you to all our veterans for their service and sacrifice.
This Veteran's day we're a bit caught up in the upkeep of grant reports, so he's a quick run down of the news and issues that caught our attention:
Tuesdays with Harry: Politico reports that Senate Majority Leader Harry Reid took procedural steps yesterday that would allow him to open debate on a bill Tuesday next week. Of course there a lot that needs to happen before then, including the release of bill with CBO scores, but still, it's a good sign that things are moving in the Senate.
My Life, Your Work: Former President Bill Clinton spoke to Senate Democrats at their weekly meeting Tuesday. His message? Git'er Done. "The worst thing to do is nothing," Clinton told reporters.
In its Room for Debate section, The New York Times asks a group of health experts what one or two provisions could be added to health reform legislation to help contain health care costs going forward. Below is my contribution to the discussion. For more on the issue, you can read my colleague's post on the real versus the ideal options for slowing the growth of health care costs.
The Medicare payment reforms in both the House and the Senate bills will help to slow the growth of costs by rewarding value over volume, as will the proposed Medicare commission and the tax on insurers who offer high-cost health plans, which are in the Senate Finance Committee bill. And both House and Senate legislation also includes “innovation centers” which will allow us to test different payment models and health care processes.
Even with these steps, the reform bills could be strengthened. Specifically:
The baton has been passed from the House to the Senate and the latest reports suggest legislation may come to the floor as early as Monday next week. The Hill's J. Taylor Rushing lays out how things could play out in the Senate:
Senior aides and senators say Democrats plan to pivot quickly and file the first procedural vote as early as Monday. A "motion to proceed" vote, which brings the bill to the floor, would require 60 votes -- a first, critical test of the caucus's unity on procedural votes.
Senators don't expect any momentum from Saturday's successful 220-215 House vote, however. They say the most realistic scenario is for a Senate vote by Christmas followed by final passage in mid-January.
That would allow sufficient time for House-Senate conference talks and final House-Senate votes during January's first weeks. Such a scenario would also put final passage around the time of President Barack Obama's State of the Union address.
Roll Call's Emily Pierce has more on the logistics and politics of this move:
The House's historic vote on Saturday feels almost like ancient history. By Monday, all eyes turned back to the Senate and the progress of the merged legislation being shepherded by Majority Leader Harry Reid.
H.R. 3962 passed by a margin of 220-215 with 39 Democrats voting against the bill and one Republican representative crossing party lines. (The New York Times has a great graphic illustrating the politics of this vote.) Speaking from the White House Rose Garden on Sunday, President Obama thanked lawmakers for their "courageous vote," and called on the Senate "to take the baton and bring this effort to the finish line on behalf of the American people."
The relay is being held up, however, as Reid waits for the CBO to return scores of the various proposals and options he submitted. Estimates are expected to be released by the end of this week, and merged legislation could be released soon after. Still the Senate is not expected to begin debating the legislation until after Thanksgiving, giving Congress essentially four weeks to try and meet President Obama's goal of signing health reform legislation into law before year's end.
At the very minimum, it currently seems Reid will try to pass legislation through the Senate before Christmas.That leaves open the option for conferees to work on merging the House and Senate Bills over the holiday recess and clear the way for a vote on final passage early in January.
In addition to the simple logistics of moving historic legislation through the historically slow moving Senate, Kaiser Health News, Slate, and the Wall Street Journal all give a good lay of the land, and here's our quick overview of some of the biggest issues going forward:
Can health reform heal our federal budget? Yes, but whatever passes now is just the beginning, and there will always be room for improvement.
That's our takeaway from an excellent event we tweeted this morning hosted by the US Budget Watch, a joint project between the Committee for a Responsible Federal Budget and The Pew Charitable Trusts.
There was a lot of ground covered by a panel of experts moderated by the Washington Post's Ceci Connolly and featuring New America's director of health policy Len Nichols. They tackled everything from raising Medicaid eligibility rates to fixing the Sustainable Growth Rate formula in a fiscally responsible way. But for now, we'll just give you the highlights of the discussion.
The AP reports that the AARP is ready to announce it's support for the Democratic health reform legislation in the House. The endorsment from the influential retiree's lobby should provide a big boost as House Democrats are expected to vote on H.R. 3962 Saturday evening. Streaming video of the AARP announcement, set to begin at 11:30 a.m., is available below.
Meanwhile, the American Medical Association will announce it's position on the House bill's at 12 p.m. More on that after we get off the call.