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. Reidpresented an $848 billion health-care overhaul package on Wednesdaythat would extend coverage to 31 million Americans and reform insurancepractices while adding an array of tax increases, including a rise inpayroll taxes for high earners.

Democratic leaders were jubilant that the nonpartisan CongressionalBudget Office determined that the Senate bill would cut federaldeficits by $130 billion over the next decade. That projection,released shortly before midnight Wednesday, represents the biggest costsavings of any legislation to come before the House or Senate thisyear, but the measure's effective date also was pushed back by oneyear, to 2014. Democrats said the savings could prove more significantin the long run, though the CBO said they "would probably be small,"amounting to around 0.25 percent of the overall economy, or no morethan $650 billion between 2019 and 2029.

Those projected reductions could prove critical in winning thesupport of three wavering moderate Democrats whose votes Reid (D-Nev.)must secure to bring the legislation to the floor before the Senatebreaks for Thanksgiving. But Reid also stacked the bill with provisionssought by liberals, including a public insurance option, albeit aversion with an opt-out clause for states.

The legislation received a positive response from across theDemocratic 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, saidafter a briefing on the bill, "I was very impressed by what SenatorReid 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 usessleight-of-hand budgetary tricks by assuming unrealistic tax increasesand Medicare cuts that members of Congress will not be willing tofollow through on."

The Senate measure is similar in scope to legislation the Houseapproved earlier this month. It would require most people to buyinsurance, 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. Insurancecompanies would have to abide by broad new rules that would banpractices such as denying coverage based on preexisting conditions.

But the bills diverge on other key provisions. The House versionwould require all but the smallest businesses to offer insurance, whilethe Senate measure would merely fine companies for not offeringaffordable coverage. The Senate bill would bar illegal immigrants frombuying insurance through the exchanges, while the House would restrictaccess only to subsidies and federal programs such as Medicaid, whichwould 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 receivefederal subsidies for insurance coverage from using that money topurchase policies that pay for abortion.

Reid took a different approach that may or may not pass muster withabortion opponents, proposing to establish a "firewall" that wouldsegregate private premiums from federal funding if abortion coveragewere 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 acompromise on the issue, said, "I couldn't be happier. For those whowant to keep abortion out of this bill, Senator Reid did it the rightway."

The National Right to Life Committee, however, called the firewall"completely unacceptable" and said it utilizes "layers of contriveddefinitions and hollow bookkeeping requirements" to permit federalfunding of abortion.

Like the House bill, Reid's proposal would be financed throughbillions of dollars in Medicare cuts, as well as new taxes. But whilethe House would impose a 5.4 percent surtax on income over $500,000 forindividuals and $1 million for families, the Senate would relyprimarily on a new tax on high-cost insurance policies that has beenhugely unpopular among House members.

To blunt opposition, Reid would impose the 40 percent tax on fewerpolicies, raising the threshold to $8,500 for individuals and $23,000for family coverage. That change required him to come up with about $60billion in additional revenue, most of which would come from raisingthe Medicare payroll tax from 1.45 percent to 1.95 percent onindividual income over $200,000 and household income over $250,000.Reid is also proposing a new 5 percent tax on elective cosmeticsurgery.

The bill's first test is expected on Friday or Saturday, with aprocedural vote required to start debate. Republicans are expected torally 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 afinal 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 threeundecided 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 whywould you block your own opportunity to amend it?"

The package the House approved on Nov. 7 would spend $1.05 trillionto extend coverage to about 36 million Americans and reduce deficits byabout $109 billion by 2019, according to the most recent CongressionalBudget Office estimate. Pelosi called the Senate bill "an encouragingdevelopment" in a quest that started decades ago and that probably willextend at least into January if Reid can meet his goal of a Senate votebefore Christmas.

Said Pelosi: "House Democrats look forward to a constructive debatein the Senate and to working together to achieve historic reforms thatwill make health care more affordable and strengthen our economy."