Saturday, June 6, 2009


The past couple of days have seen some of the veils lifted from congressional health care reform proposals.

In the Senate, the Health, Education, Labor and Pensions Committee is now circulating a 171 page draft of its proposed bill. In the House, the Energy and Commerce Committee (one of three House committees with health care legislative responsibilities) is close to releasing its own version, with some details already being publicly discussed.

Neither bill contains big surprises (although both include proposals certain to infuriate various groups), and neither deals in any detail with reform funding issues.

The Senate bill, from the ailing Senator Ted Kennedy’s HELP Committee, includes the expected public plan provision—an expansion of Medicare, but one in which providers would be paid ten percent above standard Medicare rates—along with requirements for individuals to have insurance (with subsidies for lower-income individuals) and for businesses to provide employee coverage or pay a fee to the government. The bill provides standards for guaranteed issue and rating of insurance, and provisions for helping states establish insurance exchanges (referred to as health benefit gateways). It also proposes expansion and some standardization of Medicaid, and provides for a new long-term care program, Community Living Assistance Services and Supports (under the heading of the CLASS Act!).

The House bill, from Representative Henry Waxman’s committee, is expected to include many provisions similar to those of the HELP bill, including requirements for individuals to purchase insurance and for employers to help cover the cost, for establishment of insurance exchanges, and similar insurance market rules to the HELP bill. The big unknown—until a draft becomes available in the next few days—is the approach to a public plan.

An equally big unknown is the shape of the draft Finance Committee bill, with Democrats and Republicans still battling over the public plan issue, but other details (insurance market reform, individual and employer responsibility, insurance exchanges) looking likely to parallel the other bills. The even bigger question, though, for Senate Finance is: how to pay for it all?

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