A merry Christmas; Senate eyes Dec. 24 vote on healthcare reform legislation

By Alexander Bolton - THE HILL 12/17/09 08:27 PM ET

The Senate is heading toward a Christmas Eve vote to pass landmark healthcare legislation, but instead of holiday cheer, Democrats and Republicans are digging in for trench warfare.



Senate Majority Leader Harry Reid (D-Nev.) is determined to finish work before the Christmas holiday and has set a schedule that would end with a final vote on the evening of Dec. 24.

“We’re going to finish this healthcare bill before we leave here for the holidays,” Reid declared on the floor Thursday.



But Senate Minority Leader Mitch McConnell (R-Ky.) has told colleagues that he will not give any ground on procedural hurdles and is prepared to call Reid’s bluff on a Christmas Eve vote, said a senior GOP aide. Some Republicans say they will also require Democrats to return to Washington the following week to approve an increase of the debt limit.



“If the majority leader wants to schedule a vote Christmas Eve, that’s unfortunate, but Senate Republicans will not make it easier for them to try and pass this historic mistake,” McConnell said in a statement to The Hill.

Senate Majority Whip Dick Durbin (D-Ill.) predicted this week that leaders would be able to muster 60 votes to pass healthcare by Christmas, though they are not there yet.



Democrats must approve three separate motions requiring 60 votes to cut off a GOP filibuster of the healthcare bill, and they are between one and three votes short.

The latest hurdle emerged Thursday when centrist Democrat Ben Nelson (Neb.) said he would not vote to advance the bill unless it included stricter language on abortion provisions.



“If it’s not at the point where I think it needs to be with the improvements that I’m pushing — and they’ve made a lot of them — then I will not vote for cloture on the motion to end debate,” Nelson said in an interview on KLIN radio in Nebraska.



Reid must also win over at least two liberals who are disappointed with Reid’s decision to scrap both a government-run insurance program and a proposal to allow people as young as 55 to buy Medicare coverage. Reid was forced to drop those provisions to gain support from centrists.



Sen. Bernie Sanders (I-Vt.), among the chamber’s most liberal members, has said he will oppose the legislation. But it is not clear whether he would simply vote against the bill on final passage, which requires only a majority of senators, or if he will join Republicans in a filibuster.



Sen. Russ Feingold (D-Wis.) has also refrained from saying how he’ll vote, noting he wants to review the legislation and a forthcoming analysis from the Congressional Budget Office (CBO). As of press time Thursday, the CBO score had yet to be unveiled.

Time is fast running out. Democrats have discussed an around-the-clock voting schedule, which begins at 1 a.m. on Friday and could end after 7 p.m. on Dec. 24, to get the healthcare bill and the annual defense-spending bill passed.



The first big test is expected at 1 a.m. Monday, when the Senate would vote on the final changes to the healthcare bill that are packaged in a manager’s amendment. If Reid fails to rally his entire conference for that vote, or offset any defectors with an equal number of Republicans, the game is up and Democrats go home without advancing President Barack Obama’s top domestic priority.



Reid has picked up the crucial support of some outside groups in the final hours of the debate. Service Employees International Union (SEIU) President Andy Stern on Thursday called for the Senate to pass the healthcare bill, despite the union’s misgivings about it.



“We’re for putting the bill into conference,” Stern said on a teleconference call. “We don’t like the bill. It has to be improved. But we don’t think that these senators are going to do any better.”



Stern’s comments came a day after SEIU pulled out of an event scheduled with other organizations to tout the Senate health bill.

Some Democrats hope that frustration over what they call GOP obstructionism will unify centrists and liberals to pass the bill.

A sign of growing Democratic unity in the face of Republican opposition came Wednesday when Sanders withdrew an amendment he offered to set up a single-payer healthcare system after Republicans forced a time-consuming reading of the 767-page amendment. Sanders’s gesture of teamwork, despite his opposition to the underlying bill, showed his willingness to help Democrats overcome procedural hurdles.



Also on Wednesday, nearly 30 Democrats rushed to the floor to second a series of amendments to the defense-spending bill. Usually only a few lawmakers bother to show up to second such motions, which are normally pro-forma procedures, but the charged atmosphere has created a new sense of urgency.

“I do think it’s galvanizing the Democrats and focusing us on what our mission is,” said Sen. Mark Begich, a centrist Democrat from Alaska. Begich said he encouraged Reid to schedule a 1 a.m. vote on the military spending bill to speed the pace of work.



But Republicans say Democratic efforts to push a massive healthcare overhaul through the Senate in the next few days has stiffened their resolve and unified their conference.



“You’re not going to take a bill this important and put it out and immediately file a motion to end the debate as soon as you put in on the floor and expect us to say, ‘Let’s do that,’ ” said Sen. Jim DeMint (S.C.), chairman of the Senate Republican Steering Committee.

“I think you’ll see all 40 Republicans standing together, which we rarely do, which only tells you one thing: that this is a terrible bill and a completely unfair process,” he said.



Jeffrey Young contributed to this article.

Complete destruction of the U.S. economy

The Healthcare Reform Travesty by Alan Caruba

Other than the complete destruction of the U.S. economy, one sixth of which is generated by the healthcare profession, I cannot see any reason for the bill that Harry Reid is pushing for a Saturday evening vote in the Senate

It has taken less than a year for the Democrats, led by Barack Obama, to saddle Americans with such enormous debt that your grandchildren will be paying it off. The so-called “bail-outs” have proven to be a bonanza for Wall Street firms on good terms with the Secretary of the Treasury, Tim Geithner, whose mantra is “It’s all Bush’s fault.” The “stimulus” bill has not stimulated anything except lies about “jobs created and saved.”

Rush Limbaugh calls Congress a “Kamakazi Congress” and the “Suicide Bomber Congress” because it is obvious that any Democrat Congressman or woman and any Senator who votes for this atrocious bill, probably without having read it, will be thrown out of office. And should be!



Ignoring all the town hall protests, the tea parties across the nation, and the massive September 12 rally in Washington, D.C. has to come with a penalty, but by then it will be too late for most Americans.



The November 23 edition of Business Week had a cover story by Catherine Arnst titled “Why Wait for Health Reform: Ten Ways to Cut Costs Right Now.” It makes clear that all the so-called reforms contained in the 2,000-plus page bill could be achieved in ways that do not require a monster piece of legislation intended to impose socialized medicine on America.



In brief, here how to achieve an improved, and more affordable healthcare system:



Crack down on fraud and abuse



The amount of fraud in the Medicare system is estimated to cost $125-175 billion every year. Since the system operates as a kind of honor code, the government has been unsuccessful in detecting fraud and abuse. Meanwhile, private insurers such as the Blue Cross & Blue Shield Association report its anti-fraud efforts resulted in a savings of $350 million last year, a 43% increase from 2007.



Develop a healthy workforce



Wellness programs pay real dividends for the companies that sponsor them.



Coordinate care through family doctors



A patient suffering from one or more chronic diseases may depend on several doctors and “rarely do they communicate with one another.” This results in waste, often due to duplication of treatments. By designating a primary care doctor to organize care with specialists, pharmacists, and physical therapists, sharing medical records electronically, it is estimated that $250 to $325 billion could be saved.



Make health a community effort



Campaigns to encourage people to eat better, get more exercise, and other options could greatly reduce health-related costs.



Stop infections in hospitals



Every year, 1.7 million patients develop infections while in hospital and 99,000 die as a result. They can be reduced if hospitals put more emphasis on solving the problem.



Get patients to take their medicine



Three out of four Americans do not take their medicine as directed. Noncompliance leads to more doctor visits, hospitalizations, and treatments that add an estimated $177 billion a year to the nation’s health-care bill.



Discuss options near the end of life



End of life care can be especially costly. When patients and the families are informed they can choose pain management, nursing care, and psychological support, all of which reduce costs.



Use insurance to manage chronic disease



In 2009, UnitedHealthcare introduced a Diabetes Health Plan that offers rewards to patients who manage their disease properly. The idea is to contain costs by giving patients financial incentives based on their particular health issues rather than a one-size-fits-all approach…something the proposed healthcare reform will impose on all Americans regardless of their particular health problems.



Let well-informed patients decide



Too many Americans think that drastic surgery and other procedures are the only way they can survive a healthcare crisis, but such procedures extend lives or prevent heart attacks in only a tiny minority of especially sick patients. Few really know this. Educating patients can reduce wasted health spending by up to 37%.



Apologize to the patient



When hospitals reveal mistakes to patients and their families, investigate the cause, and offer a settlement, it takes the lawyers out of the process. Honesty really is the best policy.



Instead, Congress is getting ready to impose a massive bureaucracy that will be put in charge of healthcare, increasing the nation’s deficit and debt as millions are added to the Medicare ranks and private insurance companies are driven out of business. The loss of freedom will be beyond calculation as Americans must deal with bureaucrats instead of their physicians and other healthcare professionals.



It is the worst possible “reform” imaginable. We’re running out of time to call our Senators, mostly Democrats, and demand they vote NO!



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Alan has a daily blog called Warning Signs. His latest book is Right Answers: Separating Fact from Fantasy.







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Health bill puts bite on small business and wealthy

By JANET ADAMY and LAURA MECKLER

Associated Press

House Speaker Nancy Pelosi, from left, stands with House Democratic leaders Steny Hoyer, Pete Stark, Henry Waxman, Charles Rangel, and John Dingell to announce health-care legislation on Tuesday.

WASHINGTON -- House Democrats on Tuesday unveiled sweeping health-care legislation that would hit all but the smallest businesses with a penalty equal to 8% of payroll if they fail to provide health insurance to workers.

The House bill, which also would impose new taxes on the wealthy estimated to bring in more than $544 billion over a decade, came as lawmakers in the Senate raced against a self-imposed deadline of this week to introduce a bill in time for action this summer.

Senators face a tougher battle because they are striving for a bipartisan bill. Key senators are weighing a combination of several more-modest fund-raising provisions, including some new fees on health-care industries.

Under the House measure, employers with payrolls exceeding $400,000 a year would have to provide health insurance or pay the 8% penalty. Employers with payrolls between $250,000 and $400,000 a year would pay a smaller penalty, and those less than $250,000 would be exempt. Certain small firms would get tax credits to help buy coverage.

The relatively low thresholds for penalties triggered the sharpest criticism yet from employer groups, who said the burden on small business is too high and doesn't do enough to help them expand insurance coverage.

More

• Sen. Grassley Is Key to Health Deal
• Democrats' Discord Hinders Bill
• Opinion: The Small-Business Surtax
• Health Blog: Middle Class Could Feel Pinch
• Health Blog: CBO: Plan Would Enroll Less Than 5% of Americans

"This bill costs too much, it covers too few and it has way too much government involvement," said Michelle Dimarob, a lobbyist with the National Federation of Independent Business, the main trade group for small firms. "Small business doesn't want any of those things."

According to 2006 data from the federation, businesses with between five and nine workers, representing about one million employers, had an average payroll of around $375,000 a year. A report from the Kaiser Family Foundation found that only about half of firms with three to nine workers offered health benefits in 2008.

House Speaker Nancy Pelosi unveiled the measure on Tuesday, praising it as a historic step toward insuring all Americans that has eluded lawmakers for decades. "This bill is a starting point and a path to success to lower costs to consumers and businesses," the California Democrat said.

The Congressional Budget Office on Tuesday calculated the cost of the House's plan to expand insurance coverage at $1.04 trillion over 10 years, and predicted the measure would eventually lead 97% of legal American residents to have insurance. That's in line with President Barack Obama's desired budget for a health overhaul and lawmakers' pledges for expanding coverage.

The estimate doesn't factor in the plan to pay for the bill, including the new tax on wealthy Americans, or certain changes to Medicare and Medicaid, all of which could affect the final price tag.

The House bill would place new taxes on the wealthiest people to help expand insurance coverage to the nation's 46 million uninsured people. The legislation calls for a 5.4% surtax on those with annual gross incomes exceeding $1 million.

Households with annual income between $500,000 a year and $1 million would be hit with a 1.5% surtax, and those earning between $350,000 and $500,000 would face a 1% surtax. Those rates could eventually increase to 3% and 2%, respectively, if the government doesn't achieve certain health-cost savings.

The 1,018-page initiative contains several components pushed by liberal Democrats that were long expected to be part of House legislation, but which face considerable opposition in the Senate. Most notably, the House bill creates a new public health-insurance plan aimed at individuals and small businesses that otherwise can't get affordable coverage.

The House measure would bar insurance companies from denying coverage to individuals who are sick, while also requiring most Americans to carry health insurance or pay a penalty equal to about 2.5% of their gross income. It would provide families earning up to $88,000 a year with subsidies to help them buy coverage. And it would expand health-insurance coverage through the Medicaid federal-state insurance program for the poor.

The Senate legislation is also expected to include mandates on insurers to provide coverage and individuals to carry it, although the details may differ. The bigger differences will come on the financing side, where many senators are cautious about introducing major new taxes on the wealthy to pay for health care.

The White House is pushing for action before the August recess in both houses of Congress to give lawmakers time to reconcile their two versions, pass that compromise through the House and the Senate and send Mr. Obama a final bill by autumn. The Senate Health, Education, Labor and Pensions Committee could approve its health overhaul bill as soon as Wednesday.

That will get merged with a bill in the Senate Finance Committee, where lawmakers are trying to craft a bipartisan measure. Chairman Max Baucus on Tuesday was pitching his colleagues on a plan to finance the bill through a combination of more-modest tax increases. He is trying to fill a hole of about $320 billion over 10 years, after Democrats objected to a provision to tax upper-end employee health benefits.

The fresh package included a new fee on pharmaceuticals and other health-care industries, and stiffer corporate-reporting measures aimed at collecting a greater share of corporate taxes owed each year, two Senate aides said.

Under the first proposal, health industries including drug makers and insurers would be charged an assessment, with individual companies' fees based on their market share. It's not clear how large the total assessment would be.

The proposal also seeks to raise $75 billion to $100 billion over 10 years by giving states an incentive to issue bonds that would help offset the expanded federal share of Medicaid.

"The goal here is a bunch of smaller, less controversial items that can add up," one official said.

The package may still include a modified version of the plan to tax high-end employer-provided health insurance, though on a smaller scale, aides said.

Mr. Baucus spent much of the day meeting one-on-one with members of his committee, and he put on an optimistic face. "We're going to pass very significant health reform this year," the Montana Democrat said.

But the pre-recess deadline appeared in danger as Republicans expressed concern that the process is moving too quickly.

Sen. Olympia Snowe, a key Republican whom Mr. Baucus is trying to win over, said Tuesday that the legislation is far too complex to rush and that she saw little chance of moving a bill through the Senate before the August break.

"I frankly couldn't imagine at this point bringing it to the floor and completing our deliberations...before the August recess," the Maine senator said. She said "arbitrary, artificial time frames really are not realistic given the magnitude of the task we are assigned to do."

In addition to health care, the White House also hopes for action on energy and financial-sector regulation, both of which would consume time this fall.

At a White House meeting with top Democratic leaders on Monday, Mr. Obama pushed Mr. Baucus to produce legislation by Thursday.

Senators are now talking openly of keeping the chamber in session an extra week, though some say that is simply a tactic to discourage delay by senators who have plans for vacations, congressional trips and hometown activities.

A further complication is that if it looks as if the Senate can't or won't act this summer, many House Democrats are likely to hesitate about voting on a contentious issue -- including raising taxes -- for something that might never become law.

Write to Janet Adamy at janet.adamy@wsj.com and Laura Meckler at laura.meckler@wsj.com