Concern over details complicates health effort in Senate 

A half-dozen of the Senate's Democratic freshmen gave coordinated health care reform speeches on the Senate floor Wednesday, but only one lawmaker called for the creation of a government health insurance option.

With Senate Democratic leaders in intense talks over how to craft a final reform bill, the lukewarm view of the public option by many in the caucus is but one of a slew of differences Senate Majority Leader Harry Reid must try to iron out if he is to win a filibuster-proof 60 votes.

Aside from the public option, lawmakers are worried about the expansion of Medicaid coverage. The proposed expansion would add billions to already strapped state budgets and it has sent governors into a panic. Reid has carved out a five-year exclusion for his home state and other Senators, including moderate Mary Landrieu, D-La., who opposes the public option, are demanding the same treatment, which in the end will increase the cost of the bill by billions of dollars.

Reid is facing threats from his liberals as well. Sen. Jay Rockerfeller, D-W.Va., is demanding that the bill be rewritten so that non-profit hospitals are not granted a special exclusion from a Medicare Payment Advisory Commission, or MedPac, that would be newly empowered to make cuts.

"That will be changed," Rockerfeller declared. "They have to stop all the people who cut deals so they would not be included in MedPac."

Senate Democrats also want the leadership to come up with other ways to save money rather than the unpopular proposals to tax costly insurance policies and slash Medicare by $400 billion.

Sen. Claire McCaskill, D-Mo., said Reid and his team of negotiators should consider paying for health care reform by requiring senior citizens who do not work but live off investment earnings to pay Medicare premiums.

"That is something we need to take a hard look at," McCaskill said.

Sen. Tom Carper, D-Del., wants Reid to consider changing the way fines would be imposed on people who do not purchase insurance. Under the current proposal, there would be no penalty in 2013, the first year the plan is implemented, which insurance companies say would do nothing to persuade young people to buy insurance. Carper proposes a $250 fine the first year, $500 fine the second year and a $750 fine by 2016.

"That goes some way toward addressing the concerns of the insurance industry," Carper said.

Sen. Ron Wyden, D-Ore., wants the leadership to consider his plan to open up the proposed insurance exchanges to more people, which he said would expand affordable coverage that is lacking in the current proposal and widen the coverage pool.

"When you open up the exchanges to bigger groups, you solve a lot of these problems," Wyden said.

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