Senate faces tough task in melding two health bills 

Even harder will be merging House, Senate versions

 

Now that a Senate panel has won passage of a moderate health care reform bill, the real challenge lies with Senate Majority Leader Harry Reid, who must weave it together with much more liberal legislation in a way that can win the support of at least 60 lawmakers.

Given the divergent components of each bill, it promises to be a daunting if not impossible task.

The Senate Finance Committee voted 14-9 on Tuesday to pass an $829 billion bill that expands health insurance coverage to 29 million people through billions of dollars in additional spending on Medicaid and subsidies. It requires millions of uninsured people to purchase insurance, and it increases access to coverage by, among other things, prohibiting insurance companies from dropping enrollees with pre-existing conditions.

But the bill leaves out a robust public insurance option, which many liberals consider the cornerstone of meaningful reform. A public option is included in the more liberal health care bill passed in July by the Senate Health, Education, Labor and Pensions Committee, and many Democrats are demanding that it be part of the final compromise.

 

A tale of two bills

 

HELP Committee bill

»  Health care coverage for 97 percent of legal residents

»  Robust public option

»  Employer mandate to provide insurance

»  Individual mandate to purchase insurance

»  Health insurance subsidies for people earning below 400 percent of poverty level

 

Finance Committee bill

»  Health care overage for 93 percent of legal residents

»  Privately run insurance co-operatives

»  Medicaid coverage for non-elderly adults earning below 133 percent of poverty level

»  Excise tax on insurance plans costing more than $8,000 per individual and $21,000 per family

»  Individual mandate to purchase insurance

 

Reid has suggested he will try to come up with a compromise, knowing he will lose the support of several moderate Democrats if he attempts to put the public option on the floor in its pure form. Senate Democrats control 60 votes and cannot afford to lose any of them if they are to block a GOP filibuster.

 

Reid and the White House are reviewing a new compromise plan proposed by Sen. Thomas Carper, D-Del., that would let states decide whether to establish a public option or a privately run insurance co-operative if they determine affordable insurance is not widely available for their own residents.

Reid must resolve other critical differences between the two bills. The HELP Committee version would cost much more -- topping $1 trillion, according to the Congressional Budget Office -- and would not reduce the deficit or "bend the cost curve," a priority for Obama that is accomplished under the Senate Finance bill.

Today 83 percent of legal residents have health insurance. This would rise to 97 percent under the HELP bill and 93 percent under the Finance Committee bill.

The difference is a big point of contention among Democrats and even Republicans, who point out that the staggering cost of the Senate Finance bill fails to provide the universal coverage they initially promised.

But if Democrats increase coverage, the cost will also rise, which could alienate moderates in their party as well as Sen. Olympia Snowe of Maine, the only Republican who voted for the Finance Committee bill.

"Democrats may not be able to thread that needle, which is why an attempted government takeover of health care may die, again," said Michael Cannon, director of health policy studies at the Cato Institute, a libertarian think tank.

If the Senate manages to get a bill passed, the biggest challenge of all may be finding a way to combine it with the House version. The House is waiting for the Senate to act before it begins melding three bills into a measure that will most likely mirror the liberal Senate bill but would provide even more subsidies for the uninsured and greater cuts to Medicare. Liberal House Democrats have threatened to vote against a House-Senate compromise bill that does not include a public option. With more than 80 lawmakers in their ranks, they could block final passage.

sferrechio@washingtonexaminer.com

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