by Patrick Appel
News that the Senate Democrats were going to allow insurers impose annual or lifetime limits on policy caused quite a stir a few weeks ago. And rightly so. Very few people will ever incur medical bills in the hundreds of thousands or higher. But those that do will be the ones with the worst medical problems--the ones, in other words, who need protection the most.The White House promised to seek changes, as did liberals on Capitol Hill. It looks like they succeeded.
The Kaiser Family Foundation, a wonderful source for news and information on health coverage in the United States, has a useful chart on poverty rates in the states as of 2008. Nebraska is a relatively low-poverty state, with a poverty rate of 10.6 percent of households. Fifteen other states have lower poverty rates while thirty-five have higher poverty rates. Yet it seems that Nebraska, by virtue of its impressively stubborn Democratic senator, will receive unusually generous treatment.
A smart observer told me that the bill would come down to whether Ben Nelson, in his heart of hearts, wanted to vote for it or wanted to use his demands to kill it. It looks like he wanted to vote for it. Nelson's compromises were achievable. Abortion language stronger than what the legislation had but considerably weaker than what Bart Stupak preferred. An extra year of federal funding for the Medicaid expansion, which is probably a good thing one way or the other.
The CBO score is out. It appears that the bill will be marginally more expensive than the previous version, but will also raise marginally more revenues, so the net effect on deficits (vis-à-vis the original version) is basically zero. Also, the CBO has stated that the changes introduced by Reid's Managers Amendment are unlikely to significantly alter the premiums that taxpayers are expected to pay under the bill; the public option would have saved the government some money by reducing the amount of subsidies, but would not have had a significant effect on the premiums that individuals pay.
This doesn't mean that there are no potential hurdles left: Democrats still have to reconcile the House and Senate versions, which may prove complicated. The House bill is financed in large part by a millionaire's tax on high earners, and the Senate bill is financed by an excise tax on gold-plated health care plans a tax that's opposed by unions, which have far more influence in the House. And Nelson has explicitly reserved the right to vote against final passage of the reconciled bill should any significant changes occur. In other words, it ain't over 'till it's over.
That said, Democrats are now substantially closer to wrapping up this process than they were even a day ago. If I had to guess, I'd say that, with Nelson on board, it's all but a done deal.
I don’t want to endlessly rehash the intramural argument about whether this bill is worth passing or not, since at the end of the day I’m looking forward to working with all the netroots activists of the world on more and better legislation in the future. But to repeatdespite flaws, I think this is an excellent piece of legislation. Among other things, it represents a return, after fifteen years, of the idea that congress should be trying to pass major legislation that tackles major national problems.