Looking Under the Hood of the Senate Health Care Bill

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Senate Majority Leader Harry Reid and other leading Democrats unveiled the Senate health care bill late yesterday, moving reform one big step closer to passage. The legislation, which includes a public option, would expand coverage to 31 million additional Americans and cost $848 billion over ten years, part of which would be offset by cost controls and taxes. In fact, the Congressional Budget Office says the legislation will reduce the deficit by $130 billion over ten years.

For reform to pass, it will need votes from all 58 Democrats Senators plus two Republicans or Independents. It will then need to be reconciled with the already-passed House version of the bill and signed into law by President Obama. Can Democrats do it? Should they be happy with Reid's version of reform?

  • The First And Second Political Challenges Ahead  The New Republic's Jonathan Cohn explains. "The first big test will come on the 'motion to proceed'--that is, a motion to begin debate. The goal remains to hold that vote by the end of this week," he writes. "If Reid wins on that vote, he will have earned his pay--and then some. Of course, the next big procedural vote, on a motion to end debate, will be even tougher. But that is weeks away. First Reid must deal with the coming Republican campaign to drag out the process as long as possible." 
  • Looser Abortion Restrictions  The Hill's Jeffrey Young finds that the Senate has included some abortion restrictions. They are looser compared to the tight restrictions against abortion that were in the House bill's controversial Stupak amendment. "We're basically going to keep current law, which is what we ought to do," Senator John Kerry told The Hill.
  • Tougher Immigrant Restrictions  Politics Daily's Patricia Murphy says the Senate version works harder to restrict illegal immigrants from buying insurance, which she calls the "most contentious" issue after abortion. "Although the House-passed bill allows illegal immigrants to pay for insurance through the exchange with their own money, the Senate bill says they have no access to the exchange at all."
  • Be Wary of 'Cheap'  The New Republic's Jonathan Cohn isn't so excited about the bill's low Congressional Budget Office score, which reports that the legislation would reduce the federal deficit over time by bringing in more money than it spends. "Most of Washington seems to think a low CBO score is automatically a good CBO score. But a low CBO score means a bill that doesn't involve a lot of federal outlays. And without a lot of federal outlays, you can't insure as many people or provide them with as much protection," he writes. "This is a lot less money than the House is proposing to spend. That could reflect aggressive cost control features in the bill. Or it could reflect a decision to cut corners, by covering fewer people and/or providing lesser coverage."
  • Weak Middle Class Coverage  Liberal blogger Marcy Wheeler worries that the bill will be disastrous for middle-class families making between 300% and 400% of the federal poverty level. The Senate's bill only offers subsidies for people making less than 300% of the Federal Poverty Level (FPL) but requires everyone to buy health care. "Guess Dems don't want to keep majority." She explains that Americans making "400% [of the Federal Poverty Level] couldn't afford the OLD Senate bill, with subsidies. Remember--they began leaving $8000 for transport, debt, education,etc." That is, after paying taxes and health care premiums, some families could hypothetically have only $8000 leftover annually.
  • Needs More Subsidies  The Washington Post's Ezra Klein wants more of the subsidies that would help people buy cheaper health care plans. "First and foremost are the subsidies. And not just the premium subsidies. Keep an eye on the limits placed on out-of-pocket costs and the generosity of the basic benefit package. Helping people pay the premiums on a plan they can't afford if they get sick, or that doesn't really help them, isn't much of a victory." He adds, "Regulating the insurance market is nice, but the real work is in building a new insurance market. That's the job of the exchanges, but they can only accomplish it if they're large enough and strong enough."

This article is from the archive of our partner The Wire.