Don’t look for the Senate to quickly follow the House on health care overhaul.
A government health insurance
plan included in the House bill is unacceptable to a few Democratic moderates who hold the balance of power in the Senate.
They’re locked in a battle with liberals, with the fate of President Barack Obama’s signature issue at stake.
a government plan is part of the deal, "as a matter of conscience, I will not allow this bill to come to a final vote,"
said Sen. Joe Lieberman, the Connecticut independent whose vote Democrats need to overcome GOP filibusters.
House bill is dead on arrival in the Senate," Sen. Lindsey Graham, R-S.C., said.
Democrats did not line up
to challenge him. Senate Majority Leader Harry Reid, D-Nev., has yet to schedule floor debate and hinted last week that senators
may not be able to finish health care this year.
Nonetheless, the House vote provided an important lesson in how
to succeed with less-than-perfect party unity, and one that Senate Democrats may be able to adapt. House Democrats overcame
their own divisions and broke an impasse that threatened the bill after liberals grudgingly accepted tougher restrictions
on abortion funding, as abortion opponents demanded.
In the Senate, the stumbling block is the idea of the government
competing with private insurers. Liberals may have to swallow hard and accept a deal without a public plan to keep the legislation
alive. As in the House, the compromise appears to be to the right of the political spectrum.
Republican Sen. Olympia
Snowe of Maine, who voted for a version of the Senate bill in committee, has given the Democrats a possible way out. She’s
proposing to allow a government plan, if after a few years premiums keep escalating and local health insurance markets remain
in the grip of a few big companies. This is the "trigger" option.
That approach appeals to moderates
such as Sen. Mary Landrieu, D-La. "If the private market fails to reform, there would be a fallback position," Landrieu
said last week. "It should be triggered by choice and affordability, not by political whim."
said he opposes the public plan because it could become a huge and costly entitlement program.
For now, Reid is
trying to find the votes for a different approach: a government plan that states could opt out of.
He will keep
meeting with senators this week to see if he can work out a political formula that will give him not only the 60 votes needed
to begin debate, but the 60 needed to shut off discussion and bring the bill to a final vote.
Toward the end of
the week, the Congressional Budget Office may report back with a costs-and-coverage estimate on Reid’s bill, which he assembled
from legislation passed by the Finance Committee and the Health, Education, Labor and Pensions Committee. The Finance Committee
version does not include a government plan.
Reid has pledged to Obama that he will get the bill done by the end
of the year and remains committed to doing that, according to a Senate leadership aide.
Both the House and Senate
bills gradually would extend coverage to nearly all Americans by providing government subsidies to help pay premiums. The
measures would bar insurers’ practices such as charging more to those in poor health or denying them coverage altogether.
All Americans would be required to carry health insurance, either through an employer, a government plan or by purchasing
it on their own.
To keep down costs, the government subsidies and consumer protections don’t take effect until
2013. During the three-year transition, both bills would provide $5 billion in federal dollars to help get coverage for people
with medical problems who are turned down by private insurers.
Both House and Senate would expand significantly
the federal-state Medicaid health program for low-income people.
The majority of people with employer-provided
health insurance would not see changes. The main beneficiaries would be some 30 million people who have no coverage at work
or have to buy it on their own. The legislation would create a federally regulated marketplace where they could shop for coverage.
The are several major differences between the bills.
— The House would require employers to provide
coverage; the Senate does not.
— The House would pay for the coverage expansion by raising taxes on upper-income
earners; the Senate uses a variety of taxes and fees, including a levy on high-cost insurance plans.
House plan costs about $1.2 trillion over 10 years; the Senate version is under $900 billion.
By defusing the abortion
issue—at least for now—the House may have helped the long-term prospects for the bill. Catholic bishops also eager
to expand society’s safety net may yet endorse the final legislation.