By Lori Montgomery and Shailagh Murray
Washington Post Staff Writers
Wednesday, October 14, 2009
As the last of five congressional committees completed work Tuesday on a health-care reform package, lawmakers braced for a debate before the full House and Senate about whether Americans are ready to embrace the far-reaching changes necessary to extend coverage to millions of Americans.
With the backing of a lone Republican, the Senate Finance Committee voted 14 to 9 to approve legislation that would, for the first time, require every American to have health insurance. The package would spend $829 billion over the next decade to finance the biggest expansion of Medicaid in 40 years and to provide federal subsidies to 18 million people who otherwise would be unable to afford coverage. It would tax high-cost health plans, impose new penalties on employers and slash future spending on Medicare, the federal insurance plan for people older than 65.
President Obama said that while the Finance Committee package is "not perfect," its passage marks a critical milestone. "We are now closer than ever before to passing health reform," he said in a Rose Garden news conference. "But we're not there yet. . . . Now's the time to dig in and work even harder to get this done."
That work is likely to be grueling. Groups from across the political spectrum opened fire Tuesday on the panel's measure, mindful that it is likely to form the backbone of compromise legislation to be crafted in the coming weeks. Labor unions complained that the legislation lacks a government-run insurance plan to compete with private insurers. Insurance companies said new regulations on their industry could cause premiums to rise higher. And major business groups joined with labor in decrying a proposed tax on high-cost insurance policies, which could increase health-care expenses for employers and workers alike.
"Although it was the best effort to date, the Senate Finance Committee missed an opportunity to create a truly bipartisan bill to reform our nation's health-care system," said R. Bruce Josten, chief lobbyist for the U.S. Chamber of Commerce. "One of the primary goals of health-care reform is the overriding need to reduce ever-escalating costs for both consumers and employers. The Senate Finance bill increases premiums [and] raises taxes."
Gerald W. McEntee, president of the American Federation of State, County and Municipal Employees, added: "They call it reform legislation, but we don't think it is. It's deeply flawed." Unless it undergoes major changes, he said, "we're going to oppose it."
The reaction from many Republican lawmakers was equally strong. Only Sen. Olympia J. Snowe (Maine) voted to support Obama's top domestic initiative, while her fellow Republicans were united in their condemnation of the measure, which was largely crafted during more than three months of bipartisan negotiations.
Whatever merits swayed Snowe are likely to evaporate, they said, during private talks set to begin Wednesday in Senate Majority Leader Harry M. Reid's office.
Reid (D-Nev.), Finance Committee Chairman Max Baucus (D-Mont.) and Sen. Christopher J. Dodd (D-Conn.), who shepherded a competing bill through the Senate health committee in July, expect to meet there with senior White House officials. Their task is to blend the bills into a final product that can unite the Democratic caucus, keep Snowe on board and win the 60 votes necessary to avert a GOP filibuster.
Snowe's vote lent the imprimatur of bipartisanship to the finance panel's measure, according to a senior Democratic aide, making it easier for Reid to rally support among moderate Democrats who have been reluctant to back a health-care bill without political cover from the GOP. But the politics of the Senate are complex.
For some Democrats, immediate electoral concerns are paramount. Sen. Blanche Lincoln (Ark.), a moderate and top GOP target in next year's midterm elections, sought several changes to the bill, including a provision aimed at limiting insurance executives' incomes. But minutes after she voted "aye" Tuesday, the National Republican Senatorial Committee denounced her for supporting a bill that would, it said, "ultimately shift costs to voters in Arkansas who are still struggling to make ends meet."
Polls show that Reid himself may be vulnerable next year, and he has tended to home-state interests by securing Medicaid funding for Nevada to offset the cost of expanding the program. Republicans also are targeting Dodd, who faces a tough reelection fight.
Dodd's Connecticut colleague, Sen. Joseph I. Lieberman (I), said Tuesday that he could not support the Finance Committee bill, citing insurers' concerns that the fees and taxes it would impose on their industry would drive up premiums. Connecticut is home to numerous health insurance companies.
Liberal groups also were in open rebellion. A new cable television ad from MoveOn.org features a former insurance company executive calling the finance panel's bill a dream come true for insurance companies, and it demands a government-run insurance plan to lower premium costs. Meanwhile, 27 major unions will sponsor full-page newspaper ads, expected to run Wednesday, that criticize the measure for not containing a public option or a mandate on employers to offer health insurance to their workers.
Those two issues are also most important to Senate liberals. But if Reid yields an inch to them, he risks losing support among centrists -- as well as Snowe, who could prove to be the most fragile ally of all.
Snowe said during Tuesday's session that she remains concerned that the package would do too little to make coverage affordable for the millions of Americans who would be required to buy it. But after considering the "astronomical increases in health-care costs" of recent years, she said, she concluded that the consequences of inaction would be far more damaging than the potential pitfalls of the legislation.
Still, she said, she could withdraw her support if the measure changes substantially. Like other moderates, she has serious reservations about a public option and employer mandate.
Sen. Charles E. Schumer (D-N.Y.) said he is working with colleagues to craft a compromise. Ideas on the table include letting states decide whether to create their own government plan, team up with neighboring states, or opt into or out of a national plan. But the divide over the employer mandate could prove more difficult to close. "I think that's going to be hard," Schumer said.
With Tuesday's vote, Baucus said, Democrats can rule out the need for extraordinary measures to pass a bill, such as a fast-track procedure known as reconciliation. But the challenge now is to "put on the floor a bill that is perceived as solid, balanced, common-sense and not slanted too far in one direction or the other," he said. "We want to listen to senators," he added. "But it still comes down to what gets 60 votes."
Staff writers Anne E. Kornblut and Alec MacGillis contributed to this report.