By Shailagh Murray and Lori Montgomery
Washington Post Staff Writers
Wednesday, December 2, 2009
Senators prepared to cast their first votes Wednesday on health-care reform, but even as partisan divisions hardened and contentious amendments stacked up, Democrats increasingly expressed optimism that they would succeed in passing a bill before Christmas.
The initial amendments offered illustrated the legislation's vast scope and lingering vulnerabilities. The first, co-sponsored by Sens. Barbara A. Mikulski (D-Md.) and Olympia J. Snowe (R-Maine), would increase preventative health care for women at a 10-year cost of $940 million. One aim of the measure is to blunt concerns raised last month when an independent commission recommended that women undergo mammograms less frequently.
The second amendment, authored by Sen. John McCain (R-Ariz.), would strip out the bill's primary revenue source, nearly $500 billion in Medicare cost savings. Although AARP and other seniors groups have said otherwise, Republicans are attacking the cuts as a threat that could eventually shorten lives.
"They've paid all their working lives into the Medicare trust fund, and now they're in danger of having $483 billion cut out of it, which would eventually lead to rationing of health care for seniors in order to fund a new, government-run health-care system in America," McCain told reporters.
Other flashpoints expected to reach the floor in the form of amendments would target provisions in the bill related to abortion and illegal immigrants. Majority Leader Harry M. Reid (D-Nev.) said debate could continue through the weekend. "I want people to feel that they've had an opportunity to understand the bill, offer whatever amendments they think will improve it," he told reporters Tuesday.
Republicans are targeting key sections of the bill, including the nearly $400 billion in tax increases that would finance the legislation's 10-year, $848 billion cost. GOP lawmakers also are expected to propose significant changes to medical malpractice laws.
To manage the expected deluge of Democratic amendments, Reid and other leaders are urging their colleagues to focus only on top priorities for floor consideration.
One pending proposal would increase funding for residency training to relieve the burden on large teaching hospitals in states such as Florida, California, Pennsylvania, Illinois and New York. Sponsored by Sen. Charles E. Schumer (D-N.Y.), the measure would provide $2 billion in additional funding over 10 years to create 2,000 residency slots nationwide.
Another group of Democrats, including Sens. Sherrod Brown (Ohio), John D. Rockefeller IV (W.Va.) and Robert P. Casey Jr. (Pa.), is pushing improvements to the State Children's Health Insurance Program. And a group of moderates, including Sens. Thomas R. Carper (Del.), Kent Conrad (N.D.) and Mark Warner (Va.), is crafting language to strengthen cost-cutting programs.
Centrist Democrats, who will probably decide the fate of the bill, appeared to be reassured by a Congressional Budget Office report released Monday refuting insurance industry assertions that the Senate bill would add thousands of dollars to the average family's insurance bill. The CBO found that Reid's package would leave premiums unchanged or slightly lower for most Americans who get coverage through their jobs.
Average premiums would rise in the relatively small and already costly individual market, where self-employed people and others buy policies directly from insurers. But the higher premiums would pay for better coverage, the CBO said, and most people in that market would receive hefty new federal subsidies that would leave them paying far less under the proposed legislation than they would under current law.
Warner called the report "a step in the right direction" but said "there's more that could be done" to rein in health-care costs.
Conrad, chairman of the Budget Committee and a fiscal hawk, said the report offered "reasonably good news," but added that he has deployed aides to look for ways to help the approximately 13 million people in the individual market who would earn too much for federal subsidies and could face higher premiums.
Another key moderate, Sen. Ben Nelson (D-Neb.), said he also remains concerned about people who would face higher premiums. But Nelson said he was more immediately focused on other issues in the package, including whether federal funds would directly or indirectly subsidize abortions.
Nelson said he would introduce an amendment similar to a measure adopted by the House, barring the public plan from providing abortion services while prohibiting people who receive subsidies from using the money to buy insurance that includes abortion coverage.
Despite their differences, Democrats said they remained optimistic that they can move quickly. "We're all talking to one another right now," Schumer said. "Every Democrat, every single one, wants to get a bill done. Everyone realizes that we're going to have to come together on a whole myriad of different issues."