Senate pushes ahead on long-term care program

By Lori Montgomery and Shailagh Murray
Washington Post Staff Writer
Saturday, December 5, 2009

Republican senators continued their assault Friday on key funding sources for a health-care overhaul, targeting Democratic plans to cut payments to private insurers who serve Medicare patients and to create a new government insurance program for long-term care that would raise more than $70 billion over the next decade.

Democrats beat back both efforts. They voted 57 to 41 to preserve more than $120 billion in cuts to the Medicare Advantage program, one of the primary sources of financing for a health-care package that would spend $848 billion over the next decade to extend coverage to more than 30 million additional Americans.

The Senate also voted to keep provisions to establish the Community Living Assistance Services and Support Act, or Class Act, despite concerns among centrist Democrats that the program would quickly run out of cash.

A majority of senators -- including 11 Democrats -- actually voted against Class Act, warning that congressional budget analysts say it would become a drain on the federal budget less than 20 years after enactment. But while the amendment, by Sen. John Thune (R-S.D.), garnered 51 votes, it fell short of the 60 needed for passage under an agreement between party leaders.

Class Act supporters hailed the decision, saying the program would offer a badly needed lifeline to seniors and disabled people trying to stay in their own homes. Workers would pay a premium in exchange for the promise of cash benefits of around $50 a day to be used for visiting nurses, medical equipment and home renovations, or to offset nursing home fees. A more expansive version of the program is included in the health-care bill approved last month by the House.

"The Class Act will offer hope to Americans with serious illnesses or injuries who can maintain their independence with the help of long-term care," said Sen. Christopher J. Dodd (D-Conn.), who ushered a version of the health package through the Senate health committee this summer in the absence of the committee's former chairman, Edward Kennedy (D-Mass.). Kennedy, who died of brain cancer, was a leading proponent of the Class Act.

Critics countered that the voluntary insurance program is poorly designed and would attract people who already need the benefits. The program would raise money in its first decade because it would begin collecting premiums immediately, but pay out no benefits for five years. However, payouts would quickly outrun premiums, according to the Congressional Budget Office, and the program would probably require infusions of cash in its second decade.

"The Class Act is the same old Washington -- same old smoke and mirrors, same old games," Thune said. "We are locking in future generations to deficits and debts as far as the eye can see."

Among those voting against the program on Friday were Senate Finance Committee Chairman Max Baucus (D-Mont.), the chief architect of the health package, and Sen. Ben Nelson (D-Neb.). Nelson, who is being wooed aggressively by Majority Leader Harry M. Reid (D-Nev.) to support the health package, has said he will not do so if the Class Act is included.

The votes came as senators prepared to work through the weekend on health legislation, with a focus on resolving differences among Democrats over abortion and the creation of a new government-run insurance plan known as the public option. Liberals have insisted on a public plan, but at least four moderates have said they cannot support the provision as Reid wrote it.

"We feel like we're moving to the point where soon we can talk about an end game, where we will have an agreement that can bring together 60 votes," Sen. Richard J. Durbin (Ill.), the No. 2 Democrat in the Senate, said in a conference call with reporters. "But we're not there yet."

In one possible sign of progress for Democrats, Sen. Susan Collins (R-Maine) joined Sen. Joseph I. Lieberman (I-Conn.) in announcing plans to offer an amendment aimed at improving quality and lowering costs throughout the health-care system.

Collins, one of the few remaining GOP moderates, has been a fringe player in the health-care debate, but her comments Friday seemed to foreshadow growing interest in the measure.

"The bill before us does contain a number of promising ideas to help improve the quality of care while containing costs," Collins told reporters. "All of those reforms represent positive improvements to our current health-care delivery system."

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