October 16, 2009
The Road Ahead for Health Reform;
President Proposes Another Round of $250 Social Security Payments
Health Care Reform
A significant step forward for health care reform was made this week by the Senate Finance Committee, which voted 14-9 on Tuesday to approve that committee’s bill. Despite months of negotiations with Republican committee members to enlist their support, Chairman Max Baucus (D-MT) ultimately earned just one Republican vote: Senator Olympia Snowe (R-ME) voted to approve the measure.
Democratic leaders and the White House remain determined to advance a health reform bill this fall, despite the continuing political and timing challenges. Here is a quick overview of what happens next.
What Happens Next, Procedurally?
The just-approved Senate Finance Committee bill is already being merged, painfully but as quickly as possible, with the bill passed by the Senate HELP Committee back in July. The merged bill will then need to be brought to the Senate floor for at least a week or two of debate before coming to a vote.
Meanwhile, the House’s merged bill, based on the work of three different committees earlier this year, is undergoing final tweaks to best prepare it for success on the House floor. The House Rules Committee has started its work to determine how many and which amendments can be offered, how much time is reserved for debate, etc.
If the Senate and House pass their respective bills, the next step is a conference committee made up of key leaders from both chambers, who will face the task of working out the differences between the bills. Those lawmakers will not only have to fight for their party’s and chamber’s priorities, but also keep an eye on what will be able to pass both chambers, yet again.
If a conference deal is struck, that measure has to be passed by the Senate and House before being sent to the President for final approval with his signature.
Democrats also have another procedural tool at their disposal should they be unable to garner the 60 votes needed in the Senate to block a filibuster. Through a budgetary process known as “budget reconciliation,” Senate leaders could advance legislation with a simple majority of 51 votes; however, the scope of the legislation would have to be limited to provisions that have budget implications, which could exclude some facets of health reform such as consumer protections. This week, a House committee approved a measure that could be used as a vehicle for health reform within the budget reconciliation process. As a revenue measure, however, the Constitution prescribes that the full House of Representatives would have to approve the bill before it could be considered by the Senate.
Want a visual? See this handy flow chart published in The Washington Post:
http://www.washingtonpost.com/wp-dyn/content/graphic/2009/10/08/GR2009100803080.html#
When Will It Move?
From the start of this 111th Congress and new Administration in January, the timeline for health care reform legislation has been unusually ambitious. Despite numerous inevitable set-backs along the way, it is still feasible that a bill could reach the President’s desk by the end of December.
Here are the latest estimates on timing:
End of October/Early November: Merged Finance-HELP bill comes to Senate floor for one to two weeks of debate
Weeks of November 2 and 16: House considers its bill for two weeks; the other two November weeks are planned Veterans Day and Thanksgiving recesses
Early to Mid-December: Finalization of conference bill (which would have informally started in November) and floor votes in both chambers. Leaders have already warned lawmakers to expect to work deep into December.
And What is in the Bill, Anyway?
As House and Senate leaders work to negotiate merged health care reform bills for floor consideration, there are several critical differences that they will need to resolve. Overall, each of the health reform bills would take major steps to expand access to health insurance coverage and make it more affordable for low-income Americans through expanded Medicaid eligibility. The measures would improve quality, restrain health care costs, expand prevention and wellness services under the Medicare and Medicaid programs, and create a new voluntary, government-run insurance program for long-term services and supports (i.e., the CLASS Act).
The measures take differing approaches on whether to provide a “public option” along with private plans and, if so, whether to base the public option on Medicare rates or rates negotiated with providers. Meanwhile, another proposal would take a more moderate approach, creating new insurance cooperatives to offer an alternative to private plans as opposed to a government-run insurance plan. Some have also proposed a “trigger” that would create a government-run option in states where at least 5 percent of residents lacked access to affordable care. There are also key differences on whether to require employers to offer health insurance coverage to their employees or instead require employers to pay a portion of any subsidies their workers receive from the government to purchase insurance.
What is not in the bill at this point is a “fix” to the payment structure by which doctors and other medical providers are reimbursed by Medicare. The sustainable growth rate (SGR) was a device developed years ago to address increasing costs in Medicare, but the resulting decreases in the reimbursement rates are usually put on ice by lawmakers. Democratic leaders recently announced plans to address the planned 2010 cuts to reimbursement rates outside of health care reform legislation. The Senate will take up one measure early next week.
As reported in past Legislative Updates, our next advocacy opportunity to advance Project 2020 will be via floor amendments. Project 2020 champion Senator Maria Cantwell (D-WA) has said she will offer S. 1257 as an amendment when the bill comes to the Senate floor. n4a will keep you informed as that process unfolds, but if you want to take action now, please see our October 8 Advocacy Alert.
Economic Recovery Social Security Payments
Yesterday, President Barack Obama asked Congress to legislate a second round of $250 economic recovery payments to Social Security recipients in 2010. This year’s stimulus bill (the American Recovery and Reinvestment Act, or ARRA) included those payments, which went out to all Social Security beneficiaries in the summer. The President is now urging Congress to authorize a repeat of that program for the coming year, citing continued economic hardship among the Social Security population.
The $250 figure is equivalent to approximately 2 percent of the average annual Social Security retirement benefit. It is estimated that the cost of this proposal is $13 billion. This is the White House’s first ARRA extension request. The announcement came on the heels of the news that there will be no cost-of-living adjustment (COLA) in 2010, given the country’s negative inflation rate.
n4a is supportive of the President’s plan. “Older adults struggling to make ends meet in this recession will be directly aided by this relief, and we hope the expenditure of these payments will have a stimulative effect on the economy, as well. Given the lack of a cost-of-living adjustment in 2010 for Social Security recipients, this one-time payment will be especially helpful to those living on a fixed income. As a result of the recession, Area Agencies on Aging and Title VI Native American aging programs have seen a direct and dramatic increase in the demand by older adults in their communities for emergency and supportive services. We look forward to working with Congress to advance this proposal, and thank the Administration for its leadership,” said Sandy Markwood, n4a CEO.
à If you have questions or concerns, please contact n4a’s public policy and legislative affairs staff, Amy Gotwals and K.J. Hertz, at 202.872.0888 or agotwals@n4a.org, khertz@n4a.org.
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