Analysis of the Senate Finance Committee health care reform bill

Originally posted in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

The Senate Finance Committee finished work on its healthcare reform bill in the wee hours of Friday morning, paving the way for a committee vote next week.

After considering hundreds of amendments, the committee is now waiting for a cost-estimate from the Congressional Budget Office (CBO) before it takes a final vote to report the bill to the full Senate.

“I have never felt more proud because, tonight, we take another step toward putting this country on a path to a healthy future,” said Sen. Max Baucus (D-Mont.), chairman of the committee.

The president issued a statement following the end of Thursday’s markup, which lasted until 2:00 a.m.

“Thanks to the unyielding commitment of Sen. Baucus and members of the Senate Finance Committee, we have reached another milestone in our effort to pass health insurance reform,” Obama said. “As a result of this work, we are now closer than ever before to finally passing reform that will offer security to those who have coverage and affordable insurance to those who don’t.”

If the bill earns enough committee votes — and it likely will given the panel’s makeup of 13 Democrats and 10 Republicans — the bill would be melded with the Health, Education, Labor, and Pensions Committee’s bill, and senators may vote on their version of healthcare reform as soon as Oct. 13.

Mini Public Plans Idea Debuts

In a pivotal moment during Thursday’s markup, Sen. Maria Cantwell (D-Wash.) won support for an amendment that would set aside $200 billion for block grants to states that want to set up their own public insurance plans.

The amendment would essentially allow the creation of mini public plans to insure people who make between 133% and 200% of the federal poverty line — between $29,547 and $44,100 a year.

Under the amendment, each state that accepted a block grant to participate in the program would have to offer at least two insurance plan options, likely provided by private insurance companies.

The seemingly controversial amendment — which would, after all, pave the way for a patchwork of government-run plans — was adopted with little fanfare from the Republicans or the Democrats.

Speaking about the bill afterwards, Sen. Cantwell called the amendment a “foothold” for the public plan and said “this is what we could get the votes for today.”

Sen. Debbie Stabenow (D-Mich.), a supporter of Cantwell’s amendment, said that 75% of uninsured people fall in the 134% to 200% of the federal poverty level category. So, the new state plans could go a long way toward extending coverage, she said.

Cantwell’s home state of Washington runs a similar program for low-income residents, except it’s funded by the state. The new mini public plans would be paid for by the federal government through the subsidies that were slated to go to the 134% to 200% group to buy insurance.

Death Knell for Federal Public Plan

The most controversial portion of the two-week markup came on Tuesday when the committee defeated two amendments to add a public health insurance plan to its healthcare reform bill.

Several Democrats joined Republicans to defeat the amendments, one of which was offered by Sen. Jay Rockefeller (D-W.Va), and the other by Sen. Chuck Schumer (D-N.Y.).

While committee chairman Baucus said he understands why Democrats want a public plan, he said there just isn’t enough support in the Senate to garner the necessary 60 votes for the bill to pass.

“I can count,” Baucus said after four hours of debate over the issue. “I want a bill that will become law.”

Baucus voted against the amendments.

Physician Reimbursement and SGR

On Wednesday, the committee adopted a GOP amendment that would increase reimbursement for rural physicians. The amendment, sponsored by ranking Republican Sen. Chuck Grassley of Iowa, would adjust the Geographic Practice Cost Index, or GPCI, helping to level the current payment differential between physicians in rural and urban areas for the same procedures.

The GPCI is part of the formula used by CMS to determine physician payments and reflects regional differences in practice costs, such as rent and employee wages.

The committee rejected an amendment that would have replaced deep cuts in physician payment with a 0.5% increase for 2011 and 2012. The Finance bill already replaces a planned 21% payment cut for 2010 with a 0.5% increase.

Rather than adopt another short-term fix, Baucus hinted that a more permanent solution to the sustainable growth rate (SGR) conundrum might be brought up on the Senate floor.

“I’m quite confident that as the next stages of the bill progress, we’ll find a way to fix it permanently,” Baucus said.

Doctors Rally on the Hill

While healthcare reform is progressing at a steady clip, not everyone likes where it’s heading.

Two groups of doctors with widely differing views held rallies this week — Mad as Hell Doctors protested the absence of a single, government-run healthcare plan, while the “Million Med March” brought together physicians protesting additional government interference in healthcare.

The president of one of the groups at the Million Med March — which actually pulled out just a few dozen doctors — told MedPage Today that the current healthcare reform plans would ruin the doctor-patient relationship by putting too many new mandates on doctors.

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