Originally published in MedPage Today
by Emily P. Walker, MedPage Today Washington Correspondent
After weeks of closed-door meetings, the Senate leaders released their $849 billion healthcare reform bill on Wednesday evening, paving the way for a procedural floor vote soon.
The bill, combining versions approved by the Finance Committee and the Senate Health, Education, Labor and Pensions (HELP) Committee, would create a new public insurance plan, and expand coverage to an additional 31 million people, meaning that 94% to 98% of all legal residents would have insurance.
Senate Majority Leader Harry Reid (D-Nev.) said the $849 billion, 10-year cost of the bill would be more than offset by savings and would ultimately result in a $127 billion reduction in the federal deficit over the next decade.
Although it’s similar to the $1.1 trillion legislation passed by the House of Representatives Nov. 7, the Senate version differs in several ways.
Notably, an anti-abortion amendment that was included in the House bill is not part of the Senate measure. The House amendment, sponsored by Rep. Bart Stupak (D-Mich.) would bar the government from offering abortion in its public plan, and make it illegal for private insurers who participate in the exchange from providing abortion coverage, except in the case of rape, incest, or when the woman’s health is in danger.
The Senate language is much less restrictive with regard to abortion. It reiterates the Hyde Amendment, a law that bans federal funds from being used to pay for abortion. It would allow the Health and Human Services Secretary to decide whether to allow women in the public option to have abortion coverage, as long as no federal funds were used to pay for the abortion.
The bill would expand Medicaid to cover those with incomes of up to 133% of the federal poverty line. Those who earn between 133% and 400% of the federal poverty line would receive subsidies to buy insurance through an insurance exchange.
It would require everyone to have insurance, or else pay a $95 penalty in 2014, and a $750 penalty by 2016 for not having insurance.
Also, the Senate bill would pay for expanding coverage in a different manner than the House bill.
It would impose an excise tax on so-called “Cadillac” health insurance plans, which cost more than $8,500 a year for individuals or $23,000 for a family.
The latest version of the bill raised that threshold slightly, so fewer people would be subject to the tax. Although many of those plans are part of executive compensation packages, many also cover blue-collar employees whose unions negotiated healthcare coverage in lieu of pay increases. If the Senate bill passes, it would need to be combined with the House measure.
The Senate bill would also impose a Medicare payroll tax on those who earn more than $200,000.
The bill would also levy a surprising new 5% tax on elective cosmetic surgery and procedures. It also taxes device companies and drug companies.
Like the House bill, the Senate bill would create a new public health insurance option. However, state legislatures could opt out of offering their residents the government-run plan by enacting specific legislation.
The Senate measure would also create state-run insurance cooperatives through which residents could band together to purchase insurance.
Reid has said he hopes to have the important procedural vote before Senators leave for Thanksgiving break.
It’s not clear whether Democrats will have the 60 votes necessary to break an expected Republican filibuster that would prevent a vote on the bill — which is thought to have enough votes to pass. To accomplish that, every Democrat would have to support the bill, along with the two independents in the Senate — Bernard Sanders of Vermont and Joseph Lieberman of Connecticut.
But Lieberman has said he won’t support the measure if it includes a public plan, and it does.