Health Care Reform: What to expect in the weeks ahead


Whereas most people agree that health care needs some improvement, the gay and lesbian community stands to be one of the largest beneficiaries of the proposed changes. Currently, most gay families are not covered by employer-sponsored health insurance, and even when benefits are provided, these families face burdens that their straight counterparts do not. Providing health care to all Americans will hopefully help level the playing field. The Human Rights Campaign has identified eight objectives, which will serve as their benchmark in evaluating pending health care legislation. These objectives address everything from access to affordable care to giving domestic partners decision-making authority and much more.

So where are we? The mid-October passage of the Senate Finance Committee’s $829 billion health care package brought President Obama one step closer to delivering on his promise to reform our nation’s health care system. Of the five Congressional panels to pass legislation on health care reform, the Finance Commit- tee was the only one to achieve bipartisan support with a single Republican, Sen. Olympia Snowe of Maine joining the panel’s 13 Democrats in favor of the bill. The other nine Republicans on the committee voted no on the measure. Now, Congress faces the difficult task of creating a joint measure that will satisfy the President, their colleagues on both sides of the aisle and most importantly, the American people.

What’s Next For Lawmakers?

Leaders in the House and Senate are now combining the bills that have passed in their respective chambers, with the goal of bringing them to the floor for a vote late this year or in early 2010.

In the House of Representatives, speaker Nancy Pelosi has been working with leaders since July to combine three bills that passed through their respective committees, all of which include a public option. House leaders generally agree any final measure must include a government-run option, but disagree over costs and other details.

In the Senate, Majority Leader Harry Reid is responsible for joining the finance committee bill, sponsored by committee chairman Max Baucus to the more liberal Health, education, Labor and Pensions (HELP) committee bill sponsored by Sen. Chris Dodd. The finance committee bill emerged this fall to draw support among those concerned with the expanding role of government in the health care arena, the higher costs associated with the three House bills, and the one proposed by the HELP committee. The primary difference in this measure versus the others is there is no government-run insurance program or public option, a key to gaining support from Snowe and moderate senate Democrats. Reid must balance this sensitive issue to enlist support from additional Republicans and a divided group of Democratic partners.

After the senate and House pass final measures, a conference committee will merge the legislation before sending it to the President for his signature.

Key plan elements – What’s Being Considered

While leaders seem to disagree on many elements of the health care plan, most agree the system is in need of a major overhaul. Common themes among the bills currently being considered include limiting out-of-pocket costs for consumers, preventing insurance companies from denying coverage based on pre-existing conditions or sex, and creating incentives for preventive health care. As the House and Senate complete their final bills over the next few months, they must reach compromises on other controversial issues including:

Public Option

Perhaps the most divisive issue in the senate is the public option. Many Republicans and conservative Democrats strongly oppose the option arguing that, among other things it will run private insurers out of business, create a less favorable marketplace for competition, decrease the quality of care, and limit access to immediate care. Instead of a public option, the finance committee bill included a provision for $6 billion to create nonprofit member-run health care co-ops in each state to help reduce premiums and drive competition.

Supporters of the public option believe it would make insurance companies more competitive and increase the number of people access to health insurance. Many Democrats have indicated they will not support a final measure that doesn’t include this option. To achieve the necessary 60 votes needed when it reaches the floor and to avoid a possible Republican filibuster, Reid will have to weigh how to appease those against a public option while not alienating the liberal base in favor of it.

Maximizing Coverage

Look for the final bill to expand coverage by requiring the majority of Americans to buy health insurance or pay a penalty. Support to low-income Americans and legal immigrants to help purchase coverage, along with expanded federal programs such as Medicaid are incorporated in all bills.

Senate leaders face pressure from the left to expand coverage to more Americans in the finance committee bill they believe falls short in providing assistance to the uninsured. The non-partisan Congressional Budget Office estimates the current bill will leave 25 million uninsured in 2019, approximately a third of which would be illegal immigrants, a compromise made by the committee in attempting to keep costs below

The $900 billion limit set by President Obama. In addition to substantial cuts in future Medicare payments to health care providers, all the bills propose taxes to help fund subsidies. In the House Bills, taxes would be imposed on people earning more than $1 million per year, whereas the finance committee proposes a tax on so-called “Cadillac” or high-cost health insurance plans such as the one congress has for its members. Many Democrats are against taxes on these high-cost health insurance plans, complicating efforts to reach a resolution on this issue.

Employer Provisions

While many lawmakers support an employer mandate to provide health coverage to employees, the senate finance bill places the lowest burden on employers across the five bills. it does not require employers to provide insurance. However, employers with 50 or more employees would be required to pay the government up to $400 for each of their employees who goes out and purchases their own insurance.

As lawmakers push to pass a final bill to overhaul health reform, it appears that President Obama is well on his way to accomplishing one of the top domestic priorities on his agenda. The President and his staff will likely play a key role in soliciting bipartisan support as the legislation evolves. And while the final elements of the plan are still up for grabs, one thing is certain. The daily changes and compromises to the existing bills over the upcoming weeks will continue to keep stakeholders including hospitals, drug companies, health care providers, small businesses and insurers involved and active in the discussions. Stay tuned.

Reference sources:
 John Fritze, “$829B Baucus Health Care Bill Clears Hurdle for Debate,”, Oct. 14, 2009.
Robert Pear and David M. Herszenhorn, “Republican’s Vote Lifts a Health Bill, but Hurdles Remain,”, Oct. 13, 2009. Noam Levey and James Oliphant, “Health Care Reform Bill Clears Senate Finance Committee,”, Oct. 14, 2009. David Espo, “Health Bill Clears Hurdle with Support from Snowe,”, Oct. 13, 2009.