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Washington Post's Q&A about reform... updated
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This is the second time the Washington Post has asked and answered eight questions about the politics of healthcare reform. (http://www.washingtonpost.com/wp-srv/special/politics/health-care-8-questions/index.html?hpid=topnews) It's a good overview of where things stand.
"#2 Where does the debate go from here?
House and Senate leaders are attempting to turn a patchwork of committee efforts into full-fledged bills. In the Senate, Majority Leader Harry M. Reid (D-Nev.) is working with a small team in his office to meld the Finance Committee bill with the more narrow legislation approved by the Senate health committee. In the House, Speaker Nancy Pelosi (D-Calif.) is leading the effort to combine the work of three House committees. Once the mergers are complete, the nonpartisan Congressional Budget Office will determine how much each bill costs, and they will move separately to the House and Senate floors, likely in early November.
"Assuming both measures are approved, the House and Senate will form a conference committee to combine the two bills for one final vote in their respective chambers. Then it's on to the White House for President Obama's signature. Democrats are confident of enacting health-care reform this year -- although many of the provisions won't take effect until 2014.
"#4 What are the main things the three bills have in common?
In the broadest sense, the House bill and the two Senate packages are remarkably in sync. They agree that individuals should be required to buy insurance and that all but the smallest employers ought to contribute to the cost of coverage. They would provide for a historic Medicaid expansion that would benefit all low-income people, not just select groups, while extracting significant cost savings from Medicare. The bills would create a new insurance market for individuals and families without access to employer coverage, and would provide subsidies to help those with incomes below 400 percent of the national poverty level to choose from a menu of plans.
"Reforming insurance practices is another area of broad consensus. The House and Senate agree that insurers must stop widely derided practices, including charging more to cover women and denying coverage for pre-existing medical conditions.
"#5 What are the major differences between the various bills?
Other than the public option, the House and Senate versions have several major differences. The House and Senate health committee bills would impose a mandate on employers to provide coverage, but the Senate Finance Committee bill takes a less punitive approach, merely fining companies whose employees enroll in Medicaid or receive federal coverage subsidies. To pay for the bill, the committee would slap an excise tax on insurers for issuing "Cadillac" insurance policies. But House Democrats are wary about the effect on union households and prefer a surcharge on very wealthy households. The surcharge idea is a non-starter in the Senate, leaving negotiators scrambling for new revenue sources to plug the gap.
"#6 Why does everyone keep talking about 60 votes in the Senate?
Sixty is the magic number needed to overcome a filibuster in the Senate. On paper, Democrats have 60 votes. But to reach that threshold, they will need Sen. Robert C. Byrd (D-W.Va.), who has been in frail health, and independent Sens. Joseph I. Lieberman (Conn.) and Bernard Sanders (Vt.).
"Further complicating the math, a handful of centrist Democrats say they are not yet sold on the health-care bills approved by two Senate committees. The narrow margin helps explain why the White House and Democratic leaders have aggressively courted Snowe as a possible crossover vote.
"Democrats have a procedural fallback -- a maneuver known as "reconciliation," which requires a simple majority. However, parliamentary experts say it is not clear that Democrats could achieve the sweeping health-care reform Obama envisions under this approach. Reconciliation is reserved for legislation related to the budget."
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