In a marathon session, the Senate Finance Committee wrapped up its seventh and final day of hearings on its $900 billion healthcare reform bill after 2 a.m. Friday.
The bill, which could be voted on by the full committee as early as next Tuesday following a scoring analysis from the Congressional Budget Office (CBO), has for the past two weeks elicited sharp debate over what ultimately was included in the bill (for instance, value-based physician payment formula, individual mandates) and what was not (a public option).
Numerous amendments were withdrawn Thursday because they lacked the requisite scoring—or cost estimates—from CBO. However, the process gave several senators an opportunity to let Committee Chairman Max Baucus (D-MT) know what they thought was missing from the bill.
Sen. Jay Rockefeller (D-WV), whose public option amendment was voted down by the panel on Tuesday, revisited one issue that he touched on that day: Incorporating a medical loss ratio of 85% on all healthcare insurers. This means that insurers would be responsible for making sure that at least 85% of their dollars went to paying for healthcare—and not profits, overhead, or marketing, he said.
"It's time we demand something from insurers in exchange" for the $465 billion in subsidies that insurers would be getting over the next 10 years under the proposed reform plan, Rockefeller said. He noted that much of the medical loss ratio data is not available to consumers in many states. Sen. Charles Grassley (R-IA), though, questioned if such a provision would be micromanaging insurers.
Rockefeller withdrew the amendment from consideration, but he said he may reintroduce it when reform legislation moves to the Senate floor for debate.
Also during the day, challenges arose over how some of the bill's provisions could impact the middle class. In particular, GOP panel members said the bill went against what President Obama had said about not increasing taxes on that middle class group.
"I think the American people will be surprised to learn that the only way to enact healthcare reform is through a tax burden," said Sen. Jim Bunning (R-KY). Most of the Republican proposals to exempt middle class taxpayers from fees and taxes in the Senate bill were defeated on 12 to 11 votes.
However, one amendment proposed by Sen. Olympia Snowe (R-ME) and Sen. Charles Schumer (D-NY) passed 22-1. The amendment called for lowering penalties that families could face from failing to obtain health insurance under the insurance mandate: the maximum penalty would be reduced from a high of $1,900 annually to $200 in 2014 and rise to $800 in 2017.
An amendment proposed by Sen. Maria Cantwell (D-WA) that would give states the ability to negotiate with health insurers to provide coverage at a lower cost was approved 12-11. "What's unique about it is . . . that it's a public plan but negotiated by the private sector in ensuring that there is a choice for individuals who want to receive this public benefit option," she said.
Under the original provision in the Chairman’s mark, individuals with income between 133% and 200% of the poverty level (about $44,000 a year) would have been eligible for tax subsidies to help them purchase individual insurance coverage. With Cantwell’s proposal, the revenues to the states could be redirected voluntarily where they could negotiate and cover this group more cost-effectively, she said.
This model is based on Washington State’s 20-year-old Basic Health Plan. Cantwell said this model could provide coverage to up to 75% of the state’s uninsured population.
Following the full Finance Committee vote next week on the bill, it will be combined, through negotiations, with the Senate Health, Education, Labor and Pensions (HELP) Committee healthcare reform bill. If negotiations proceed as expected, Senate floor debate could begin by mid-October.