Health reform bill moving ahead, despite lingering questions

Some news outlets looked beyond the Senate Finance Committee's consideration of a health overhaul bill this week. 

CongressDaily: "Senate Finance Chairman Max Baucus said his committee will convene again Tuesday. Sen. Olympia Snowe, R-Maine, the only committee Republican who might cross sides to vote for the health bill, remained on the fence late last week. 'Obviously, there's some things that require significant improvement, for example, on the individual mandate,' Snowe said. 'I'm going to review the document and all that's been added and modified and go from there.' Snowe and Senate Democratic Conference Vice Chairman Charles Schumer of New York were instrumental in making changes last week to Finance's proposal that will make health insurance more affordable." 

"While most of the work so far has fallen to committees and party leaders, the wait for the bills to get to the floor provides a window for President Obama to play a bigger role in the debate, some lawmakers said. 'The role of the president to this point in time has been more to steer the boat, not as much to row the boat,' Sen. Thomas Carper, D-Del., said last week. 'I think going forward the administration needs to do a little more rowing'" (Edney and Hunt, 10/5).

The New York Times: "Party leaders still face immense political and policy challenges as they combine rival proposals — two bills in the Senate and three in the House. But the broad contours of the legislation are in place: millions of uninsured Americans would get subsidized health benefits, and the government would move to slow the growth of health spending. Senior Democrats said they were increasingly confident that a bill would pass this year. 'I am Scandinavian, and we don't like to overstate anything,' said Senator Kent Conrad, Democrat of North Dakota and an architect of the Finance Committee bill. 'But I have a solid feeling about the direction of events.' Step by difficult step, the legislative process is lurching forward." 

The Times notes that there are "huge issues" remaining, including the requirement that most Americans have insurance, whether "the government should require employers to provide health benefits," how to pay for the legislation, whether to create a government-run insurance option,  ways "to provide more generous subsidies to help low- and middle-income people buy insurance" and whether the final bill will control costs (Pear and Herszenhorn, 10/3).

Politico reports from the Sunday talk shows: "The healthcare reform bill apparently poised to clear the Senate Finance Committee would raise taxes on families making less than $250,000 and thereby violate President Obama's campaign promise to protect middle-income Americans from tax increases, asserted Sen. John Cornyn (R-Texas). Committee Democrats last week cleared the way for the healthcare reform bill ... partly by beating back GOP amendments, including one from Sen. Mike Crapo (R-Idaho) to bar middle-income tax increases. But Sen. Chuck Schumer (D-N.Y.), who also sits on the panel and appeared with Cornyn on 'This Week,' said Crapo's amendment defined taxes so broadly, it could apply to 'just about anything,' and was merely an effort to score political points" (Vogel, 10/4).

Meanwhile, The Hill reports that "House Speaker Nancy Pelosi and fellow House Democratic leaders next week are expected to wade into the treacherous waters of how to pay for the House healthcare bill as they continue to negotiate the shape of the bill behind closed doors."

The most public debate is about the 'public option,' as Pelosi tries to mediate a burgeoning feud between liberals and centrist Blue Dog Democrats about what form the government-run plan should take in the legislation. But the tax question could be even more divisive within the Democratic Caucus, pitting union allies against business-minded centrists who believe that a tax-the-rich strategy will backfire by hitting small business. Pelosi appears to have sparked a revolt among unions and a significant portion of the Democratic Caucus by suggesting last month after one of those closed-door meetings that she might be open to raising taxes on so-called 'Cadillac' insurance plans" (Soraghan, 10/3).

The Washington Post: Any health-care overhaul that Congress and President Obama enact is likely to have as its centerpiece a fundamental reform: Insurers would not be allowed to reject individuals or charge them higher premiums based on their medical history. But simply banning medical discrimination would not necessarily remove it from the equation, economists and health-care analysts say. ...  Cognizant of the threat, lawmakers are trying to neutralize it. For example, the bill advanced by Senate Finance Committee Chairman Max Baucus (D-Mont.) calls for creation of complex mechanisms to essentially raise or lower compensation to insurers, depending on whether they attract disproportionately sick or healthy populations."

"The bill assumes the problem would be greatest during the first few years; after that, part of the machinery to compensate for variations would go away" (Hilzenrath, 10/4).