Lawmakers hope to combine Senate, House health reform bills quickly

The Wall Street Journal reports that Democrats are hoping — and planning — on fast negotiations between the Senate and the House in January to come up with a merged health care reform bill.

First, they must settle differences on "abortion, taxes and a government-run health plan. … The House is likely to be under enormous pressure to compromise. That's because Senate Majority Leader Harry Reid has secured exactly the 60 votes needed to ensure passage in the Senate, leaving the Nevada Democrat with little room to negotiate if he has any hopes of keeping his bloc intact." Senators themselves call the bloc fragile while Representatives have so far not indicated much about how far they will be willing to compromise (Hitt, 12/22).

The New York Times reports on the treatment of abortion in the bills, one of the most dividing issues among lawmakers — even among Democrats. "In the House, advocates and opponents of abortion rights and conservative Democrats have made clear that they object, for different reasons, to the Senate's compromise language. … The House, more liberal than the Senate on many issues, would impose more stringent restrictions, barring coverage of abortion by any health plan bought even partly with federal subsidies." In the Senate bill, health plans could cover abortion, but beneficiaries would have to write separate checks for premiums to pay for their abortion coverage and all other coverage. "Representative Bart Stupak, Democrat of Michigan and the author of the anti-abortion provisions in the House bill, said Monday, 'It would be extremely difficult for me to vote for a bill' taking the Senate approach on abortion" (Pear and Herszenhorn, 12/21).

NPR: "On the surface, the House and Senate health overhaul bills have a lot in common. They both require everyone to have health insurance and provide generous subsidies to help people buy it. They both create new insurance 'exchanges' where individuals and small businesses would go to buy insurance, and they both put new requirements on health insurers, like banning them from discriminating against people who have pre-existing medical conditions." But they are also different, particularly in financing, NPR reports (Rovner, 12/22).

The Christian Science Monitor: "The largest source of new revenue in the House version of healthcare reform legislation is a tax on wealthy Americans. It consists of a 5.4 percent surcharge on families with annual incomes over $1 million and on individuals with incomes over $500,000. It's estimated to bring in $461 billion over the next decade." In the Senate, the largest revenue source comes from an excise tax on high-cost insurance plan, which could raise $149 billion over 10 years. Both ideas for financing have met stiff opposition (Grier, 12/21).

Roll Call reports that immigration is also of concern for lawmakers trying to forge a consensus. "Hispanic lawmakers, meanwhile, have complained repeatedly about the Senate bill's restrictions prohibiting illegal immigrants from buying health insurance through new exchanges. The House bill allows them to buy insurance but prohibits them from receiving subsidies." The issue could be mute, however, if illegal immigrants are given a path to citizenship before 2014, when exchanges begin operating, though the White House has signaled that it supports the Senate treatment (Dennis and Newmyer, 12/21).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.