American Public Human Services Association

This Week in Washington

TWIW Sneak Peek

11/6/2009, Vol. XXX, No. 37

House Plans Vote on Health Care Overhaul on Nov. 7
On Nov. 7, the House is planning to vote on its health care overhaul bill, H.R. 3962. House Majority Leader Steny Hoyer (D-Md.) and House Speaker Nancy Pelosi (D-Calif.) are working to garner the 218 votes needed to pass the bill. While the bill gained some support from AARP, the American Medical Association, and two newly elected Democrats this week, there is some resistance within the caucus regarding provisions such as the public option, abortion, and medical cost reimbursement. Some members from rural districts worry that current reimbursement plans may not be equitable for their states. Some Democrats also contend that the measure does not sufficiently implement sweeping changes to cut the cost of medical services. Additionally, some members are seeking clarification on language in the bill that would prevent illegal immigrants from purchasing health insurance through new marketplaces called exchanges. Some liberal Democrats are pushing for a more “robust” public insurance option. Finally, some Democrats who oppose abortion want stronger guarantees against the use of federal funds to pay for abortions.

According to House Rules Committee Chair Louise M. Slaughter (D-N.Y.), the rule on the bill will include language from Rep. Brad Ellsworth (D-Ind.) that would explicitly prohibit federal funding for abortions and guarantee patients access to “pro-life” insurance plans that would not cover the procedure. The bill will also include a six-month extension of the Federal Medical Assistance Percentage increase included in last February’s stimulus legislation, the American Recovery and Reinvestment Act. While some Democrats are looking for opportunities to assist states, they are wary of increasing the cost of the bill and of Republican opposition to the economic recovery efforts undertaken thus far. However, states are apprehensive that an overhaul of the health care system will increase their Medicaid costs, and the FMAP boost in the overhaul could ease some of those concerns.

Meanwhile, the Congressional Budget Office analyzed H.R. 3262, a Republican alternative to the Democrats’ bill, and determined that it would be less expensive but would also do less to reduce the number of uninsured Americans. According to the CBO, the Republican bill would result in health insurance for 83 percent of the population while the Democratic bill would lead to coverage of about 96 percent of the nation. The CBO analysis projected that the Republican bill would cost $61 billion over 10 years, compared with the estimated $1.1 trillion cost of the Democrats’ bill. Both bills contain tax increases and spending reductions that would reduce the overall federal deficit. The Republican bill is intended to reduce health care costs, and the CBO says the proposal would likely result in lower health insurance premiums in the future relative to projections under current law. Unlike all of the Democrats’ proposals, the Republican bill would not include subsidies to help low-income people purchase insurance. Other differences between the Republican bill and Democratic legislation in the House and Senate are:

Republicans would not mandate Americans to carry insurance or employers to provide insurance. Instead, the Republican proposal encourages states to expand “high-risk pools” offering subsidized insurance to sick people who cannot obtain affordable private coverage.
The Republican legislation would modify Health Savings Accounts, which are tax-advantaged savings plans for routine medical expenses that are used in conjunction with high-deductible insurance policies for catastrophic medical expenses.
The Republican proposal would cap non-economic and punitive damages in malpractice lawsuits, which the CBO says “would reduce health care costs directly by reducing premiums for medical liability insurance and associated costs and indirectly by slightly reducing the utilization of health services.”

Meanwhile, despite President Obama’s one-on-one meetings with Democratic senators who are reluctant to support health care overhaul, Senate leadership has indicated that it may not act on the health care issue until 2010.

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