As House bill continues to stir reaction, focus turns to costs, potential amendments

Oct 31 2009

Lawmakers and various groups continue to react to the House health bill, which was released Thursday and may significantly increase federal spending on health care.

The Washington Post reports that the House bill "would increase federal spending on health care by nearly $600 billion over the next decade, according to the nonpartisan Congressional Budget Office, a dramatic increase that dwarfs the expansion envisioned by the latest Senate bill." The latest CBO estimates indicate that the House bill would reduce deficits by $104 billion over the next decade while the Senate Finance bill would trim deficits by $81 billion. "But lawmakers also want to know whether the bills would increase overall federal spending on health care. To measure that effect, the CBO looked at the cost of expanding coverage ($829 billion in the Senate Finance bill versus $1.055 trillion in the new House bill) and subtracted other changes in outlays. For example, both chambers would reduce spending on Medicare and Medicaid by more than $400 billion over the next decade."

The CBO notes that in contrast to the Senate bill, the House "has resisted all efforts to limit tax subsidies for employer-provided health insurance, the single biggest loophole in the tax code. The House plan tinkers at the edges, by limiting tax-free contributions to Flexible Spending Accounts, for example, but would gain only $32 billion from the effort. As a result, less than half of the cost of the House coverage expansion would be offset by other changes, leaving the government spending $598 billion more on health care by 2019 than it otherwise would have -- seven times more than under the Senate package" (Montgomery, 10/30). 

The Hill reports that the House bill is not likely to receive additions as it advances: "Hispanic members, abortion-rights opponents, supporters of 'single-payer' healthcare and liberal members are all clamoring for the chance to offer amendments to the landmark legislation. Some want to change the bill, while others want to make a point or gauge support for their proposals. But Rep. George Miller (D-Calif.), a key player in the healthcare debate, said Friday he doesn't expect those groups will have much of a chance. 'Unless there are major problems I would expect the opportunity for amendments to be very limited, if at all,' Miller said in a telephone news conference."

"Miller and fellow leader Rosa DeLauro (D-Conn.) said the dozens of closed-door caucus meetings and private consultations between leaders and the different sub-groups of House Democrats are replacing the need for [floor] amendments. ... They also noted that the bill will be available online for three days before the vote and the previous versions of the bill have been online for months" (Soraghan, 10/30).

But NPR's Health Blog reports that there could be a special and lengthy "manager's amendment" that could swell the House bill and may address the abortion issues. The "'manager's amendment' from House Democrat leaders could run 800 pages or more and contain all sorts of surprises that nobody will know about until shortly before lawmakers have to vote on it, Rep. Roy Blunt, a Missouri Republican, warned Thursday. 'This won't be the bill that comes to the floor,' Blunt said at news conference where a copy of the House Democrats' plan was piled on the podium. At the session, Republicans said the measure would raise taxes, cost jobs and deepen the federal deficit, charges House Speaker Nancy Pelosi of California and her Democratic colleagues dispute. ... House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) who helped write the House Democrats' legislation, said the manager's amendment would likely address some unresolved issues -- such as abortion -- as well as make technical corrections to the proposal but be nowhere near the scale of change that Blunt fears" (Carey, 10/30).

On this point, abortion is proving to be a major obstacle for Democrat lawmakers. CQPolitics reports: "A showdown is shaping up among Democrats as abortion foes press House leaders to change the health care bill to explicitly ban abortion funding, or at least permit a floor vote on the issue. The effort led by Bart Stupak of Michigan and Daniel Lipinski of Illinois could have far-reaching implications for the fate of the legislation when the House takes up the health care overhaul late next week ... House Majority Leader Steny H. Hoyer of Maryland points to the abortion disagreement as perhaps the most important unresolved issue as he prepares to move the measure to the floor. ... Stupak said he would look for ways to work with Republicans, if necessary, and moderate senators including Bob Casey of Pennsylvania to override the decision by House Speaker Nancy Pelosi, D-Calif., to omit an outright ban on abortion funding from the legislation she unveiled Thursday (10/30).

The Hill reports, in a separate story: "The final version of the House health bill may include sections strengthening a ban on federal funding for abortion, Majority Leader Steny Hoyer (D-Md.) said Friday. Hoyer, the second-ranking House Democrat, said he cannot exactly predict will be in the 'manager's amendment,' a package of agreements preceding the floor debate of some legislation" (O'Brien, 10/30).

Fox News reports on hurdles to passing the House bill (10/30). Likewise, MSNBC examines whether House Speaker Pelosi will be able to garner the 218 votes needed to pass it (Curry, 10/30).