Policy flashpoints fuel reform debate

Kaiser Health News: "The health care overhaul debate in Congress now centers on two bills: the House-passed measure and the Senate Democrats' version unveiled Wednesday. They differ in important ways." KHN provides a consumers' guide that discusses mandates, new regulations on health insurers and how the legislation would affect both the insured and uninsured (Appleby, Carey, Galewitz and Rau, 11/19).

USA Today reports on how the respective chambers have handled the public option. New estimates from the Congressional Budget Office show that a government-run public plan would cover less than 1.5 percent of the population — up to 4 million people. "Under the House and Senate bills, the government option would be available only to people who shop for insurance on their own — meaning they don't get coverage through work — or who work for small firms. The plan would be offered alongside private policies in online 'exchanges' that would let people compare coverage and prices." The House version would cover up to 6 million people, the CBO has said (Fritze, 11/20).

Abortion, too, remains a sticking point for lawmakers, as House Speaker Nancy Pelosi insists that including related language in health reform legislation won't kill the bill, NPR reports. "In an interview with NPR airing Friday on 'Morning Edition,' Pelosi said that the key will be separating House members who are looking for any way to kill the bill from those who, 'in good faith,' want to pass legislation that embraces the longtime practice of prohibiting the use of federal funds for abortion" (Halloran, 11/19).

But CongressDaily reports that "House Minority Leader Boehner claimed Thursday that the Senate Democrats' health bill would make Americans who buy public insurance coverage pay a fee to help the plan cover abortion. The problem? The provision he's attacking won't dictate premium costs at all." The complicated provision would require insurers that offer abortions and accept government subsidies to set aside at least one dollar per month in a separate account to cover the procedure. Federal payments for abortions are not allowed under long-standing law. Boehner said that section amounts to a new fee for abortions. "But the provision doesn't dictate coverage requirements, which would affect premiums. It just tells plans how much money needs to be set aside" (Hunt, 11/20). 

NPR, in a separate story: "The truth is no one in the House or Senate is trying to score a big win on abortion. In fact, ask anyone and they'll tell that if this health care overhaul is going to pass, it shouldn't tinker with current abortion policy at all. And that means it should maintain the extremely delicate truce of sorts that lawmakers have had for decades. That is, that no federal taxpayer funds should go to pay for abortions" (Seabrook, 11/20).

On other issues, however, senators on both sides of the aisle are trying to score. One case in point: the Senate cut in half a proposed tax on medical devices, which is drawing praise from industry leaders, the Minneapolis-St. Paul Star Tribune reports. "The Senate bill unveiled Wednesday ... preserves the tax on industry revenues, but cuts the dollar amount by half, to $20 billion over 10 years." This amount, "but not the structure of the tax, now matches that in the House bill." The Senate Finance Committee originally proposed a $40 billion tax on device makers. Medical device makers are happier with the current version of the tax because they recognize the need for "shared responsibility" according to officials with leading device maker Medtronic (Hage, 11/19). 

The Associated Press has a small Q&A on the mandate that would require people to carry health insurance. "With proposed subsidies to help the poor buy in, the so-called 'individual mandate' gets Democrats closer to moving millions of uninsured into coverage plans." Insurers worry, however, that the mandate's penalties don't have teeth and don't assure that people will actually comply with the requirement (11/19).

Politico reports, in the meantime, that Hispanic lawmakers are blaming White House chief of staff Rahm Emanuel for pushing the Senate to prohibit illegal immigrants from using their own money to purchase health insurance in a new insurance marketplace. "The health care bill passed by the House earlier this month would prevent illegal immigrants from getting subsidies to buy insurance, but they would be permitted to buy plans from the exchange with their own money. The Senate bill would cut off that option." Democratic Rep. Luis Gutierrez said Emanuel's fingerprints are all over the measure. "(T)he perception that Emanuel is pushing policies that they see as harmful to their communities for the political advantage of the president or moderate Democrats in Congress could cause the White House problems with the CHC in future negotiations" (Allen, 11/19).