Many amendments to massive Senate health bill expected

The Senate is scheduled to begin debate Monday on health care, and according to some news organizations, they have their work cut out for themselves. 

The Wall Street Journal: "A handful of Democratic senators are pushing to change pending health-care legislation so that it would help increase the country's stock of primary-care doctors ... More than 30 million Americans would get health insurance under the health-care overhaul that passed through the House and a similar bill moving forward in the Senate. If that does indeed happen, many previously uninsured people who haven't had a regular doctor before will need a primary-care physician." 

"Medical colleges, backed by some Democrats, want funding for 15,000 more slots for graduate medical residencies in primary care and general surgery. The government currently pays part of the cost for such residencies through Medicare. Senate Majority Leader Harry Reid co-sponsored a separate bill to do just that this spring. But when doctors pressed him to include the measure in the broader health-care overhaul he crafted, the Nevada Democrat balked because the estimated $10 billion to $15 billion cost over a decade would inflate the bill's overall price too much. ... Sen. Charles Schumer of New York plans to introduce an amendment that would add about 2,000 residency spots to the current 100,000. The amendment would give first priority to primary-care doctors and general surgeons" (Adamy, 11/27)

Roll Call: "Dozens of amendments will be considered over the next month, and Majority Leader Harry Reid (D-Nev.) must hold together all 60 members of the Democratic Conference in order to beat back politically harmful GOP amendments and ultimately clear the way for final passage. Reid successfully rallied his Democratic colleagues to vote in favor [60-39] of bringing the bill to the floor. ... Moderate Democratic Sens. Mary Landrieu (La.), Blanche Lincoln (Ark.) and Ben Nelson (Neb.) all voted to proceed to the bill, but they pledged not to vote in favor of final passage if the bill includes a public insurance option. Reid's package includes such a plan. While Members begin the amendment process to the health care bill this week, behind-the-scenes talks between Landrieu and Sens. Charles Schumer (D-N.Y.) and Tom Carper (D-Del.) on an alternative public option will capture the attention of both moderates and liberals, who strongly support having a government-run alternative" (Brady and Bendery, 11/26).

Politico: "Democrats searching for a compromise on health care reform may find a little Thanksgiving light in a new policy paper out Wednesday: Skip a 'weak' public option now in favor of a much stronger one that would kick in automatically if the health industry doesn't meet its promises to slow the growth in medical costs. The paper, from the Washington-based Urban Institute, offers a fresh look at the whole public option debate, casting the issue as 'one of fiscal conservatism' — more about containing health costs than extending benefits to the uninsured."

"The timing of the paper's release, just prior to the Thanksgiving weekend, makes it difficult to assess its impact. But it goes to the heart of two questions now before Senate Democrats: how best to contain health care costs and what's more important: getting a weak public option foot in the door or reserving the right to come back stronger if the private market fails to slow the rise in spending." (Rogers, 11/25).

The Associated Press: "Thousands of drivers on the nation's roads don't carry auto insurance, despite laws in all but two states requiring it. Critics of President Barack Obama's health overhaul plan ask: What are the chances scofflaws will treat a requirement to carry health insurance any differently? Nearly 40 years of car insurance mandates — which the insurance industry says have failed to make roads safer or lower auto insurance costs — raise questions about how well such mandates work."

"'Not everyone complies,' said Scott Harrington, a professor of health care management and risk management at the University of Pennsylvania.'"The auto insurance mandate is almost everywhere. But it's not rigorously enforceable.' David Sampson, president and CEO of the Property Casualty Insurers Association of America, said drivers' personal financial situations, not the rules of their states, are a better indicator of whether they carry insurance. States with higher poverty rates show a corresponding rise in uninsured drivers, he said. Simply put, people skirt car insurance when they can't afford it. They may do the same with health insurance, so the trick for Congress will be how to enforce a mandate without scuttling the program." Forty-eight states have some insurance requirements for drivers (Wyatt, 11/26).