Details of the policies inside the Senate's health overhaul bill

Nov 30 2009

Hot-button provisions in the Senate health Bill, such as the public option, cost controls and subsidies to expand coverage continue to get a lot of attention, while some interesting details have gone with little notice.

Kaiser Health News reports on some of these bill provisions, including requirements for "reasonable" time off at work for nursing mothers, $400 million for sex education and "adult preparation" to help teens transition to adulthood. It also would clamp down on nonprofit Blue Cross Blue Shield plans that behave like their for-profit cousins by revoking their favorable tax status if their overhead tops 15 percent. Medicare would boost payments for bone density scans under the legislation, and would require some limits on what uninsured people have to pay for emergency room care (Carey, Galewitz, and McGinley, 11/30).

The Hill reports on "seven key issues" that warrant attention: "Senators will be asked to cast their votes on numerous amendments as they begin a debate to reshape the country's healthcare system. Some amendments will be designed to improve the bill, some to satisfy a special interest or pet peeve. Still others will be presented as poison pill." The Hill's list includes: the public option, abortion, a tax on so-called "Cadillac" health plans, prescription drugs, affordability, insurance exchanges and Medicare cuts. "Because these cuts are essential to financing the rest of the bill, however, they're here to stay - though some could be scaled back. The deep cuts to private Medicare Advantage plans, for instance, could be mitigated to assuage senators from states with large senior populations" (Young, 11/29).

The New York Times reports that plastic surgeons, and some of their patients, are outraged by a 5 percent tax on cosmetic surgeries proposed in the legislation. The tax would not apply to cosmetic surgeries that are already tax deductible, including those to correct deformities. Surgeons "say they are being singled out because of an outdated perception that people who have cosmetic procedures are well-to-do" (McKinley, 11/29).

Related KHN story: Plastic Surgeons Cry Foul Over 'Botax' In Senate Bill (Galewitz, 11/20)

One detail Democrats chose to leave out in order to keep the bill's cost lower is Medicare funding for 15,000 additional graduate medical residencies in primary care and general surgery, The Wall Street Journal reports. That could complicate the planned expansion of health coverage to 30 million more Americans, given that in some places, doctors are already in high demand (Adamy, 11/27).

Big and small, the proposed reforms, such as one protecting people from being denied coverage may take longer to take effect than many expect, assuming the bill clears Congress, The Washington Post reports. "The delay in implementing some key reforms contrasts with the urgency of [President] Obama's call for action. ... (who) said in July, 'We shouldn't have to wait a long time to make sure that people don't lose their insurance because of a preexisting condition.' Delaying relief until 2014 means that Obama could face reelection -- and Congress be transformed by two elections -- before voters begin feeling the legislation's full effect. It would also reduce the cost of the bill during the 10-year budget window measured by the Congressional Budget Office" (Hilzenrath, 11/30).