WASHINGTON - U.S. Senate Finance Committee Democrats working on sweeping health care legislation are attempting a delicate juggling act: Making health insurance more affordable for millions of Americans while holding down spending.
Their dilemma was clearly evident Tuesday as Finance Committee Chairman Max Baucus, D-Mont., presided over the first day of a committee meeting to debate and vote on his nearly $900 billion, 10-year bill. The legislation, built along the lines President Barack Obama is seeking, aims to extend coverage to most uninsured Americans, expand protections for those already covered and generally reduce the ruinous growth in medical costs nationwide.
The session dragged late into the night with Republicans raising a slew of questions, from the legislation's cost to its basic constitutionality, and only one amendment out of 564 pending came to a vote. That was a non-controversial measure, approved by voice vote, creating a test project in Medicare to allow hospitalized patients to be monitored electronically from afar by specialists.
As the committee took up a daunting task that has thwarted past congresses, Baucus heralded the occasion. "This is our opportunity to make history," he said.
By the end of the night he just wanted an end in sight. "At some point we've got to get to amendments," Baucus said as Sen. Orrin Hatch, R-Utah, raised question after question.
"We've got to understand what's in this doggone bill," Hatch complained. "This is not some itty-bitty bill. This could wreck the country."
Baucus is aiming to get the bill through his committee by the end of the week and he's expected to succeed. But if Day One is any measure, there will be plenty of fights along the way.
In a sign of the tensions evoked by the bill, several committee Democrats called for increasing the rebates that drug companies must pay the government for certain low-income patients. That would breach an agreement among the White House, Baucus and drug makers under which drug companies have agreed to pay $80 billion toward the cost of a health overhaul, including reducing prescription drug prices for some seniors.
Sen. Chuck Schumer, D-N.Y., complained that he and others were never part of the deal with the Pharmaceutical Research and Manufacturers of America and were under no obligation to protect drug makers from further costs.
"I wasn't at the table," Schumer said. "If you think the deal was too fair to PhRMA and not fair enough to citizens" there's nothing wrong with breaking it, he said.
Sen. Chuck Grassley, R-Iowa, responded angrily that the deal would stand, noting that the White House helped adopt it.
"If you think this is a bad deal you ought to be embarrassed at your president at sitting down with these folks," Grassley said.
Baucus kept his mouth shut through the debate on drug costs but postponed a vote on the amendment until Wednesday. The amendment's author, Sen. Bill Nelson, D-Fla., said the change would raise some $86 billion which he would use to protect seniors enrolled in private insurance plans under Medicare from any changes under the legislation.
Despite Obama's repeated claims that Medicare benefits will not be cut, Congressional Budget Office Director Douglas Elmendorf told senators Tuesday that the elderly in the private Medicare Advantage plans could see reduced benefits under Baucus' bill.
Baucus' bill is the most conservative, and cheapest, of five bills in Congress, and as a result committee Democrats and the one Republican whose vote Baucus is courting -- Sen. Olympia Snowe of Maine -- had concerns about whether it did enough to make insurance affordable for people who will face a new requirement to buy it.
Baucus announced $50 billion in changes Tuesday to address that issue. The most significant would sweeten the subsidies for individuals and families with incomes up to four times the government's poverty level -- which would work out to be $43,320 for individuals and $88,200 for a family of four. Baucus also decided to reduce the penalty for families who defy a proposed requirement to purchase coverage, from $3,800 to $1,900.
It wasn't enough.
"I still think there is more work to do to make this affordable," Sen. Debbie Stabenow, D-Mich., said.
Elmendorf estimated in a letter to Baucus that some families with annual incomes in the range of $66,000 could wind up spending as much as 20 percent of that -- $13,300 -- in out-of-pocket health expenses such as premiums and copays. The changes Baucus announced Tuesday would reduce that somewhat but the estimates still alarmed some Democrats.
The Finance Committee is the only congressional committee with jurisdiction that has yet to approve a health overhaul bill, so committee approval would clear the way for action within a week or so on the Senate floor. Across the Capitol, majority Democrats are working on the same timeline as they push for a vote in the House.
