Daily Dose: Live Blogging the Senate Finance Markup
11:55 a.m. | The Wyden Plan
No one ever accused Ron Wyden of lacking persistence. Even as the Finance Committee is marking up a bill that is premised on leaving the current employer-based insurance system in place (for now), the Oregon Democrat was making another plug for his far more aggressive reform plan.
For several years, Wyden has, with Utah Republican Bob Bennett, been pushing a plan that would essentially dismantle the employer-based insurance system and replace it with one in which people would get tax deductions to purchase their own coverage. The thinking is that this would introduce far more competition and personal choice to health insurance and would be fairer than the current system, where people who get employer-based coverage benefit from the tax exempt nature of employer based benefits while people who buy insurance on their own must do so with after-tax dollars. The primary objection to the proposal is that it is just too dramatic a change for a country where health reformers feel the need to constantly reassure people with insurance that they can "keep what they have."
The Baucus bill has actually moved slightly closer to the Wyden vision by expanding accessibility to a new "exchange" where small businesses and people without employer-based coverage would buy insurance. The bill opens up access to the exchange to employers with as many as 100 workers, and envisions further expansions in coming years, which could over time lead to a shift away from employer-based plans and into the exchange. But Wyden said this is not going far enough to provide true choice to the 200 million Americans who now have employer-based coverage.
"It does not hold insurance companies accountable and it denies choice of insurers to 200 million Americans," he said. "It stipulates that you can keep what you have but if you don't like what you have...you're stuck."
He said he realized that the odds of his plan had always been long: "I know I'm taking on what amounts to the status quo lobby," he said.
And he made clear that he would be prepared to vote for the Baucus bill even if it fell short of his vision, as many other dissatisfied Democrats would. "This bill for a lot of my colleagues is not our first choice," he said.
11:30 a.m. | All Politics is Local
The home-state pressures facing the senators on the Finance Committee are not hard to discern so far. First, there was Olympia Snowe speaking up for the fairness of the Medicaid burden being imposed on states like Maine that have been much more generous than other states when it comes to Medicaid.
Then there was Chuck Schumer, the New York Democrat who in addition to making another plug for the public option, zeroed in on two issues of real concern to his constituents: the affordability of the insurance they will be required to buy and the proposed tax on high-cost plans. Because health care costs are higher in New York, middle and working-class residents will have a harder time affording insurance with the subsidies that they'll be getting under the plan. And the high health care costs in New York also mean that people who do have coverage are more likely than elsewhere to fall above the $22,000 threshold for a family plan at which plans will be subject to an excise tax that will result in yet higher premiums. Schumer said he would be proposing an amendment to address one subset of constituents in particular -- firefighters and others whose coverage plans are costly because of their line of work. But look for him to be trying to protect other union members and middle-class residents more broadly from the excise tax, which is the main new revenue source for Baucus's bill.
Up next came Bill Nelson, the Florida Democrat who, after some hemming and hawing, focused in on the issue most important to his many elderly constituents -- proposed cuts in Medicare, and specifically in the subsidies to insurers who offer Medicare Advantage plans. If those subsidies are cut, some insurers will in all likelihood stop offering the plans, which are HMO-style enhanced forms of Medicare chosen by about a fifth of Medicare recipients. Nelson argued that the cuts should not hurt people in Medicare Advantage plans now, that they should be grand-fathered into their current plans -- a step that would greatly reduce the savings gained from reducing the Medicare Advantage subsidies. "These citizens have come to rely on [Medicare Advantage]. To suddenly whack it away from them is unconscionable," he said.
10:53 a.m. | Winning Over Snowe
Source: Washington Post
