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Healthcare Q&a

The state of overhaul legislation in the House and Senate

September 27, 2009|James Oliphant

WASHINGTON — Some reader questions on the national healthcare debate:

Where do the various healthcare bills stand now?

There's a single House bill that will go to the floor when Speaker Nancy Pelosi (D-San Francisco) deems it politically expedient. That is expected to happen in October. Pelosi will probably wait to see what the Senate produces before she subjects her caucus to a vote, because many Democrats are nervous about the way the bill will play back home. She also has to worry about whether the centrist Blue Dog Democrats will support a more liberal bill.

In the Senate, one version of a healthcare bill has been passed by the health, education, labor and pensions committee. Another is working its way through the finance committee.

What's up with that bill?

That is the Baucus bill, which has garnered so much recent attention. Finance Chairman Max Baucus (D-Mont.) wrote his version of a healthcare overhaul, which was notable for receiving criticism from just about every side. So Baucus has subjected the bill to a markup, in which the rest of the 23-member committee is given a chance to revise the legislation through amendments. When the process started last week, there were more than 500 amendments waiting to be offered. One week later, nothing much has changed.


The markup has given Senate Republicans a platform to air their grievances over the Baucus bill. The GOP has used the process to complain about cuts in Medicare, whether healthcare would be rationed, and whether the bill would be transparent enough.

How are Democrats proposing to change the Baucus bill?

Plenty of Democrats are unhappy too. Their concerns revolve around the level of federal support for low-income Americans who would be required to purchase health insurance. But addressing those concerns would significantly affect the cost of the bill. There will also be an effort to insert a provision creating a government-run insurer to compete with private companies -- the so-called public option.

What is the conflict over Medicare?

Republicans have seized upon statements by President Obama and others that there would be no cuts in Medicare services for seniors, despite the fact that Democrats have vowed to shave hundreds of billions of dollars out of the entitlement program.

In particular, Republicans say that the Democrats' plans to trim payments to providers who accept Medicare Advantage, a private insurance program, will result in reduced services. Democrats say that they are simply trying to reduce the gap between payments to the Advantage program and payments to providers in regular Medicare, and that services won't be affected. It's clear, however, that this is a sensitive subject, as Democratic senators from states such as Florida and Oregon, where Medicare Advantage is popular, are looking for ways to preserve the program as it is.

When will there be a final Senate bill?

The clock is ticking. Senate Democrats have until Oct. 15 to use reconciliation, a procedure that allows passage of budget-related matters by a simple majority. Last week, Majority Leader Harry Reid (D-Nev.) warned Republicans that he would use the tactic if they remained recalcitrant. But that would be politically risky. Even if a bill passes the Senate by mid-October, it would have to be reconciled with the House bill in a conference committee. That could take weeks.


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