Senate Passes Health Reform, Now What Next?

The Senate passed its version of health reform this morning. One Democrat voted "No" and then changed his vote. The Democrat was Senator Harry Reid. The "No" vote was a mistake.

David Waldman at Daily Kos has a good article on what might happen next. Waldman outlines five possibilities:

1. The House could agree to the Senate version. In that case, the deal is done.
2. The House could amend the Senate version and send it back to the Senate with a request for a conference to work out the differences
3. The House could amend the Senate version and send it back to the Senate with no comment. In that case the Senate must decide either to accept the House changes or request a conference.
4. The House could simply disagree with the Senate version and request a conference.
5. The House could do nothing, but instead begin informal negotiations to develop a package of amendments acceptable to a majority in the House and 60 Senators.

Numbers 2, 3, and 4 would likely mean that the Democrats in the Senate have to seek cloture on multiple procedural motions that Republicans are likely to offer. This could delay the process passing a final bill possibly until February and result in the Democrats not getting a bill to Obama prior to the State of the Union.

Number 1 & 5 are the quickest routes to getting a bill passed. Waldman says all signals appeared to be the House simply accepting the Senate bill. I don't think that will happen. However, informal negotiations (Number 5) are a real possibility and makes a lot of sense. The Wall Street Journal in a related article thinks Pelosi and Reid will use the informal negotiation route to get to a final bill.

http://online.wsj.com/article/SB10001424052748704254604574614183270356274.html

We will see.

See Waldman's complete article at http://www.dailykos.com/storyonly/2009/12/23/818491/-After-tomorrows-Senate-vote,-what-next

Also, CNN has a good article on the major differences between the House and Senate versions of health reform and possible outcomes of negotiations--public option, abortion and funding. Looks like the House has the weaker hand.

http://www.cnn.com/2009/POLITICS/12/24/health.care.bill.differences/index.html

No/Nothing Republicans Defeated. Obama wins.

The Senate has voted to end debate on health reform. The bill will be voted on and passed tomorrow morning at 7AM moving us to almost certain health reform.

This is a great victory for President Obama, the Democratic Party, and the country.

What to expect during the first six months of health reform

According to a report from the Senate Finance Committee, here are the benefits you can expect to see from passage of the Senate Health Reform bill starting in the first six months of 2010:

Consumer Protections

• Ending Insurance Company Discrimination - In 2010, the bill will set aside $5 billion to provide immediate, affordable insurance coverage options, through a high-risk pool, for Americans that have been denied coverage because they have a pre-existing condition and who have been uninsured for six months. This provision will provide immediate insurance options for those who would otherwise not have coverage until the new health insurance marketplaces, or exchanges, are up and running.
  
  
• Ending Harmful Insurance Company Practices - Beginning right away in 2010, the Senate health care reform bill will make it illegal for insurance companies to drop coverage for Americans who get sick. Within six months of enactment, the bill will also bar insurance companies from limiting the total benefits Americans can use over the course of their lifetime or unreasonably restricting the benefits Americans can use each year.
  
  
• Transparency and Accountability for Insurance Companies - Between 2010 and 2013, insurance companies will be required to report the proportion of premium dollars that are spent in areas other than medical care – including profits. If a company isn’t spending enough of its premium dollars providing benefits, it will be required to issue rebate checks to its customers to make up the difference.
  
  
• Increasing Services for Health Care Consumers - Within six months of enactment, the bill requires insurance companies to create effective appeals processes for customers who have been denied claims and provides grants for states to create ombudsmen to act as consumer advocates regarding health insurance coverage. And in 2010, before exchanges are up and running, the bill requires the Secretary of Health and Human Services to set up a website where Americans in any state can access the quality, affordable health insurance options available to them.

Investing in Wellness and Prevention

• Access to Preventive Services - Within six months of enactment, the bill will require all insurance plans in the individual market to provide first dollar coverage for preventive services. That means all Americans who purchase insurance on their own will receive preventive care from their doctor without paying a co-pay. Beginning in 2010, the bill will also create a public health investment fund to promote wellness and prevention nationwide. By 2011, seniors in Medicare will receive free annual check-ups and personal wellness plans. And the bill will require states to provide pregnant women with tobacco cessation services in Medicaid.
  
  
• Patient-Centered Outcomes Research Institute - Beginning in 2010, the Senate health care reform bill creates an independent research institute to provide for research on which treatments work best for different patients. This research will help patients and doctors get the best possible information when making decisions about their health, and it is critical in the effort to develop new innovations, like generic prescription drugs, that save money and contribute to better patient health.

Access to Quality Care

• Ensuring Seniors Have Access to Doctors - In 2010, the Senate health care reform bill will prevent a scheduled pay cut for doctors in the Medicare Program to ensure that doctors can continue to provide care for seniors in Medicare. By 2011, the bill also provides a 10 percent bonus to primary care doctors and general surgeons through the Medicare Program to ensure seniors have access to these crucial services.
  
  
• Family Coverage up to Age 26 - Within six months of enactment, the Senate health care reform bill will require insurance plans that cover dependents to provide benefits to children up to age 26.
  
  
• Help for Seniors’ Prescription Drug Costs - Beginning in 2010, the legislation provides a 50 percent discount on the costs of brand name prescription drugs and biologics for seniors who are in the gap in coverage in the Medicare Prescription Drug Program, often referred to as the “doughnut hole,” where no coverage exists today. This legislation also closes the coverage gap by $500 in 2010.
  
  
• Support for Rural Providers - Effective immediately in 2010, the Senate health care reform bill extends Medicare payment protections for small rural hospitals, to help those hospitals continue to provide vital services to their communities.
  
  
• Investing in the Health Care Workforce - Effective immediately in 2010, the Senate health care reform bill expands and improves financial aid for medical students to help ensure we have enough quality doctors and nurses to serve patients’ needs.

Tax Credits

• Investment in Innovative Treatments - The Senate health care reform bill will provide a tax credit to qualifying small businesses for 2009 and 2010 investments in new therapies to treat and prevent chronic health conditions.
  
  
• Small Business Tax Credits - In 2011 through 2013, small businesses that provide health insurance for their employees can receive a small business credit for up to 35 percent of their contribution. Once the health insurance exchanges are up and running in 2014, qualified small employers purchasing insurance through the exchanges can receive a tax credit for two years that covers up to 50 percent of the employer’s contribution.

Source: http://finance.senate.gov/press/Bpress/2009press/prb121509.pdf

Why should you support the Senate Health Reform Bill?

What exactly will the Senate Health Reform do? Why should you support it? David Plouffe of Organizing for America provides this useful summary. The bill will:

• Extend coverage to 31 million Americans, the largest expansion of coverage since the creation of Medicare.
• Ensure that you can choose your own doctor.
• Finally stop insurance companies from denying coverage due to a pre-existing condition.
• Make sure you will never be charged exorbitant premiums on the basis of your age, health, or gender.
• Guarantee you will never lose your coverage just because you get sick or injured.
• Protect you from outrageous out-of-pocket expenditures by establishing lifetime and annual limits.
• Allow young people to stay on their parents' coverage until they're 26 years old.
• Create health insurance exchanges, or "one-stop shops" for individuals purchasing insurance, where insurance companies are forced to compete for new customers.
• Lower premiums for families, according to the non-partisan Congressional Budget Office especially for struggling folks who will receive subsidies.
• Help small businesses provide health care coverage to their employees with tax credits and by allowing them to purchase coverage through the exchanges.
• Improve and strengthen Medicare by eliminating waste and fraud (without cutting basic benefits), beginning to close the Medicare Part D donut hole, and extending the life of the Medicare trust fund.
• Create jobs by reining in costs fostering competition, reducing waste and inefficiency, and starting to reward doctors and hospitals for quality, not quantity, of care.
• Cut the deficit by over $130 billion in the next 10 years.

And, the No/Nothing Republicans say, “No, Nothing.” Shame on them.

Republican's huge blunder on health reform

When the story of the struggle to pass health insurance legislation in 2009 is written, much of the credit for the bill being as strong as it will turn out to be will go to the Republicans. In fact, there might not be anything more than limited reform had the Republicans not committed what may go down in political history as one of the biggest blunders ever.

Imagine if the Republicans had seriously worked with the Obama administration and/or Blue Dog Democrats to shape a version of health reform that was much less comprehensive, perhaps costing no more than $400 billion or less with fewer restrictions on private insurers. They might well have pulled it off. After all, liberal Democrats were going to have a difficult time getting 60 votes in the Senate and the Obama administration was anxious to get a bi-partisan bill.

Instead of working toward limited reform, the GOP leadership decided to oppose any reform at all. By late summer, it was clear to everyone that the Democrats weren’t going to get any Republican votes for health reform. More importantly, the No/Nothing Republicans with their high profile, tea-party opposition had placed Democrats in a bind. Democrats realized that if they did not come together and get some kind of health reform done in 2009 then they could suffer a 1994-like defeat in 2010. The Republicans had forced a showdown directly along partisan lines. They were betting that the Democrats would never get to 60 votes in the Senate. It looks very much like they have lost that bet.

If the Democrats get health reform done, which it looks like they will, the political payoff for Democrats may be huge. Most Americans don't really know what is in the Senate bill - which will be closer to the version Obama will sign than the House bill. When the bill is signed into law and Americans start finding out about all the good things the legislation will do such as end denials for pre-existing conditions, protect them from being dropped, lifting restrictions on maximum coverage, allow them to change employers or start their own business without losing health insurance and on and on, they will develop a different opinion. I predict most people will like what this legislation does for them and their families and never, ever want to go back to the way we now do health insurance. They will credit Democrats for this historic achievement and blame Republicans.

If Democrats play the politics of this huge achievement right, this could be a Social Security/Medicare-type moment for their party and a stunning defeat for Republicans that will cost them elections for a generation. It could have been so different if the No/Nothings had they just said "maybe/yes." Mistake, big mistake.

All economic indicators are up says the Conference Board

All indicators of economic trends were up in November according to the Conference Board's report on most recent data. Compare that to October data below.

November data:

Consumer Confidence
Index®
0.8 pts

U.S. Leading Index
0.3%

Help-Wanted Online
106,500

Employment Trends Index
0.7%

CEO Confidence
8.0 pts

New evidence that the Obama administration has done a excellent job in saving and creating jobs

Although much remains to be done to improve the job picture, there are definite bright spots. November saw a decline in the percentage of unemployed for the first time in over a year from 10.2% down to 10% and revised numbers show fewer jobs were lost in September and October than expected.

Plus, in spite of numerious news reports last month criticizing the administration’s estimates of jobs created or saved by the Stimulus package it turns out the job creation/savings were considerably higher than the administration reported. Recovery.gov had estimated that 640,000 jobs had been created or saved. Obama put the number at more than 1 million. Now independent analysis by the Congressional Budge Office puts the figure at easily 600,000 and very likely as high as 1.6 million.

Could this signal that unemployment has bottomed out and that the expected post-recession hiring has begun? Maybe. Would that be bad news for the No/Nothing Party? You, betcha—(as their leader likes to say.)