Staffers for the House and the Senate are already starting to talk about the negotiations needed to reconcile the two different versions of health reform.
Since the Senate is seen as a more delicate compromise, some people think the final product would look much closer to the Senate version. While it is important to be realistic, I think there will be some significant improvements from the Senate. There are some compromises that have been made which were very contentious, and probably won’t get reopened. But as the opponents tell us, it is a 2,000+ page bill, so there lots of opportunity for improvements in other areas. The House, which by passing their version earlier already exerted some influence on the Senate bill, has a political imperative to put its stamp on the final bill. Also, the House version didn’t pass with lots of extra votes, and their members are all up for re-election next year, so they have as much reason to ask for adjustments.
We earlier linked to the New York Times editorial page abuot the differences. Paul Waldman at The American Prospect has a good top ten list. Igor Volsky does one better with a chart of 11 changes at the Wonkroom of the Center for American Progress. Here’s a shorter (but not complete) list of issues that we are working on:
* Affordability, Affordability, Affordability: Required insurance could still be too expensive for many. Both bills require many Americans to have insurance. In the Senate bill, the caps on how much we’re expected to pay are too high, and the subsidies for working families are too low. Many are working to fix this, but it’s going to be a significant fight.
* Employer responsibility: The Senate bill’s requirement on employers has major loopholes for large employers who don’t provide coverage to their workers. Also, this complex and confusing “free rider” provision has potentially negative workforce impacts, encouraging part-time rather than full-time work. The Senate also needs to apply basic benefit standards to all employers, including large ones. The House bill has simple standard for large employers, who would either provide coverage to their workers, or pay a flat percentage (sliding scale up to 8%).
* Progressive Financing: Though the House bill is financed through progressive options like a surcharge on wealth individuals and families, the Senate bill includes an excise tax on high-cost health plans. We advocate a variety of progressive revenue options to offset a repeal or narrowing of the excise tax.
* Immigrant inclusivity: While both bills prohibit the use of federal funds to fund coverage of undocumented workers, the Senate bill excludes undocumented workers from using their own wages and money from being able to buy coverage in the national insurance exchange. Another issue is that the bills continue a 5 year waiting period for recent legal residents who would otherwise be eligible for Medicaid. We are urging Senators to support an amendment being offered by NJ’s Senator Menendez to lift this restriction.
* Abortion: While both bills adopt the current law that federal funds not be used for abortion coverage, the House bill goes beyond that in restricting reproductive rights. The Stupak provision House bill virtually prohibits anyone purchasing insurance in the Exchange from buying a plan that covers abortion—even if paid for with their own money. The Senate leaves the issues to the states. We need to work against a rollback of reproductive rights.
* State consumer protections: The new Senate bill did remove the permission of “nationwide plans” that seriously threatened state-based consumer protections. However, both bills do allow “interstate compacts,” where states can allow insurance plans from another state without having to abide by their consumer protection laws. We are advocating for this provision to be removed.
* Public health insurance option: While the House passed health care with a public option, the Senate does not include one. We need to continue to advocate for a public health insurance option. The public option would provide competition for private insurance—and we need to continue to support its inclusion, even after a bill is signed into law.