Senate Votes to Open Debate on Healthcare Legislation

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22 November 2009 :: staff

For the first time in decades, the United States Senate has voted to open floor debate on comprehensive healthcare insurance reform legislation. All 58 Democratic members of the Senate, plus the two independents that caucus with them, voted to approve debate. 39 of the 40 Republicans voted against opening debate, except Sen. George Voinovich (R-OH), who did not vote. Though not expected to vote with Democrats today, Maine Republicans Olympia Snowe and Susan Collins were thought to be more conciliatory with regard to passing legislation containing a compromise on the public option, so their no-votes are seen as a further challenge to the Democratic majority.

Many senators were adamant that their vote to approve debate is not a guarantee they will vote to end debate or to approve the legislation. Joe Lieberman continues to threaten a filibuster if he doesn’t like the language regarding a public option, and conservative Democrats Mary Landrieu, of Louisiana, Blanche Lincoln, of Arkansas, and Ben Nelson, of Nebraska, have all said they are not promising to vote for passage. Sen. Bernie Sanders (I-VT), a committed liberal who is demanding a strong public option, has also said he is not predetermining a yes-vote, if the result of debate is a bill he cannot approve.

Senate majority leader Harry Reid (D-NV) has his work cut out for him. He will need to find a way to shepherd the bill through what is likely to be intense and vitriolic floor debate, with threats running rampant and distortions a constant irritant, and produce something that is not just workable but able to win committed support from strict conservatives and staunch liberals in his party, in order to get the 60 votes he needs to break a filibuster and call an up-or-down vote.

There is already an escalating campaign of political pressure by Democratic organizing groups to urge every member of the Democratic caucus to back a floor vote. Where Sen. Lieberman may want to oppose with all his might the public option, he is already being urged by ads, email and calling campaigns, to support the Democratic majority’s right to hold an up-or-down vote on the bill, especially if a majority are committed to the language of the legislation. Sen. Lieberman would be the first senator in history to vote to filibuster his own majority.

Sen. Lieberman has also been accused of lying to support his claim that the legislation under consideration would undermine economic recovery and balloon the federal deficit. He has made claims about analyses by the Congressional Budget Office that are simply different from what the CBO found. While CBO found the bill would reduce the deficit by over $100 billion over ten years, Lieberman says it would increase it; while CBO found it would insure more people and reduce the average premium cost, Lieberman says it will drive costs up.

During the first week after he made his pledge to filibuster the public option, MoveOn.org secured $3.5 million in pledges from its members to stage an electoral challenge against Sen. Lieberman. Other groups are already pressing Democratic leadership to strip the Connecticut senator of his chairmanship of the Homeland Security committee.

Debate is now scheduled to open on Monday, 30 November, the week after Thanksgiving. The Senate is moving at its reputed glacial pace, with healthcare proponents accusing even Democratic leaders of foot-dragging and lack of commitment to passage. Pundits and pressure groups will now turn to the guessing game of what words do wavering Democrats need to hear in order to stir up the strength to vote 60-0 to block a Republican filibuster.

There may also be a continuation of efforts to court Sen. Olympia Snowe, of Maine, whom many Democrats see as an inspirational figure, a principled public servant, and a secret weapon they could use to out-flank both the Republican majority and Sen. Joe Lieberman. Ohio is a battleground state even in the US Senate, and specifically on health insurance reform. The freshman senator Sherrod Brown, a Democrat, is a staunch proponent of a strong public option, while the state’s senior senator, George Voinovich, vehemently opposes the bill and, strangely, for reasons unknown at this writing, was not present to vote.

According to the Examiner:

For Voinovich, who did not vote and who was not in the chamber, the proposed bill “cuts Medicare, raises taxes, increases premiums, hurts states and threatens the health choices that millions currently enjoy,” according to a statement posted on his office Web site that added, “This is not reform, and it is not what the American people are asking for. That is why I cannot support Sen. Reid’s health care bill and will not support the vote on the motion to proceed to the bill.”

But for Brown, who has expressed confidence over the weeks that the bill would indeed include a public option for a government run health exchange that will provide competition to private health insurers, the bill was historic for many reasons. “Passing health insurance reform means that Americans won’t lose health coverage if they change or lose their jobs,” he said in a statement on his office Web site. “It means an end to insurance industry practices that limit medical care or charge higher rates to women or individuals with pre-existing medical conditions. We’re one step closer to lowering costs for small businesses and middle class families,”

Ohio has a higher than average unemployment rate and made headlines last year for having more than 20% of its residents on food stamps, a sign of deep economic hardship from a state economically dependent on industrial production. Brown argues that a strong public option is the only way to bring down private insurers’ soaring fees, while Voinovich —who voted for over $2 trillion of tax giveaways and over $1 trillion in war spending, under George W. Bush— is focused on reducing the deficit and demanding that no new government policy entail any new spending.

Among the key provisions contained in the comprehensive proposed reforms:

• Low-cost exchanges: The legislation would set up a low-cost insurance “exchange”, where individuals and small businesses could choose among a range of options, including a public option states could “opt out” of. States could form larger regional exchanges to expand pool, increase competition, lower costs.
• Minimum benefits: The exchanges would mandate minimum benefits insurers must provide to consumers in four categories of insurance policy.
• Ban on dropping coverage: Immediately, in 2010, insurers would be barred from dropping coverage for existing customers.
• Ban on pre-existing condition discrimination: Starting in 2014, insurers would be barred from denying coverage based on “pre-existing conditions” (the lag-time is presumed to be necessary for the affected firms to reformulate their business model.

• Mandatory coverage: By 2013, most US citizens would be required to secure health insurance in one form or another.
• Assistance for buying coverage: Scaled subsidies would be available to anyone making up to 400% of the official poverty level.
• Reduced out-of-pocket costs: The bill will place limits on how much insurers can charge in deductibles and other out-of-pocket expenses; limits will vary based on income-level.
• Penalties for non-coverage: Fines for failure to purchase insurance to be phased in, starting at $95 per adult in 2014, moving to $350 in 2015 and $750 per adult in 2017. Failure to insure children will incur higher fines.
• Exemptions from mandate: Financial hardship and religious views could permit an exemption from the insurance mandate.
• Young adults: The age for remaining on parents’ health plans would be increased to 26 to help young people secure coverage at low cost.
• Medicaid expansion: Medicaid would be expanded to cover anyone earning up to 133% of the official poverty level.
• No employer mandate: Employers are not mandated to provide insurance, but any business with 50 or more employees could pay fines up to $750 per employee, if any of their workers buy federal insurance options.
• Small business: Tax credits will help small businesses provide coverage to more employees.

• Tax on “Cadillac plans”: Bill will tax expensive insurance policies, with premiums of $8,300 or more per year for individuals and $23,000 or more for families; threshold $3,000 higher for high-risk jobs or high-premium states.
• High-income: Individuals earning $200,000 or more and couples with a combined income of $250,000 or more, would pay 1.95% Medicare payroll tax, up from 1.45%.
• Industry fees: Health insurers will pay collective $6.7 billion annual fee, pharmaceutical companies $2.3 billion, medical device makers $2 billion, with fees allotted in each industry according to market share.
• Bo-tax: Elective cosmetic surgery will see a 5% excise tax applied.

Once floor debate begins, the form of the legislation may change dramatically, as senators will be able to offer and vote on amendments to the legislation. One major sticking point is abortion policy. Conservatives want a strict ban on any government assistance funding any plan that covers abortion; Democrats might be willing to stick to language of the Hyde amendment, which bars federal funds from specifically paying for abortion.