Senate Began Series of Health Care Votes This Morning

The mathematics of the Senate—getting to 60—has been a struggle from the beginning to the end of Senate deliberation on healthcare reform this year. Unlike the mid-1990s when the Senate took up the Clinton health care legislation under unanimous consent, this time the Senate could not proceed on the Senate Leadership bill (The Patient Protection and Affordable Care Act (H.R. 3590)—a substitute to the House-passed bill——without first gaining 60 votes to end a filibuster to proceed. The 60-vote hurdle has continued throughout the month-long struggle to proceed to a vote in the Senate on a historic, comprehensive health care legislation.

The Senate began its 19th day of debate on health care legislation Saturday in the midst of an historic snow blizzard that shut down the Washington, D.C. metro area for three days through today. The weather was surpassed only by the wild ride in the Senate to gain the 60 votes to advance health care legislation before the end of the year.

Majority Leader Reid (D-NV) delivered his 860-page manager’s amendment (substitute package of unknown changes to the underlying Senate health care bill) and CBO score Saturday morning. That sent the signal that Reid had gained his 60th vote. By mid-morning, Senate leadership announced that Senator Ben Nelson (D-NE) would vote to move on health care legislation. The announcement set up a timetable for three cloture votes to end Senate filibusters before a final vote on Christmas Eve.

The Saturday morning revelations followed a week of ups and downs that included last Sunday’s announcement by Senator Lieberman (I-CT) that he objected to some provisions in Senate Majority Leader Reid’s manager’s amendment. The week continued with pronouncements by other Democrats to start over on health care; possible rebellion by both liberals and conservatives in both chambers; a meeting with President Obama and Senate Democrats; Republicans requiring a single-payer amendment to be read aloud by Senate clerks because of objections to the Senate process, arbitrary deadlines, and rush to vote; behind-closed-door negotiations with Reid and deals that gained the support of Senators Lieberman (I-CT) on Thursday and 13 hours on Friday with Ben Nelson (D-NE); and corrected CBO score on Saturday . With President Obama invoking Tuesday the oft-used phrase—don’t let the perfect be the enemy of the good—Majority Leader Reid made the deals to gain the 60 votes needed to cut off debate.

The three cloture votes, which allow for 30 hours of debate each, began 1:01 a.m. this morning. The first vote ended debate on the manager’s amendment; the second vote will be on the underlying substitute bill (underlying Senate bill and manager’s amendment) to the House bill; and the third vote will end Senate debate on its version health care legislation—clearing the way for a final vote on the Senate bill itself on Christmas Eve. This last vote only requires a simple majority vote—not 60 votes—to actually pass the bill.

Highlights of What Is Initially Known

ANCOR is still combing through the manager’s amendment and no analysis is available on effects on the underlying bill. The rubric’s cube puzzle created by the evolving nature of the Senate bill and the effects of the manager’s amendment on the underlying bill will take days to unravel.

What is known is that the bill is paid for through a combination of tax credits, new taxes and penalties, and changes in public policy. It expands coverage to 32 million people—or 94% of those under the age of 65. The Senate Democrats say the bill makes health insurance more affordable and available, reduces the future growth in health care spending, and builds upon employer-sponsored, private and public health coverage. Different provisions in the bill take effect in different years, with most not taking effect until 2014.

ANCOR believes the Senate approach is preferable to the House version which includes an employer mandate for employee and family coverage. Highlights of the Senate bill of greatest interest to ANCOR members include the following:

• Although Lieberman and Nelson both objected to the new voluntary, opt-out public long-term services insurance program, The CLASS Act provisions are included in the manager’s amendment. Employers are not required to make any contributions. CBO estimates $2 billion in federal Medicaid savings (does not include state Medicaid savings) in the first five years due to CLASS provisions.
• Senator Maria Cantwell’s (D-WA) Medicaid Balanced Incentives amendment that provides a tiered enhanced federal medical assistance percentage (FMAP) to states that increase Medicaid home-and community-based services is included in the manager’s amendment.
• Funding for the State Children’s Health Insurance Program is continued for another two years (September 30, 2013 through September 30 2015) and the amendment also creates a new option for states to provide SCHIP coverage to children of state employees eligible for health benefits.
• Individual mandate (not employer mandate as in House bill) requiring most Americans to have qualifying health insurance with penalties beginning in 2014. Those without coverage must pay a tax penalty of $750 per year up to a maximum of three times that amount ($2,240) per family. (Effective 2016)
• Imposes an excise tax on insurers of employer-sponsored health plans that exceed $8,500 for individual coverage and $28,000 for family coverage. (Effective 2013)
• Creates state-based Health Benefit Exchanges through which individuals can purchase coverage, with federal premium and cost-sharing credits available to individuals/families with income 100-400% of the federal poverty level.
• Expands Medicaid coverage for non-traditional Medicaid recipients under age 65 (non-disabled individuals, parents, adults without children) to 133% of federal poverty level. States will receive 100% FMAP from 2014 to 2016 for newly eligibles; thereafter, financing will be shared by both state and federal with increased federal share.
• Requires employers with more than 200 employees to automatically enroll employees into health insurance plans offered by the employers. Employees may opt out of coverage.
• Assess employers with more than 50 employees that do not offer coverage will pay the lesser of $750 for each full-time employee or $3,000 for each employee receiving a premium tax credit. For employers who require a waiting period for employees, require payment of $400 for any full-time in a 30-60 day waiting period and $600 for any employee in a 60-90 day waiting period. (Effective 2014)
• Require employers to pay penalties for employees who receive tax credits for health benefit exchanges.

The next step will be a House-Senate conference to reconcile (iron out the differences) between the two widely different versions of health care legislation. A single bill will emerge in early January which will require another vote by both the House and Senate. ANCOR will provide additional information in early January.

NOTE: ANCOR’s office will be closed from the afternoon of December 24th through January 1st.