published Tuesday, March 23rd, 2010

Health care fight switches to Senate

The fight over health-care reform shifts to the Senate this week, as lawmakers in the upper chamber prepare to vote on a package of changes to the historic bill that cleared the House of Representatives late Sunday.

The Senate bill that passed the House on Sunday night will become the law of the land when President Barack Obama signs it today.

But Democratic leaders in the Senate want a vote by the end of the week on a "reconciliation" bill that amends the Senate bill that House lawmakers have now approved. Under reconciliation, floor debate is limited to 20 hours. Reconciliation bills are reserved for budget-related matters, and provisions may be determined out of order.

But Republicans vow to load the bill up with amendments in an attempt to send it back to the House and kill it.

U.S. Sen. Johnny Isakson, R-Ga., who is running for re-election this year, blasted the Democrats for using the budget reconciliation process to revamp the health care plan, calling the step "an unfortunate way to do business."

"The reconciliation process was never intended for comprehensive policy changes, and I will work with my Republican colleagues in the Senate to fight this effort every step of the way," he said.

Other senators from Tennessee and Georgia vowed to join the Republican fight against approving the reconciliation bill this week.

Sen. Lamar Alexander, R-Tenn., and the Republican Caucus chairman, said the health care reform bill "taxes job creators in the middle of a recession," which could hurt the recovery.

"The mistake is to expand a health care delivery system that is already too expensive instead of reducing its cost so more Americans can afford health insurance," Sen. Alexander said.

Sen. Saxby Chambliss, R-Ga., said most Americans don't want the Democrats' version of health reform.

"This bill is a political victory that will only make health care more expensive," he said.

But Republicans are hoping to weaken the overall legislation by stripping out parts of the reconciliation bill.

The changes in the reconciliation include an extension of subsidies to buy insurance and adjustments to a tax on high-value health plans. Put together, the bills are estimated to cost $940 billion over 10 years and aim to extend insurance coverage to 32 million more Americans.

Democrats are using the reconciliation process in the Senate to make changes to the main bill since it takes just 51 votes for approval. President Obama's party needs the tactic since it lost its 60-seat supermajority after the election of Sen. Scott Brown, R-Mass. With just 59 votes, Democrats can't block Republican stalling tactics on bills.

The reconciliation bill also includes "fixes" aimed at special deals for states like Nebraska -- the so-called "Cornhusker Kickback" that Republicans want to keep to embarrass Democrats. That deal, under which the federal government would pick up 100 percent of the tab for expanding Medicaid in Nebraska, is now part of the Senate bill, but the reconciliation bill would take it out.

Capital countdown

* President Barack Obama is expected today to sign the health care reform plan, as originally adopted by the U.S. Senate in December.

* If the Senate parliamentarian agrees, the Senate will take up the reconciliation bill that the House approved Sunday to revise the original Senate bill.

* If Republicans are able to amend the reconciliation bill, the House will have to again approve any changes.

* If the Senate approves the reconciliation bill, President Obama will sign that version of health care reform.

* President Obama will travel to Iowa City, Iowa, on Thursday to promote the advantages of the health care reform plan

Timetable for reform

* Within six months of passage, Medicare prescription drug benefits will be expanded, family health plans will extend coverage to children up to age 26 and tax credits will begin for small businesses to buy insurance.

* In 2011, $2.3 billion annual fee on drugmakers begins, increasing over time, and Medicare begins promoting "accountable care organizations" along the lines of Mayo clinic.

* By 2014, insurers can't deny coverage to adults with pre-existing conditions, Medicaid is expanded to anyone earning up to 133 percent of poverty and income-based tax credits for consumers to buy insurance.

* In 2018, health insurance policies are taxed at 40 percent of the value of any plan worth more than $10,200 for an individual or $27,500 for a family.

* In 2020, the doughnut hole coverage gap in Medicare prescription benefit is phased out.

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