Then There Were Two - Senate HELP Votes Bill Out of Committee

The Senate Health, Education, Labor and Pensions Committee voted along party lines to advance its bill for comprehensive health care reform to the floor of the Senate.  This makes it the first of three – although the House will be working on its bill through 3 committees, they’ll be working on the same bill.  There were lots of sage congratulatory words and even a pensive release from Sen. Ted Kennedy, who has not been able to attend any of the hearings or mark-ups in person because of his illness.  But because so much of the week has been focused on what the President had to say or about the House bill, the Senate HELP proceedings have largely flown under the radar.  So the obvious question is – how did they do?

Well, if you haven’t seen any of the mark-ups, let me show you the single best three minutes.

No, this isn’t a parody scene on The Office.  Sen. Chris Dodd and the Democrats offered to accept without revision 65 amendments authored by Republican committee members.  The Republican members didn’t want them accepted – they wanted votes.  Why?  Pretty much just to run out the clock.

And the kick in the pants is after scores of non-preposterous Republican amendments were accepted (check out some of the amusing ones here and here) were accepted, all the Republicans on the committee voted against the bill so they could loudly complain the process wasn’t “bipartisan.”  Classy.

So how much did the bill improve or decline under this marathon month of mark-up?  The short version is it’s largely the same bill, with changes so minute that I’m having trouble telling the difference.  That’s a great thing, by the way – Dodd could easily have given away the farm for a bipartisan vote that would never have been forthcoming.  The most intriguing amendment was a requirement that federal elected officials would be required to enroll in the public plan (called the “Community Health Insurance Option” in the bill) once it’s created.  Republicans thought they were being clever when they offered it, but Dodd and others called their bluff.  (For the record, I think this is a phenomenal idea -- I’d throw the whole Federal Employee Benefits Program pool in there while you’re at it!)

How different is the Senate HELP bill from what’s being worked on in the other committees?  Well, we can’t compare it yet to the Finance bill, which doesn’t yet exist.  The general structure of the House and HELP bills may not be identical twins, but clearly they’re fraternal.  A lot of people say the HELP bill is watered down – certainly, the initial principles outline released by Kennedy was bolder than the detailed bill we actually have.  The employer pay (contribute to a fund) or play (give your employees benefits) is weaker than what’s in the House:  Wall Street Journal did some estimations and found that a 50-person company with a $2.5 million payroll would pay $200,000 as part of the employer mandate in the House bill, but only $37,500 in the HELP bill.  The cost of premiums in the Gateway/Exchange for families at 400% of poverty is a little higher than the House.  The cap on how much you spend out-of-pocket is higher, too. The eligibility for people to get their insurance through the Gateway/Exchange would be more closed (the Congressional Budget Office thinks we’d be talking 20 million+ in the Gateways instead of the 30 million + for the House, with those extra millions staying in employer-provided insurance).  The “community health insurance option” would need to negotiate rates with providers from the get-go, meaning it’d take longer to set-up and would have less of an immediate effect on costs – although hey, the Senate HELP bill doesn’t suggest that it will push off creating a public plan until 2013, so it may be faster after all.

All true.  But considering that the Senate is traditionally the place where a good reform goes to get crushed or die, it’s remarkable all the same that we’re really talking about degrees rather than a fundamentally different or even a gutted plan.  The HELP bill’s new regulations on insurance is just as strong, its commitment to developing the provider workforce we need is just as strong, the ideas for improving quality for insured and uninsured alike are just as strong, and its focus on primary and prevention to transform us from a mediocre quality “disease care system” instead of a high-performing health care system is just as extensive.

The Senate HELP bill, for reasons of jurisdiction, can’t outline how it would pay for reform or modify anything relating to Medicare and Medicaid.  But presuming Senate Finance sticks to the script, the CBO estimates it will cover 97% of Americans.  You may or may not agree with the approach Congress and the President have taken, but it can’t be denied that this is a pretty significant milestone on the road to reform.

Jungle gyms and all.