Countdown on the Senate Reform Bill: Is the Finish Line Close?

Janice Simmons, for HealthLeaders Media , December 14, 2009

This weekend, the Senate sat in a waiting pattern for healthcare reform—waiting for the Congressional Budget Office to complete a scoring of what several alternate proposals to the public insurance option will cost. If the numbers are there with the plans—showing no increase in deficit spending—will Senate Majority Leader Harry Reid (D-NV) insist on pushing ahead quickly to meet a deadline of passing a reform bill before Christmas?

Maybe he will. President Obama, speaking on CBS' "60 Minutes" on Sunday night, expressed confidence that a bill will be coming through:

"I think it's going to pass out of the Senate before Christmas," Obama said.

However, Reid will need to answer the major question: Are the 60 votes there to ensure passage? While the opt-out public option seems to be a thing of the past, new proposals—such as permitting individuals ages 55 to 64 without insurance to purchase Medicare coverage—have created debate among the senators.

One senator who appears unmoved by the Medicare proposal is Sen. Joseph Lieberman (I-CT), who has traditionally voted with the Democrats and is considered one of the 60 votes needed for bill passage. He has repeatedly stated that he would not vote for a bill with a public option. And yesterday, speaking on CBS' "Face the Nation," he said several areas of the current bill need to be removed as well—including the Medicare buy-in.

"There's a good basic bill in here,” Lieberman said, adding, parts of it can be supported by 60 senators, including some Republicans. “But we've got to stop adding to the bill. We've got to start subtracting some controversial things," Lieberman said. "I think the only way to get this done before Christmas is to bring in some Republicans who are open minded on this—like [Senator] Olympia Snowe" (R-ME).

On Friday, a group of 10 senators from states whose providers have consistently received lower reimbursements from Medicare (including Minnesota, Oregon, Vermont, New Mexico, Washington State, Vermont, and Wisconsin), sent a letter to Reid—saying that "creating a Medicare buy in program will exacerbate the existing funding inequity."

They said that Medicare is spending over a third more for each Medicare beneficiary in some states compared to theirs and that "an antiquated payment formula" has "penalized rural providers and greater medical efficiency" in their states—forcing many physicians to stop accepting or limiting the number of Medicare patients they serve. They called for ways to "incentivize providers to see more Medicare patients."

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