The ACP Advocate Blog
by Bob Doherty
Tuesday, September 22, 2009
Let the sausage-making commence!
Senator Max Baucus today released a revised draft of his health reform bill, which will be marked up (amended) by his Senate Finance Committee beginning today. As many as 600 amendments have been drafted. The amendments generally fall into the following categories:
1. Amendments by Republicans who will not vote for the bill, no matter what, and that have little possibility of being accepted by the committee. Most of the GOP amendments would eliminate the cost controls in the bill (striking Baucus' proposals to create a Medicare advisory commission, or fund comparative effectiveness research, for instance), eliminate mandates on individuals and employers, strike proposed cuts in payments to providers, and eliminate any and all tax increases to fund coverage expansions.
2. Amendments by liberal Democrats to replace the bill's health plan co-operatives with a strong public plan option.
3. Amendments by Democrats to increase the subsidies so as to make coverage more affordable when an individual mandate takes effect. Olympia Snowe (R-ME), the one Republican who seems open to voting for the bill, also supports increasing the subsidies.
4. Amendments offered by Republicans and Democrats alike to promote specific policies they favor. For instance, a number of amendments were offered to increase support for primary care training programs.
My favorite amendment, apparently offered tongue-in-cheek by Senator Orrin Hatch (R-UT), would exempt any state beginning with the letter "U" from the excise tax on high cost insurance plans.
The overall direction of the revisions made today by Senator Baucus, and the amendments most likely to pass, will be to broaden federal assistance to those who need help buying coverage (which will drive up the cost of the bill) while at the same time reducing the tax increases and budget offsets (cuts) that he hopes to use to pay for the legislation. The risk is that this will end up increasing the price tag to the point that it will test his, and the Senate's, commitment to passing a bill that won't add to the deficit.
ACP, for its part, sent a letter to Senator Baucus with our views on what we like and don't like about his proposal.
The legislative process is not for the faint of heart. It is messy and contentious and sometimes produces an unpalatable product that no one will swallow. Other times, though, it produces something worthy of consumption - just like the sausage-makers to which Congress is often compared. We'll see soon which will be the case this time around.
Today's question: How many states begin with the letter U? Or, more seriously, what do you expect this process to produce?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
- A Tale of Two Presidents
- Baucus offers plan to extend coverage, cut deficit...
- New poll shows physician support for expanded gove...
- Internists and the pursuit of happiness
- Obama tells the public what "ObamaCare" really mea...
- Will Health Care Reform Restrain Rising Costs of H...
- Does prevention save money?
- Do internists really want everyone to have health ...
- Why are fiscal conservatives opposed to Medicare c...
- What should Obama do about the drop in public supp...
The Wall Street Journal's blog on health and the business of health.
Health Affairs Magazine Blog
The Policy Journal of the Health Sphere.
The Health Care Blog
Everything you always wanted to know about the Health Care system. But were afraid to ask.
Vignettes and commentaries on the medical profession.
The New Health Dialogue Blog
From the New America Foundation.
DB's Medical Rants
Contemplating medicine and the health care system
Notes From The Road
Bloggers post from medical meetings, press conferences, and policy gatherings from the U.S. and around the world, providing readers with a tasty analysis of the buzz, the people, and the stories that don't get told.
A blog dedicated to medical education, news, and policy as well as career advising.
Disease Management Care Blog
An ongoing resource for information, insights, peer-review literature and musings from the world of disease management, the medical home, the chronic care model, the patient centered medical home, informatics, pay for performance, primary care, chronic illness and health insurance.
Medical Professionalism Blog
The Medical Professionalism Blog was created by the ABIM Foundation to stimulate conversation and highlight best practices related to professionalism in medicine.