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?

3 comments :

Rich Neubauer MD said...

Thanks for this semi-humorous diversion. Indeed, if nothing else at the end of the reform debate, we'll have all received a civics lesson. I made sausage once and it was a messy deal but worth it and good eating for quite some time. Hopefully, your analogy will carry forward.

Jim and Carol said...

The ACP should DEMAND TORT REFORM as a sine qua non of support for any bill NOT just demonstration projects and $25Million for "research" but the caps on non economic dammages and other reforms proposed. If there is to be a bill, it will be imperfect, expensive, and likely to drive more business to the insurance companies giving them leverage to reduce MD payments to medicare levels - the net effect may be coverage for more patietns but less payment per service to providers. Only by limiting expense structure can we even hope to maintain access. Liability costs MUST be cut to make this remotely possible.

jfddoc said...

My favorite "sausage" moment so far:

It would take two weeks for the Finance Committee staff to post their amendments online, but they want to mandate electronic medical records for everyone.