The decision by Senator Olympia Snow (R-ME) to vote "yes" today on the Senate Finance Committee (SFC) package does not mean that there suddenly will be a blizzard of Republican support for the pending health care reform legislation. She was the only Republican to vote for the bill, which was approved by the committee this afternoon on a 14 - 9 vote, with all of the Democrats voting in favor. It may be that she will end up being the only Republican, House or Senate, who votes in favor when the final tally on health care reform legislation is taken later this year. Still, in Washington it just takes a single vote from a member of each party to get the highly "coveted" bipartisan label.
By reporting out its bill, the Finance Committee has joined the Senate Health, Education, Labor and Pensions Committee (HELP) and three House committees in moving President Obama's signature domestic priority a step closer toward a debate on the House and Senate floors, and possibly, enactment. At no other time in U.S. history, going as far back as to 1912 when President Teddy Roosevelt first called for universal coverage, have health care reforms designed to cover (almost) all Americans made it to the House and Senate chambers for a vote.
This doesn't mean, though, that the road ahead is an easy one. The House and Senate leadership and the White House will have to reach agreement on such contentious issues as a public plan option, employer and individual mandates, taxes and fees, offsets/cuts to different stakeholders, the level of subsidies and benefits, and a myriad of other issues, all of which are far from being resolved. The Senate HELP bill and H.R. 3200 would provide higher levels of spending on a host of programs than the SFC bill, which will pose a challenge to Congress in coming up with a common approach that doesn't break the budget.
One of the budget issues that still has to be resolved is how to fund a solution to Medicare physician payment cuts. The House includes a long-term physician payment fix - at a budget cost $250 billion. To keep the price tag down, the SFC bill offers only a one year reprieve from the SGR cuts, with a much lower budget price tag. (The different approach to the SGR is the single biggest reason why the CBO found that the Senate bill pays for itself while H.R. 3200 does not.) The House reportedly is considering taking the SGR fix out of the health reform bill to keep the price tag down and, get a favorable CBO "score," so that it meets Obama's requirement that the bill not add "one dime" to the federal deficit. Even if taken out of H.R. 3200 itself, the House leadership and the White House continue to be committed to getting a long-term solution to the SGR physician pay cuts enacted this year, even if the cost ends up showing up somewhere else in the federal budget and not in the health reform bills. How to do this - in a way that will get the fiscal conservatives in both the House and Senate on board - remains unresolved. But the physician community - including ACP - will insist that Congress find a way to put an end to the cycle of SGR cuts, once and for all.
Finally, I expect we will see more and more interest groups sharpening their knives to kill parts of health care reform that they don't like, which could still result in health care suffering a death of a thousand cuts.
The SFC is far from perfect - ACP has its own list of major concerns about it - but the vote today was historic, in that it moves the United States closer than ever toward the goal of providing all Americans with access to affordable coverage. I hope we all keep our eye on the prize even as we try to change the things we don't like.
Today's question: What do you think of today's Senate Finance Committee vote?