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Reid Releases Health-Care-Reform Bill     Permalink

After nearly a year of deliberations, majority leader Harry Reid released the full text of the Senate's health-care bill, which consists of the Finance Committee Bill merged with the HELP Committee bill and some new twists. Here are some key features of the 2074-page (doubled-spaced) bill:

  • Insurance exchanges will be set up in 2014 to help the uninsured get coverage.
  • A public option will be available on these exchanges.
  • Anyone below 133% of the federal poverty line will be eligible for Medicaid.
  • Anyone between 133% and 300% of the poverty line will get subsidies to buy insurance.
  • Insurance companies will be required to accept all new customers, even with preexisting conditions.
  • Annual and lifetime limits on coverage will be prohibited.
  • Insurance companies will be forbidden from canceling policies when a person got sick.
  • Insurance companies will not be allowed to charge sick people more than healthy people.
  • Employers with more than 50 employees will be fined for not providing health insurance.
  • Small businesses will receive tax credits to help them buy insurance for their employees.
  • Uninsured individuals will be fined $750 per year.
  • The size of the Medicare donut hole will be reduced by $500.
  • Children will be allowed to stay on their parents' policies until age 26.
  • Policies will have to explain their benefits in a standardized form in simple English.
  • An appeals process will be created so patients can fight back when coverage is denied.
  • There are many provisions encouraging preventive medicine.

The bill will result in 31 million additional Americans getting insurance and will cost the government $848 billion over 10 years but this amount is more than covered by new taxes, resulting in a net reduction of the federal debt by $130 billion over this period. In the second decade, the savings will reach $650 billion. President Obama insisted that the bill come in below $900 billion simply for political reasons--then the Republicans would have to talk about an $848-billion-dollar boondoggle instead of a trillion-dollar boondoggle, which sounds much worse. There are new taxes on gold-plated health-care plans, medical devices, and elective surgery. Medicare payroll taxes for high earners will be increased and growth of Medicare expenditures will be curtailed. The new taxes proposed are one of the major areas where the Senate and House bills differ so there will be much haggling in the conference.

Health-insurance exchanges would be set up on which private companies as well as a public plan would be offered to people not covered by their employer's plan. Any state that wanted to prevent its residents from choosing the public plan could ban it by legislation, but it is hard to envision many state legislators running in 2010 or 2012 saying: "If elected, I will vote to make sure you can't choose the public plan." Since both the House and Senate bills now have public options, it is highly unlikely it will be stripped out in conference. While many members of Congress have been pontificating about how even a tiny public plan will destroy in the insurance industry, no knowledgeable person believes this. Even with Medicare, insurance companies prosper by selling supplemental plans to seniors. What the public plan might actually do though, is reduce insurance company profits a little bit, but for a senator to say: "I am against reducing insurance company profits" wouldn't sound so good. Even in "socialist" France there is a thriving private-sector health insurance industry selling supplemental plans.

A sticky issue is abortion coverage. The House bill went very far in prohibiting insurance companies from offered abortion coverage. The Senate bill does not go as far. It merely sets up a firewall to make sure federal money is not spent on abortions. Adding irrelevant bits and pieces of legislation to a bill has been a congressional staple for decades. It is surprising that no opponent of the war in Afghanistan has proposed an amendment to the funding bill requiring the Army to provide an abortion to any female soldier requesting one. It would kill the bill.

Democrats of all stripes praised the bill as being the greatest thing since sliced bread. Republicans of all stripes said it would be the end of the world as we know it. If you expected a rational discussion of the bill's many provisions, welcome to Planet Congress.

Reid will file a cloture motion today, which means the vote will be on Saturday (Senate rules require an intervening day). Then we will find out whether Reid has managed to corral all 60 members of his caucus. Probably even the holdouts will find some cover in the bill. For example, Ben Nelson could say: "While I oppose this government takeover of our wonderful country, the bill reduces the federal deficit by 2.6% a year so I am voting for it" or something equally stupid. Also, Nelson, Sen. Mary Landrieu (D-LA) and Sen. Blanche Lincoln (D-AR) could find some reason to vote for cloture but vote against the bill itself (when their votes are not needed). Some Democrats are willing to ditch their deeply held fundamental principles for a small bowl of pork. Sen. Evan Bayh (D-IN) has miraculously dropped his opposition to this government takeover of the country when the tax on medical devices (many of which are produced in Indiana) was halved.

Next Big Elections are Primaries     Permalink

While the midterm general elections are a year away, there is plenty of election activity on tap before them. In particular, a number of key primary elections will be held before next November. Here is a quick rundown of some of the most contentious ones.

Date State Race Party Candidates
Dec 8 Massachusetts Senate Dem Martha Coakley, Michael Capuano
March 2 Texas Governor GOP Rick Perry, Kay Bailey Hutchison
May 4 Ohio Senate Dem Lee Fisher, Jennifer Brunner
May 18 Pennsylvania Senate Dem Arlen Specter, Joe Sestak
May 18 Kentucky Senate Dem Jack Conway, Dan Mongiardo
May 18 Kentucky Senate GOP Trey Grayson, Rand Paul
May 18 Utah Senate GOP Bob Bennett vs. ???
June 8 Nevada Senate GOP Danny Tarkanian, Sue Lowden
June 8 California Senate GOP Carly Fiorina, Chuck DeVore
June 8 California Governor GOP Meg Whitman, Steve Poizner
Aug. 10 Connecticut Senate GOP Rob Simmons, Linda McMahon, Tom Foley
Aug. 10 Colorado Senate Dem Michael Bennet, Andrew Romanoff
Aug. 24 Florida Senate GOP Charlie Crist, Marco Rubio

Here are notes on some of the primaries. The Texas gubernatorial primary between Gov. Rick Perry (R-TX) and Sen. Kay Bailey Hutchison (R-TX) is all-out ideological warfare. Perry is an extreme conservative who even suggested Texas could secede from the union. Hutchison is more moderate than Perry, although also conservative. This is one of the marquee races of 2010.

The Pennsylvania Senate primary pits former Democrat, then former Republican, now Democrat again, Sen. Arlen Specter (D-PA) against Vice Admiral Rep. Joe Sestak (D-PA), the highest ranking military officer ever to serve in Congress. The Democratic establishment is backing Specter and the blogosphere is backing Sestak. This race is a bit of a reprise of the 2006 Connecticut senatorial primary between Ned Lamont and Joe Lieberman except that nobody doubted that Lieberman was a Democrat until after he lost the primary and became an independent. Here, a lot of people doubt whether Specter is really a Democrat. To parry this line of attack, since Sestak announced his candidacy, Specter has been toeing the Democratic Party line very closely.

Kentucky has competitive primaries in both parties. The Democratic primary is not ideological. There are simply two guys who want to be a senator. The Republican primary has some potential to be an ideological fight, but different from Florida. If Rand Paul, Ron Paul's son, can get his father's (libertarian) supporters to back him, he could give the establishment candidate, Secretary of State Trey Grayson, a real battle.

Utah is a bit of an oddity. The candidate will be chosen by a convention rather than a primary, and the convention is expected to be dominated by conservatives who don't like Sen. Bob Bennett. Still, dumping an incumbent senator for a unknown quantity is a rare thing.

California has two contentious Republican primaries. For senator, former Hewlett Packard CEO Carly Fiorina will face off against Chuck DeVore, a darling of the far right. Fiorina is the establishment candidate, but she has a lot of baggage, starting with her disastrous tenure at HP where she fired 28,000 people and ended up being fired herself by the board of directors for incompetence. She also had a battle with breast cancer and although she claims she is cured, some people may wonder if she is up to the rigors of representing 30 million people in the Senate. Throw in the strong backing of national conservatives for state assemblyman DeVore and this could be a real humdinger.

The gubernatorial race between former eBay CEO Meg Whitman and insurance commissioner Steve Poizner is less ideological but no less exciting, pitting one billionaire against another. Whitman, who has never held public office and who hardly even registered to vote in the past will be accused of trying to buy the governor's mansion. But Poizner is no pauper. He founded a company that developed the technology to put GPS in cell phones and sold it for a billion dollars but then he was elected to the office of state insurance commissioner. Billionaire vs. billionaire races aren't that common, so this one will generate a lot of interest, especially when the prize is so big. But California is a blue state and the likely Democratic nominee is Jerry Brown, a former governor (and son of a former governor) who wants his old job back, so whoever wins the Republican primary is automatically the underdog, even as a billionaire.

The mother of all ideological battles will be the Florida senatorial primary, pitting the current governor, Charlie Crist, against a far-right Cuban-American, Marco Rubio. The Republican establishment is backing Crist, a moderate, but conservatives across the country will be pouring money into Rubio's campaign. The recent near-victory of Doug Hoffman in NY-23 will spur them on. It will be very messy. Also, the late date of the primary will give the winner little time to mend fences in the general election against Rep. Kendrick Meek, a young (43) black congressman. Normally, Meek wouldn't be given much chance at winning, but if Crist and Rubio manage to disgust enough people during the primary, he might have a small chance.

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