Senate's Health Care Bill Faces Hurdles

Senate Finance Committee chairman Max Baucus unveils a health care bill today that he hopes can win the backing of a majority on his committee — and the full Senate. But it's getting some negative reviews from those he is counting on to support it.

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RENEE MONTAGNE, host:

This is MORNING EDITION from NPR News. I'm Renee Montagne.

The debate on health care has, for the most part, played out in public. But some of the most important discussions have been going on behind closed doors among a small group of Democrats and Republicans on the Senate Finance Committee. Today, Committee Chairman Max Baucus put forward his plan: a ten year health care bill with a price tag of more than 850 billion dollars.

Even before the bill has been made public, both Republicans and Democrats were voicing their objections.

NPR's Julie Rovner has been covering this issue. Good morning.

JULIE ROVNER: Good morning.

MONTAGNE: Julie, before we get to the politics of this thing, let's talk about the bill itself.

ROVNER: Well, you know, when you describe the outline, it sounds an awful lot like all of the other bills that are circulating on Capitol Hill and even what the president described in his speech last week. There will be new regulations for the insurance industry for people who have insurance; a new marketplace for people to buy insurance, who don't have insurance; requirements for people to get insurance and for most businesses to help their employees get insurance; and subsidies and tax credits for those with low incomes and small businesses afford that new coverage; and finally changes to the Medicare payment system in an effort to help slow the increase in overall health care spending.

MONTAGNE: So, how is this latest bill different than from the others, if at all?

ROVNER: Well, in just about every single detail. You know, Senator Baucus was trying very hard to win the votes of the three Republicans he has been negotiating with behind closed doors for all these last weeks - the top Republican on his committee, Chuck Grassley of Iowa, along with Mike Enzi of Wyoming, and Olympia Snowe of Maine.

In order to do that, he's made a lot of concessions. He's brought the overall cost of the package down under $900 billion over 10 years. That's at least $100 billion dollars less than most of the other packages. He's entirely dropped the idea of having a government sponsored public plan option to compete with private insurance. And he really doesn't have any broad based tax increase to help pay for the plan.

Those are just a few of the things that he's done to try to win these Republicans over.

MONTAGNE: Although from what we're hearing, those concessions, they haven't won the Republican votes that Senator Baucus has been after.

ROVNER: Well, certainly not yet. The general feeling is that he probably eventually will get Senator Snowe's vote, but last night Senator Grassley put out a statement that made it pretty clear the bill still isn't anywhere close to anything he can support. Senator Enzi meanwhile, has asked for changes that are unlikely to be granted.

Things like guarantees that the bill won't be changed from now until it reaches the president's desk. In a legislative process, that's something that's pretty unlikely to happen. Meanwhile, in moving the measure really to the right, so far unsuccessfully, to get those Republican votes, Senator Baucus has really angered a lot of Democrats; so much so that J. Rockefeller, who's the chairman of the Finance Committee's subcommittee on health care, said yesterday, that he couldn't vote for the bill in the form it's in now.

MONTAGNE: Well, what in particular has the Democrats so upset?

ROVNER: I think primarily what worries the Democrat, is that now that the package has been shrunk down overall, it just won't be generous enough. What fell out at the end wasn't so much the subsidies to the poor, those are still in there, but really helped to cushion the cause for middle class people. People who earn around $50,000 for a family of three.

Now remember ,under the bill people would be required to spend up to about 13 percent of their income on health insurance. This is a new requirement that people have insurance. This is a mandate. And now the subsidies that those middle class people will get will be very small because after all that was where they had to do it to make the overall bottom line of the bill smaller.

I think Democrats that I talked to are also worried about whether the insurance that's going to be offered will not just be affordable, but it's going to be worthwhile enough in the type of benefits that they offer. In other words, you know, whether voters in the end is going to think that this entire effort is really worth it.

MONTAGNE: Although Julie, what happens if this bill doesn't get enough support?

ROVNER: Well, in the - the Senate, the key of course is to get 60 votes. That's what you need to avoid a filibuster. Right now that would require all the Democrats, both Independents, at least one Republican, assuming the late Senator Kennedy's seat doesn't get filled until next year. If this bill can't do that - and remember even if they do get Olympia Snowe, it looks like they might not get all the Democrats in this form - they may have to turn to something called budget reconciliation. That's where they'd only need 51 votes, because it can't be filibustered. But both President Obama and Senator Baucus have said repeatedly they want this to be bipartisan if they can. And reconciliation comes with its own set of complications, because it limits what kinds of things they can put in that bill. So, I think that would really be a last resort.

So, I think for now they're going to continue work to see if they can continue to negotiate to try to get those 60 votes. From the looks of it, it really won't be easy.

MONTAGNE: NPR's Julie Rovner, thanks very much.

ROVNER: You're very welcome.

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