Waxman On House, Senate Health Care Bills

The health care bill approved by the Senate Finance Committee Tuesday differs from bills passed by other Senate and House panels, most notably in the fact it does not include a public option. Democratic Rep. Henry Waxman of California, chairman of the House Energy and Commerce Committee, and one of the lead authors of a House proposal on health care, says the House strongly backs the public option, and encourages the Senate to do so, too.

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MICHELE NORRIS, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.

ROBERT SIEGEL, host:

And I'm Robert Siegel.

On Capitol Hill today, Senate Democrats begin the process of coming up with one compromise health care bill. A small group of senators are meeting behind closed doors to try to merge the bill approved yesterday by the Senate Finance Committee with the one passed by the Health Committee earlier this year. A big difference between the two - the Finance Committee's bill has no public option, the Health Committee's bill does. More on what's going to happen in the Senate in a moment, but first, the House also has several health care bills that it needs to merge.

Democrat Henry Waxman of California is a lead author of one of them and he joins us now from Capitol Hill. Welcome to the program.

Representative HENRY WAXMAN (Democrat, California): Thank you. Pleased to be with you.

SIEGEL: First, what do you think of the Senate Finance Committee bill that was approved yesterday?

Rep. WAXMAN: I was delighted that they were able to vote the bill out. We've got to work out our differences with the House and the Senate into one bill to send to the president for his signature.

SIEGEL: Big differences over the public option and the compromise that's been proposed by Maine Senator Olympia Snowe, the lone Republican so far to have voted for one of these bills, is that a public option might kick in after a set amount of time, a trigger if private insurers don't live up to their end of the deal. Is that acceptable to you?

Rep. WAXMAN: Well, in the House we stand strongly behind a public option from the very beginning. I think the House will have a clear public option as a choice and we would encourage the Senate to come along with us.

SIEGEL: Here's something the health insurance industry is saying. They're saying that for them to do away with such things as caps on benefits or higher premiums when you get sick or no insurance for people with pre-existing conditions - to do all that they need to see everybody in the insurance pool. And that means there has to be a big penalty for not having insurance. How much should, say, a healthy 30-year-old who makes $40,000 a year be penalized if she does not have health insurance?

Rep. WAXMAN: We want to get everybody health coverage. We think that there's a responsibility for people to have insurance. I must say that the insurance companies are crying a little too loudly for my comfort, because they're going to make a lot of money out of this legislation. A lot more people are going to be covered, paying premiums. The idea is to spread the risk to a large pool of the population who won't be using health care services at any particular time, but it will be there when they need it.

SIEGEL: But if those people, so far, those, say, young healthies have decided so far that they should risk going without health insurance, wouldn't they make the same decision unless the consequences of making that decision were very negative, that is, the penalty they'd have to pay?

Rep. WAXMAN: Well, I think we need to really push them hard to get insurance, but I'm not...

SIEGEL: But, what does that mean to push them hard?

Rep. WAXMAN: Well, I think we've got to, first of all, make it available to them. We've got to make sure that the cost of insurance is reasonable for the budget of people who are going to be required to buy it. I think it's a reasonable requirement that we all take responsibility, including young people, for coverage.

SIEGEL: On prescription drugs, do you feel that Congress should get more out of the industry than the Senate Finance bill proposes? And can the Congress get any more than what President Obama negotiated with the drug companies?

Rep. WAXMAN: I do believe we ought to get more money from the pharmaceutical companies. I think we have a strong case to make and the agreement didn't bind us and a law has to be passed by both the Senate, the House, with the support of the president.

SIEGEL: In your book, in which you wrote about your career in Congress, you pointed out that the most important thing is to get a bill. And there are lots of complaints that people make about the bill and there are things that you will have been in favor of that you ultimately cannot get, either in your own House or in conference, but in the end you have to have a bill. Is it fair to say that just about everything you've said here today might have to be sacrificed in order to get a bill?

Rep. WAXMAN: I don't look at it that way. We're going to make our arguments and try to get the best we can and then we'll see if it's worthwhile at the end of the day to go forward. I think it will be. But we're not giving in on some of these important issues at this point and maybe we won't at all.

SIEGEL: And when you say at the end of the day, roughly what date are you thinking of as the end of the day of this process?

(Soundbite of laughter)

Rep. WAXMAN: The end of the day will be before the end of the year when we get to a final health bill that the president will sign and we will look back on some day and say, why did it take so long for our country to have affordable good quality health care for everyone?

SIEGEL: Congressman Waxman, thank you very much for talking with us.

Rep. WAXMAN: Thank you.

SIEGEL: That's Democrat Henry Waxman of California, the chairman of the House Energy and Commerce Committee with his take on where things stand in the House.

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What Will Make It Into The Final Senate Health Bill?

Sen. Harry Reid CUSTOM i i

Senate Majority Leader Harry Reid testifies during a Senate Judiciary Committee hearing on Capitol Hill Wednesday. Reid also began private meetings Wednesday with fellow Democrats and the White House to merge his chamber's two health care overhaul bills into a single plan that could win a filibuster-proof majority in the Senate. Mark Wilson/Getty Images hide caption

itoggle caption Mark Wilson/Getty Images
Sen. Harry Reid CUSTOM

Senate Majority Leader Harry Reid testifies during a Senate Judiciary Committee hearing on Capitol Hill Wednesday. Reid also began private meetings Wednesday with fellow Democrats and the White House to merge his chamber's two health care overhaul bills into a single plan that could win a filibuster-proof majority in the Senate.

Mark Wilson/Getty Images

Senate Majority Leader Harry Reid began private meetings Wednesday with fellow Democrats and the White House to merge his chamber's two health care overhaul bills into a single plan that could win a filibuster-proof majority in the Senate.

Work on combining the Senate's Finance and health committees' bills was supposed to be, in theory at least, the less contentious part of this new phase of overhaul negotiations. But the question of what will hit the Senate floor for debate in less than two weeks remains large and open.

Reid's task is complicated by the fact that although Senate Democrats enjoy a 60-vote, filibuster-proof majority, it is a fragile caucus that includes a handful of moderates whose votes on President Obama's signature domestic initiative are not a given.

And already at least one of Reid's fellow Senate Democrats, New York's Charles Schumer, is agitating for a final bill that includes a public insurance option — something missing from the measure passed this week by the more conservative Senate Finance Committee.

"In one sense, the debate begins all over again," says Bob Moffit, director of health policy studies at the conservative Heritage Foundation.

The long-awaited $829 billion proposal approved Tuesday by the Senate Finance Committee with a single Republican vote "concludes one big chapter of the health care debate," Moffit says. "But you're not going to see that bill again."

Opposition Pumps Up The Volume

Schumer wasn't the only one stirring the pot in the wake of Tuesday's vote.

Interest groups have ratcheted up their message machines this week — from insurers denouncing the Finance Committee proposal for failing to require that all Americans obtain coverage to unions balking at proposed taxes on generous benefit packages.

So Reid, with a tough re-election battle back home in Nevada and a looming showdown with House Speaker Nancy Pelosi over her chamber's competing legislation, has to devise a strategy that not only melds the Finance Committee's bill with the more liberal offering from the health committee but still gives the president a win.

There are a few certainties: There is little doubt that the ultimate Senate bill will include changes that prohibit insurers from denying coverage to Americans with pre-existing health conditions or canceling coverage when a policyholder gets sick.

And both Senate bills contain similar provisions for creating state-based insurance exchanges — or pools — that can be used by poor and low-income individuals and families, and small businesses, to purchase more affordable coverage.

The Finance Committee's plan to expand Medicaid coverage to more poor Americans is also expected to make the final bill, though details on how to pay for it — and for many other bill provisions — have yet to be worked out.

But the Finance Committee bill is the only proposal that does not include a government-run plan, and it does not require employers of a certain size to offer coverage to its employees.

"Do you impose an employer mandate that unions want, but employers will fight to the death?" Moffit asks. "Do you include a public plan that moderate Democrats don't want? Do you impose an individual mandate?"

Those big, fundamental questions are unanswered, says Michael Tanner, a senior fellow at Cato Institute. "There are real problems yet to be resolved," he says. "This is not even halfway there."

Different Mandates, Different Parameters

The Senate Finance Committee bill would require that most individuals obtain insurance, but its proposed phased-in penalties for failure to comply are nominal and would do little, critics argue, to encourage insurance purchase.

It proposes that penalties of $200 per adult begin in 2014 and reach $750 by 2017. The Senate health committee has proposed a penalty of up to $750 a person, with no phase-in period.

The insurance industry had banked on a vastly increased pool of potential clients under a mandated-coverage plan. Now the industry is attacking the Finance Committee's proposal as guaranteeing an increase in the cost of premiums.

Also at odds are the competing Senate committee proposals for employer mandates, which have emerged as one of the stickiest issues Reid faces.

The Finance Committee would require that businesses with more than 50 employees foot the bill for government insurance subsidies for which their workers may qualify. The health committee bill demands that employers pay for part of the cost of worker coverage or face a penalty. Both bills include exemptions for small employers.

A merged Senate bill will very likely include both an individual and employer mandate, but just who will be exempted is expected to be one of the issues dominating closed-door sessions over the coming days.

Meeting Obama's Objectives Without A Public Option

Schumer may be pushing hard again for a public option to be included in the final Senate bill, but Obama suggested Tuesday that the Finance Committee bill — sans public option — brought Congress closer to achieving the president's core objectives: dramatically expanding the number of Americans covered by insurance, and bending the cost curve.

Len Nichols, director of the health policy program at the nonpartisan New America Foundation, said there has been "fertile thought" around an alternative to a full-blown public option.

That alternative, he says, could be some kind of a melding of so-called trigger proposals advocated by both Democratic Sen. Tom Carper of Delaware and Sen. Olympia Snowe of Maine, the only Republican on the Finance Committee to vote for the proposed overhaul plan.

Under a trigger plan, a public insurance option would kick in if a state fails to meet federal insurance coverage goals.

"I would not be surprised at all to see that emerge" from the Senate's bill-merging discussions, Nichols says.

"Some kind of trigger is the best way to square the circle," he says. "It shows the right that there's no government takeover going on here, and moderate Democrats can get onboard."

But on Capitol Hill Wednesday, Reid said he wanted to note where he stands at the start of bill negotiations.

"I believe in a public option," he said, adding, pointedly: "Remember: I said I do."

A Win For Obama?

And that may be the path to what Obama could define as success on his signature domestic issue.

Even with a plan emerging that would contain an alternative to a full-blown public insurance option, and with considerably watered-down mandates for individuals to buy insurance and employers to pay for at least some coverage costs, the White House would most likely declare victory.

"The reason this is historic has almost nothing to do with the specifics," Nichols says, "but [with] the commitment now on the part of five congressional committees to make health insurance and health care affordable for all Americans — and to simultaneously bend the cost curve."

"We've never gotten this far before," he said.

But, for overhaul opponents, the game has only begun — and it will play out in the home districts of members of Congress facing re-election in 2010.

"If this is defeated, it will be defeated at the grass-roots level," says John Goodman, president and CEO of the National Center for Policy Analysis, which has gathered the signatures of more than 1.3 million who oppose the "nationalization" of health care.

"There is," Goodman says, "a real intense battle going on out there."

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