Health Care Bill Advances Strictly Along Party Lines

Eleven months after taking office, President Obama is close to having a bill that will substantially change how Americans receive and pay for medical care. And the President is claiming victory. The health care overhaul bill passed a key test when the Senate voted along party lines to move the bill forward. Pamela Gentry, senior political analyst for BET Networks, and Mary Agnes Carrey, senior correspondent with Kaiser Health News, discuss next steps in the push to overhaul health care, despite strong conservative resistance in Congress.

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JACKI LYDEN, host:

This is TELL ME MORE from NPR News. I'm Jacki Lyden filling in for Michel Martin.

Coming up, how the H1N1 virus is taking a particular toll on Native Americans, that's in a few minutes.

First, though, 11 months after being sworn in as president, Barack Obama is close to having a bill that will substantially change how Americans get and pay for medical care. And the president is claiming victory.

President BARACK OBAMA: Simply put the protections currently included in both the Health Insurance Reform Bill passed by the House and the version currently on the Senate floor would represent the toughest measures we have ever taken to hold the insurance industry accountable.

LYDEN: Republicans though are crying foul. Not one Republican senator will be voting for the bill. Here is South Carolina Republican Lindsey Graham with some harsh words about the pending legislation.

Senator LINDSEY GRAHAM (Republican, South Carolina): Change you can believe in after this health care bill debacle has now become an empty slogan and it's really been replaced by shady Chicago politics when you think about it: backroom deals that amount to bribes.

LYDEN: To talk about how the bill will change America's health care system, we've invited Mary Agnes Carey, senior correspondent of Kaiser Health News, an independent news gathering service. And to discuss the bill's political ramifications, we have invited Pamela Gentry. She's the senior political analyst for BET Networks. I want to thank you both for joining us today.

Ms MARY AGNES CAREY (Senior Correspondent, Kaiser Health News): Thank you.

Ms. PAMELA GENTRY (Senior Political Analyst, BET Networks): Pleasure.

LYDEN: The health care bill cleared the first of three procedural votes in the Senate at 1 a.m. Monday morning, today. The Senate is expected to approve the legislation later this week at which point differences between the House bill and the Senate bill has to be ironed out ahead of one final congressional vote. Mary Agnes, what are the differences between the House and the Senate bills?

Ms. CAREY: There are actually several differences. One would certainly be on abortion. The Senate changed its abortion language, but it's not as restrictive as what's in the House. The House bill of course has a public option, a government-run health insurance option that is not in the Senate bill that had been under consideration with some changes, but it was dropped. The financing of the bills are very different.

In the Senate, you have, for example, a tax on high cost health insurance plans. Here, we're talking about plans that are worth about $23,000 for families or $8,500 for a single person. The House looks to a tax on high wage earners. And again, for an example, that's talking about individuals who make $500,000 or couples who make a million. So, these are key differences that they're going to have to resolve between the bills to get that conference report with the hope of getting it to President Obama's desk.

LYDEN: And how will those differences be resolved, you think? And how will the bill change how we actually receive health care?

Ms. CAREY: Well, both bills, for example, would put tighter restrictions on insurers against lifetime caps or annual limits on coverage. Both bills would provide subsidies to help people buy coverage and both bills would have something called a health insurance exchange, which are going to be created to allow a market place, if you will, especially for people who have to buy their own health insurance in the individual market. But I think that you're already hearing from members of the Senate, Kent Conrad, who's head of the Budget Committee, for example, that the final package would have to get very close, extremely close to the Senate bill or it won't pass the Senate.

This is going to be a problem in the House, especially for liberal Democrats that want that public option. But I think as the process goes on, the final conference package - as many Democrats in the Senate are saying - is to going to have to adhere closer to theirs if they want any hope of approving a final conference package.

LYDEN: What doesn't the bill do?

Ms. CAREY: The bill does not, for example, say there are any limits on what a health insurance company can charge you. In the eyes of some people, the bill may require people, especially who may - not so much at the super lower income levels but, for example, subsidies stop at 400 percent of the poverty level. That's about $88,000 for a family of four. Folks in that category may be required to provide what some people think as too large of a share of their health insurance for the premiums, the co-pays and the deductibles.

Another thing about this bill that could be bothersome to some people is a requirement - there would be some exceptions, but a requirement that individuals buy health insurance or face a penalty. So it does a lot. Democrats are saying that they know the bill is not perfect and it may not provide as much aid to people as proponents had wanted; may not provide, for example, as much choice.

In the Senate bill, they would have the Office of Personnel Management - this is the agency that oversees the federal health insurance plans - negotiate two national plans, one would have to be a nonprofit plan for everyone in the country. But if you are a proponent of the public option, as many House Democrats are, you would say the bill wouldn't go far enough in that area.

LYDEN: If you're just joining us, you're listening to TELL ME MORE from NPR News. I'm speaking with journalist Mary Agnes Carey and analyst Pamela Gentry about health care. Let's talk about the political fallout a little bit. Markos Moulitsas, whose Daily Kos Web site is the online standard bearer for liberal Democrats. He was guest on NBC's "Meet The Press" and sounded less than enthusiastic in his support of the bill.

Mr. MARKOS MOULITSAS (Founder, Daily Kos): Yeah, I don't think this is a reform bill. I think it's very clear. This is not insurance or health care reform. What it is, it's allowing more people, 30 million people, to buy into the existing broken system.

LYDEN: Pamela, we'd characterized Lindsey Graham as harsh, but you could say the same thing about Markos Moulitsas. Who is happy about this health care bill?

Ms. GENTRY: Well, no one is completely happy about it, but I think one of the things that Mary brought up that's critical here is that even though they're talking about holding down the cost of the health care with this bill, they're not talking about how they're going to hold down the cost that is to individuals who have to buy into the system, especially those who might be charged the fee.

And I think that's what's keeping the liberals away from supporting this bill because they really feel that there's no cost containment being directed at the insurance companies. And that's why they are saying there is no reform if they can still charge you whatever they want to charge you.

This is something that they ended up being kind of saddled with under the creation of COBRA. Even though COBRA was created to extend benefits for people when they lost their employment, what happened is they lost their job and found that they could not afford the fees that the insurance companies wanted to charge them to keep their health care insurance. So, I think that's what those who are really pro-public option are trying to avoid. They want one program, at least, out there offered in the exchange that they can control the cost.

But for the president, both of these bills are doing a couple of things. It is going to eventually do new incentives for physicians that say more preventive care are things that they will get paid higher for versus just hospitalizations and kind of that cycle of bringing people into the hospital, where you can bill higher or having long term diseases that could be preventable. So, they want to change the incentive.

They also want to increase access, meaning that they would, you know, open the doors to say that there would be a larger number of physicians that would be available to folks. And I think the last thing as the president kept saying, he wanted to hold costs down. And all of these formulas that we're discussing as to whether or not, you know, who pays and how much everyone pays and how the reform is actually going to be paid for, does reach some point of holding costs now.

LYDEN: Pamela, I wanted to just ask you, there are obviously going to be multiple, multiple spins on this, and this has been a dramatic weekend of voting in the midst of the snowstorm, possibly a vote as late as Christmas Eve. You're not really expecting any Democrats to fall out at this point, are you?

Ms. GENTRY: I don't think that any of the Democrats are going to fall out simply because - nor are the two independents, but simply because right now, they voted to get this from debate to conference. And I think right now, they know the toughest battle is going to be in House because the Senate is really the lion in the sense that they're going to be able to hold the bar. Mary's very right. It is going to have to meet their watermark of what they want.

So, I think the Democrats in the Senate will be able to hold. What's going to be the most contentious and probably the biggest fight will be with those very, very less Democrats who really feel that there is no health care reform without a public option.

LYDEN: Mm-hmm. In the few minutes we've got left, Mary Agnes, I just want to talk the issue of abortion has been a huge obstacle to passage of this health care bill. Where does it stand now?

Ms. CAREY: Well, in the Senate, you've got two different approaches. In the Senate, for example, and this was a compromised fashion to get the vote of Ben Nelson, who is a Democrat in Nebraska, but was very concerned about abortion funding, the legislators could pass laws that would ban abortion coverage in the health insurance exchanges.

The exchanges under the Senate are planned as it stands now would have to offer a plan, one plan that does not cover abortion. And if you were enrolled in a health insurance plan that did cover abortion, you'd have to write two different checks, one for the premium, and then one for the underlying health coverage. And in both the House and the Senate bills, no federal funding could be used for abortion except in cases of rape, incest or to save the life of the mother.

Now, the House bill is much stricter. It would require rather that the exchanges could not cover abortion services because they received federal money, and the public option could not cover it because it receives federal money. And so, you're going to have a real showdown over this because a lot of the federal funding on abortion is done through the appropriations process, which means every year, there's a vote on that bill for funding.

Of course, any law that Congress could pass can be open to changes, but this will be put into permanent law. So there is a great concern about would the Senate bill extend the current Hyde amendment language? Does it go too far? It's interesting. In the Senate compromise, both abortion proponents and opponents dislike it for different reasons.

LYDEN: Right.

Ms. GENTRY: I actually don't think that the abortion issue is going to be as debatable as the public option is going to be. I actually think in the end, even the left Democrats will kind of succeed to that because that has always been able to push that back to the states to let them decide how to handle it in the end.

LYDEN: So Pamela, let me ask you this has been a grueling political experience for the president and the domestic political agenda, particularly a scorching -you mentioned the left, a moment ago, editorial by Robert Samuels in today's Washington Post, called it a parody of leadership. Where do you think politically he goes from here? Of course, you know, he deemed it a victory, but what do you think?

Ms. GENTRY: Well, I think that this is something that the president staked a lot on coming in to his presidency, and I'm sure that right now, they're saying that if they get some reforms, something that they can at least say makes a difference in health care, and at least opens access and holds down costs is budget. And I hate to use the word neutral, but if it doesn't increase the deficit, I think they will claim victory.

LYDEN: Mary Agnes, what else can happen this week before Christmas Day?

Ms. CAREY: I think you're going to hear a lot of the same points repeated over and over again on the Senate floor. Republicans think this bill is a monstrosity. They think it will raise taxes. It is going to drive up premiums, even though that really hasn't been affirmed by anyone. That's their feeling that it's going to increase health insurance costs. The Democrats will say that this is a good bill. It is good for America. It will help a lot of Americans, and I think you'll hear this played out all the way through Christmas Eve.

LYDEN: Well, I want to thank you both. That was Mary Agnes Carey, senior correspondent for Kaiser Health News, and Pamela Gentry, senior political analyst for BET Networks. Thank you both very, very much for joining us.

Ms. GENTRY: It's a pleasure.

(Soundbite of music)

LYDEN: Coming up, a holiday curmudgeon explains why he prefers to spend Christmas parties in the corner alone.

Mr. GENE WEINGARTEN (Humor Columnist): There are nothing like a party to create these little knots of small talk, where people are constantly straining to be funny and interesting and it just makes me want to sleep.

LYDEN: Author Gene Weingarten on surviving all that holiday cheer. That's just ahead on TELL ME MORE from NPR News. I'm Jacki Lyden.

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