NPR logo With Health Care Bill, One Day You're In ...

With Health Care Bill, One Day You're In ...

The Cornhusker Kickback, Louisiana Purchase and other health care provisions are back in the cross hairs, as the House lurches toward final votes on the health care overhaul and reconciliation bill.

Some of those provisions are being killed, while others aren't as ominous as the rhetoric makes them seem. Some examples of what's in, what's out and why:

OUT: The Cornhusker Kickback, added by Senate Democrats last December at the behest of Sen. Ben Nelson (D-NE).

He had opposed the bill, but after negotiating tougher abortion language and this provision, he voted for it. The provision would have given Nebraska a big break on Medicaid — the health insurance program for low-income families, jointly financed by Washington and each state. The overhaul bill expands Medicaid to cover childless adults. Nelson's provision would have Washington, not Nebraska, pay the state's share of the new coverage — an estimated $100 billion over the next 10 years.

The provision drew so much criticism that Nelson renounced it. Instead, there's more Medicaid money for all states.

IN: Something that looks a lot like the Cornhusker Kickback, but isn't.

A provision in the reconciliation bill sends an extra $8.5 billion in Medicaid funds over 10 years to 11 states: Arizona, Delaware, Hawaii, Maine, Massachusetts, Minnesota, New York, Pennsylvania, Vermont, Washington and Wisconsin, plus the District of Columbia.

But they're not Nebraska. They're already doing what Medicaid will have all states do — cover childless adults — but they're using their own funds. The new provision gives them federal dollars so they won't end up paying more of their own dollars than other states for the same coverage.

STILL IN: The Louisiana Purchase, providing a boost in Medicaid funding for Louisiana — and political cover for Sen. Mary Landrieu (D-LA), whose vote was on the line.

That nickname is a bit misleading. The Louisiana Purchase applies to one state now, but it would benefit others that are hit by natural disasters. Hurricane Katrina drove thousands of poor people out of the state, which made it statistically wealthier, and that new "wealth" led to reductions in federal Medicaid funding. The provision readjusts the formula for Louisiana, but it's written to establish post-disaster readjustments as a policy.

OUT: An extra $3.5 billion to subsidize Medicare Advantage recipients in Florida, from Sen. Bill Nelson (D-FL).

He added the provision last year to protect 800,000 Floridians from cuts in Medicare Advantage, a program that pays health insurance providers to offer additional services. The program is costly, and many critics say it's wasteful. The new cuts would affect Medicare Advantage providers and users in other states, and now will affect Florida, too.

STILL IN: Medicare benefits for victims of asbestos contamination in Libby, Mont., added by Sen. Max Baucus (D-MT).

The town of 2,900 has high rates of lung disease, due to decades of vermiculite mining, and EPA made Libby a Superfund site in 2002. Baucus inserted language to the Senate bill giving Medicare coverage to ill residents who wouldn't otherwise qualify. It's still there because Baucus chairs the Finance Committee and has been a central figure in shaping the bill.

OUT: A student-loan provision for North Dakota, from Sen. Kent Conrad (D-ND).

The reconciliation bill actually has two subjects: health care and a big revamping of the federal student-loan program. President Obama wants to end federal loan guarantees for private lenders, who make loans, and profits, while the government assumes the risk. The administration says private-sector loans add little value for borrowers, and the government can save money by eliminating the middlemen.

The legislation to do this has been rolled into the reconciliation bill, where Conrad then added an exemption for the state-owned Bank of North Dakota. He makes two arguments: First, that BND — the only state-owned bank in the nation — keeps its loans and services them itself, unlike private lenders that sell loans to third-party investors and servicers. And second, that its default rate is one-quarter the national default rate. But when the exemption became controversial, Conrad asked the House to remove it.