America's health-care bill

Nearer and nearer

Dec 21st 2009
From Economist.com

A procedural vote in America's Senate brings Barack Obama's health-care reforms closer

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IT NOW looks certain that Barack Obama will get what he wanted for Christmas—a health-care reform bill passed out of the Senate, probably just a few hours before Santa begins his rounds. Republicans, who have been fighting tooth-and-nail to block passage of the bill seem to have given up the fight, and have given warning instead that this will be a wish that he comes to regret.

Shortly after 1am on Monday December 21st, the health bill cleared the first, and the most difficult, of the procedural hurdles it has to leap in order to secure passage through the Senate. Technically only a motion to end debate on a “manager's amendment” put together by the Senate's majority leader, Harry Reid, what the vote really represented was a crucial exercise in nose-counting. The result was a vote on precisely partisan lines, with all 40 Republicans opposed, and all 58 Democrats plus the two independents who are grouped with them voting in favour. Since 60 votes is the precise number needed to avoid a filibuster, there was no room for error whatsoever, the reason why the procedural motion had taken so long. But with all 60 members of the “Democratic caucus” now signed up, the final vote, on Christmas Eve, looks like a formality.

From the point of view of the Democrats, this victory has come at a high price. The health bill has been stripped of something very dear to many of then: a “public option” of a government-backed insurance scheme that would compete with private insurers in order, supposedly, to keep costs down and guarantee access. The version of the bill already passed by the House of Representatives does contain just such a public option, one of several reasons why final passage of a reconciled bill is still a way off. Some Democrats hope, however, that a public option can be added later on, after the initial bill has gone into effect.

Still, the Senate version does tick most Democratic boxes; it obliges everyone to have health-insurance, and sets out a generous system of subsides to help the uninsured obtain coverage, along with a system of government-regulated exchanges that should encourage competition among private insurers. It fines employers who do not offer health cover to their workers. And it makes it illegal for insurers to refuse people coverage on the basis of pre-existing medical conditions, as well as putting strict limits on the way that premiums are allowed to increase with age. The hope is that tens of million of Americans currently without coverage will now be able to get it, and many tens of millions more, who have insurance but fear losing it through redundancy or ill-health, will have those worries lifted from their shoulders.

Republicans, however, hate the bill, mostly on the ground of cost. The advertised price-tag of the Senate bill is a bit under $900 billion over the next ten years, but Republicans contend that the numbers will be much higher than that, as the cost of subsidies has been underestimated and predicted savings will not materialise. [snip].

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Completion of work on the bill is by no means a formality, though it does now look more or less certain that the Senate will vote the bill out before Christmas. The next difficulty will come in producing a single “reconciled” version from the very different bills that the Senate and House have produced; that reconciled bill then has to go back for final clearance by both chambers. The public option is one big stumbling block. It is clear that the Senate cannot pass any version of a bill that contains a public option, so the House will have to give ground, which is going to require a lot of presidential arm-twisting in January. And the two bills are funded in very different ways, one with a tax on the rich, the other with an insurance-policy surcharge. As of today though, health-care reform, expensive and imperfect though it is, is looking a lot more likely.

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