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Welcome to Stat! Health Reform Weekly. On this page, Segal will provide highlights of health care reform developments in the past week, as well as information on important developments to come.
January 25, 2010
Health care reform legislation has hit its biggest hurdle to date following the election of Republican Scott Brown to the U.S. Senate from Massachusetts. Brown's election means that the Democratic majority in the Senate no longer has the 60 votes needed to prevent a Republican filibuster of health legislation. Prior to last week's election, the leadership of the House and Senate had been negotiating the elements of final legislation that could pass both houses of Congress. These discussions are now stalled as lawmakers decide on a course of action.
With Brown's win, there are a handful of difficult options that are being discussed to move health reform forward. These include the following:
- Reconciliation/House Passage of Senate bill: To avoid needing 60 votes in the Senate, the House could just pass the Senate bill. Under this scenario, the Senate would not have to vote again on the health care reform legislation, and the Senate bill could go to the President's desk for signature. The Senate passed its version of health reform legislation on December 24, 2009 with 60 Democratic votes.
Speaker of the House, Nancy Pelosi, stated last week that she did not have the votes needed in the House to pass the existing Senate bill. Many House members object to several provisions in the Senate bill, including the excise tax on high-cost employer-sponsored plans. To get the House votes needed to pass the Senate bill, Congress would then use the budget reconciliation process to pass changes to the Senate bill that would satisfy House members otherwise opposed to elements of the Senate bill. A budget reconciliation bill only requires 51 votes in the Senate. However, a budget reconciliation bill can only contain provisions that affect the US Budget, which may limit the kinds of compromises that House and Senate negotiators have been discussing, including changes to the structure of a health insurance Exchange. The Senate bill would create a separate Exchange in every state but permit them to combine into regional enterprises, while the House bill creates a single federal Exchange with the option to separate out into regional or state Exchanges. - Rework and/or Downsize the Legislation: Some members are calling for an overhaul of the legislation, essentially starting over with a less ambitious approach to health reform. This could target noncontroversial provisions as incremental changes that would have broader support, perhaps even by some Republicans. On the other hand, with so many other issues looming and an upcoming Congressional election, there is little time if any to start over on health care. In addition, the insurance reforms in the pending bills will be a challenge to break apart, as many of the provisions were designed to work together.
Neither the Democratic leadership in Congress nor the White House has yet endorsed any particular approach. Many will be looking for some signal on a direction in the President's State of the Union address on Wednesday, January 27, 2010.
It is unclear what the latest activities mean for the provisions in the House and Senate bills that directly impact group health plans. A more limited reform bill could mean more of a focus on reform of the individual and small group insurance markets and less on efforts toward universal coverage and other provisions that would impact employer-sponsored plans. The reconciliation approach could mean that existing provisions in the Senate bill that affect group health plans will stay, including an excise tax on high-cost employer-sponsored plans, perhaps with some of the compromises that the White House reached with union groups two weeks ago. Either way, time appears to be limited for health care reform generally. If neither approach results in legislation soon, comprehensive health reform could be off the table indefinitely.
Summaries of the House and Senate bill are available on our Web site at the following links: