Thread: Three Big differences in House and Senate Healthcare Bill

Reid's Gifts To Nelson And Landrieu Push Snowe Further Away



The perks that Senate Democratic leadership put into the final health care bill to win the support of conservative caucus members may cost them the one opportunity to secure a bipartisan bill.

On Monday, Sen. Olympia Snowe (R-ME), the only Senate Republican who has voted for a version of health care reform, said that she was offended by the sweeteners that Senate Majority Leader Harry Reid (D-Nev.) threw into health care legislation to win the votes of individual senators.

"I think we all should be concerned about all of these last-minute arrangements and sweetheart deals considered in there," said the Maine Republican. "I don't think that that is fair, frankly. As one who has worked on the policy for as long as I have and as long as I have and my staff, I just think that, in all fairness to all parts of the country, I think it is important that the policy be equitable."

Snowe, who voted for the Senate Finance Committee's version of reform, has said she is not inclined to back the current version produced by Democratic leadership -- though she hasn't fully ruled it out. It wasn't because her home state of Maine wasn't getting its piece of the pie, she insisted: "I didn't ask for carve-outs for Maine. That wasn't what I was all about."

It was because the legislation has been tainted by parochial interests.

The Maine Republican wasn't alone. On the Senate floor on Monday, a host of Republican senators -- none of whom have engaged in honest brokering during the health care debate -- excoriated Reid for the legislative sweeteners he added to the final health care product such as the $300 million in Medicaid funds for Sen. Mary Landrieu (deemed "The Louisiana Purchase") or the $100 million in Medicaid relief for Sen. Ben Nelson (described either as the "Cornhusker Kickback" or, cleverly, "Clash for Cloture"). Sen. Saxby Chambliss (R-Ga.) set the tone early when he declared that "votes have been bought."

The carve-outs -- as they have been called -- have had the side effect of pitting Republican lawmakers against the needs of their constituents. Sen David Vitter (R-La.) was forced weeks ago to come out against needed health care funding for his state, and was berated by local and national Democrats for doing so. On Monday, Sen. Mike Johanns (R-Neb.) walked the same plank.

Taking to the floor around midday, the Nebraska Republican said he was heartened to see local constituents rise up in disgust against the deal that Nelson made on their behalf.
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"Less than 24 hours after [the] announcement of the special for Nebraska with virtually no warning, no preparation to speak up, 2,000 people gathered in Omaha, Nebraska; Nebraskans, who in one voice, cried foul," said Johanns. "Nebraskans are frustrated and angry that our beloved state has been thrust into the same pot with all of the other special deals that get cut here. In fact, Mr. President, they're outraged that a backroom deal for our state might have been what puts this bill across the finish line. You see, Mr. President, I fundamentally believe that if this health care bill is so good, it should stand on its own merits. There should be no special deals, no carve-outs, for anyone in this health care bill. Not for states. Not for states. Not for insurance companies. And not for individual senators."

In actuality, the sweeteners are proving more difficult for Democrats to defend than they have been for Johanns and Vitter to vilify. Progressives begrudgingly acknowledge that it sends a bad message when Democrats appear to be "buying" Senators off, with only a perfunctory nod to the defense that these paybacks won't kick in until 2016.

The most common response has been that this is simply the seedy underside of the legislative process. And that it is better to have a bill with these perks than no bill at all. On Monday, however, Reid scrapped those lines in favor of something more novel: casting the carve-outs as politically virtuous and a reflection of a particular senator's legislative acumen.

"That's what legislation is all about," Reid told reporters. "It is the art of compromise. In this great country of ours, Nebraska has many different problems than does New Hampshire. Michigan has many different problems than does Georgia. We have a wide range of different needs throughout regions of this country."

"I don't know if there is a senator who doesn't have something in this bill that is important to them," he concluded. "And if they don't have something in it important to them, then that doesn't speak well of them."

http://www.huffingtonpost.com/2009/12/2 ... 99854.html

Midnight in the Garden of Good and Evil: Healthcare Set for Senate Passage

Written by Joe Wolverton, II
Monday, 21 December 2009 15:42

“The die is cast.â€

UNREAL THEY BRIBED THE AMA TO GET THEIR SUPPORT!!!!




ERICA WERNER
Associated Press Writer

WASHINGTON (AP) - Well on the way to winning passage before Christmas after clearing its biggest hurdle in the wee hours of the morning, the Senate's health care bill will make a "tremendous difference for families, for seniors, for businesses and for the country as a whole," President Barack Obama said Monday.

Senate Democratic leaders basked in the victory for the landmark legislation that will insure 30 million more Americans. They looked ahead to the next make-or-break vote Tuesday morning. They snapped up a coveted endorsement from the American Medical Association and batted down Republican complaints about special deals lawmakers got in the bill.

"I don't know if there's a senator that doesn't have something in this bill that was important to them, and if they don't have something in it important to them, then it doesn't speak well of them," retorted Majority Leader Harry Reid, D-Nev., when questioned at a press conference about the GOP criticism.

The deals in the massive bill range from $100 million to pay the full cost of a Medicaid expansion in Nebraska, home to Democratic Sen. Ben Nelson, the crucial 60th vote for the bill, to exempting roughly 800,000 seniors in Florida from potential benefit cuts by private Medicare Advantage plans, something sought by Sen. Bill Nelson, D-Fla.

The American Medical Association got some special deals itself before declaring its support. A 5 percent tax on elective cosmetic surgery procedures was replaced with a 10 percent tax on indoor tanning services; a proposed fee on physicians to enroll in Medicare was dropped; and payment cuts to specialty and other physicians to pay for bonuses to primary care doctors in underserved areas were also eliminated, the AMA's president-elect, Dr. Cecil B. Wilson, said.

"America has the best health care in the world _ if you can get it," Wilson said at a press conference with Reid and other leaders. "For far too many people access to care is out of reach because they lack insurance. This is not acceptable to physicians."

Democrats prevailed 60-40 over Republican opposition early Monday, voting to block a threatened GOP filibuster of a last-minute package of Democratic amendments.

Democrats will have to put up 60 votes again Tuesday morning for a procedural vote on Reid's underlying, 2,074-page bill. A last 60-vote hurdle awaits Wednesday, and final passage of the legislation _ requiring a simple majority _ is set for late Thursday, Christmas Eve, if Republicans take all the available time. As of Monday they said they would.

"I am willing to stay here. The flight that I have is Christmas morning, and I don't plan on changing that reservation," Sen. Bob Corker, R-Tenn., told reporters after a meeting of GOP senators. "We potentially are getting ready to pass a bill that there's no question in my mind is going to lead to huge deficits down the road."

With final passage on track, Republicans ramped up their criticism, denouncing the last-minute concessions that put the bill over the top.

"I am tired of the Congress thumbing their nose and flipping a bird to the American people," Republican National Committee Chairman Michael Steele said in a conference call with reporters.

Reid promptly criticized Steele for saying "something so obscene" and "so crass and such a terrible example for the youth."

Sen. John McCain, R-Ariz., called the side deals "Bernie Madoff gimmicks," referring to the disgraced financier Bernard Madoff.

The Senate measure would still have to be harmonized with the health care bill passed by the House in November before final legislation would go to Obama.

There are significant differences between the two measures, including stricter abortion language in the House bill, a new government-run insurance plan in the House bill that's missing from the Senate version, and a tax on high-value insurance plans embraced by the Senate but strongly opposed by many House Democrats.

But the bills have much in common. Each costs around $1 trillion over 10 years and installs new requirements for nearly all Americans to buy insurance, providing subsidies to help lower-income people do so. They're paid for by a combination of tax and fee increases and cuts in projected Medicare spending.

Each sets up new insurance marketplaces called exchanges where uninsured or self-employed people and small businesses can compare prices and plans designed to meet some basic requirements. Unpopular insurance practices such as denying people coverage based on pre-existing conditions would be banned.

___http://www.wtop.com/?sid=1702512&nid=111

This is from super-liberal blog:
Ten Reasons to Kill the Senate Bill

By: Jane Hamsher Monday December 21, 2009 7:22 am


FDL has become the go-to place for coverage of the health care bill due to the work of our incredible team. So, I asked them to help make it simple: how do we let people know what's going to happen to them if the Senate bill passes? Everyone put their heads together and came up with a list: Top 10 Reasons to Kill Senate Health Care Bill
Forces you to pay up to 8% of your income to private insurance corporations -- whether you want to or not.
If you refuse to buy the insurance, you'll have to pay penalties of up to 2% of your annual income to the IRS.
Many will be forced to buy poor-quality insurance they can't afford to use, with $11,900 in annual out-of-pocket expenses over and above their annual premiums.
Massive restriction on a woman's right to choose, designed to trigger a challenge to Roe v. Wade in the Supreme Court.
Paid for by taxes on the middle class insurance plan you have right now through your employer, causing them to cut back benefits and increase co-pays.
Many of the taxes to pay for the bill start now, but most Americans won't see any benefits -- like an end to discrimination against those with preexisting conditions -- until 2014 when the program begins.
Allows insurance companies to charge people who are older 300% more than others.
Grants monopolies to drug companies that will keep generic versions of expensive biotech drugs from ever coming to market.
No re-importation of prescription drugs, which would save consumers $100 billion over 10 years.
The cost of medical care will continue to rise, and insurance premiums for a family of four will rise an average of $1,000 a year -- meaning in 10 years, your family's insurance premium will be $10,000 more annually than it is right now.
http://firedoglake.com/

Allows insurance companies to charge people who are older 300% more than others.

Blood boiling alert!!!

They forgot to list the AMERICAN PEOPLE in the LOSER LIST!



FACTBOX: Winners, losers in U.S. Senate health bill
WASHINGTON


Mon, Dec 21 2009WASHINGTON (Reuters) - Makers of brand-name drugs, medical devices and cosmetic treatments as well as suppliers of home health care services are among the industry winners in the U.S. Senate's sweeping healthcare reform bill.

The Senate is expected to approve the $871 billion, 10-year legislation by Thursday.

Negotiators will then blend the Senate's language with a version approved by the U.S. House of Representatives on November 7. It is unclear how long negotiations will take given some substantial differences between the Senate and House versions.

Following are some of the health industry winners and losers based on the Senate bill.

WINNERS

DRUGMAKERS

* The pharmaceutical industry kept intact its $80 billion agreement with the Senate Finance Committee to provide savings and rebates, including a $2.3 billion annual industry fee to be parceled out among companies such as Pfizer Inc and Merck & Co Inc. Wider insurance coverage could help offset the costs by providing more potential customers.

* Drug companies overcame an attempt to allow consumers to import cheaper medicines from other countries such as Canada. Senators rejected two related amendments.

* Drugmakers also avoided House bill provisions calling for bigger rebates under the government's low-income Medicaid insurance program and price negotiations in the Medicare program for the elderly.

* However, top Senate Democrats aim to eliminate a gap in Medicare's prescription drug coverage known as the "doughnut hole." While the Senate bill calls for a 50 percent reduction in the gap, senators said they will seek more changes during negotiations with the House, which wants to eliminate the entire gap by 2019.

* The bill also creates a stronger Independent Medicare Advisory Board to recommend Medicare payments for private drug insurance plans, which could in turn impact prescription drug usage.

DEVICE MAKERS

* Medical device makers such as Boston Scientific and Medtronic Inc earlier won a big reduction in an industry tax to $20 billion, down from $40 billion, to conform with the House bill.

* Senate Majority Leader Harry Reid's amendment offered on Saturday also delayed the tax by a year until 2011. Device makers had sought to eliminate the tax and are now pushing for a delay until 2013.

HOSPITALS

* Hospitals, including companies such as Universal Health Services Inc and Tenet Healthcare Corp, retained a $155 billion, 10-year deal accepting lower government payments from Medicare and Medicaid in exchange for what the industry hopes will be a boost in insured customers.

* The industry also kept an exemption from the Independent Medicare Advisory Board, insulating it from recommended future payment cuts from the panel.

BRAND BIOLOGIC DRUGMAKERS

* Amgen Inc and Roche's Genentech unit and other biological drugmakers won a 12-year period of exclusive sales for brand-name drugs before facing competition from generic rivals.

* The bill calls for creating user fees that generic biologic drugmakers would pay to the FDA to review their products. This could put them on par with brand-name biologic drugmakers but keep some generic companies from pursuing rival products. Traditional generic drugmakers do not currently face such fees though they are under consideration.

* The bill would reimburse doctors 6 percent more for using generic biologic drugs over costly, branded ones. That could affect their use among the tens of millions of Medicare and Medicaid patients.

COSMETIC PRODUCT MAKERS

* Reid's amendment dropped a 5 percent tax on elective cosmetic procedures such as Botox injections to smooth wrinkles, breast enlargements and tummy tucks that could have cut sales for companies such as Allergan Inc and Johnson & Johnson's Mentor unit. The bill instead levies a 10 percent tax on consumers who use indoor tanning salons to raise $2.7 billion by 2019.

HOME HEALTH CARE

* Providers of home health care would see smaller payment cuts that are also imposed more gradually. That could be good news for companies such as Amedisys Inc, Addus HomeCare Corp and Gentiva Health Services Inc that provide services in patients' homes.

* The bill would delay by one year, until 2014, changes to reimbursement rates.

* Various analysts estimated the payment cuts at $39 billion over 10 years in the final bill, instead of original payment cuts of $42.1 billion.

LOSERS

HEALTH INSURERS

* Insurers such as WellPoint Inc, UnitedHealth Group Inc and Aetna Inc overall will face a host of tighter regulations, higher taxes and caps on profits.

* Insurance plans for large groups would have to spend at least 85 cents out of every dollar on medical costs -- leaving 15 cents toward overhead and salaries, among other things. Small groups or individual plans would have to spend at least 80 cents per dollar on care. That proportion of spending, known as a "medical loss ratio," has varied widely and is closely watched by Wall Street due to its impact on profits.

* Private Medicare plans called Medicare Advantage would see roughly $118 billion in cuts over 10 years, according to various analysts. Reimbursement rates for the plans, which can offer more benefits than traditional fee-for-service Medicare coverage at a higher cost, would be tied to a competitive bidding process.

* New consumer protection provisions will change the way companies do business. They include banning preexisting medical conditions and ending limits on how much coverage patients can get from their insurers over their lifetime.

* The new Medicare advisory panel could recommend lower payments to private prescription "Part D" plans operated by a number of insurers.

* There are some bright spots for the industry: A government-run health insurance option was dropped from the Senate bill amid heavy lobbying by insurers, although the House version still includes a such a plan -- often called a "public option."

* Costlier penalties for individuals who do not buy health insurance as mandated were included in the final Senate version, which could boost the number of people who opt for insurance. Penalties could now be as high as 2 percent of a household's income, compared to a previous plan to phase in the penalty to reach $750 by 2017.

GENERIC DRUGMAKERS

* Companies that make cheaper, generic versions of brand-name medicines see little direct help from the Senate bill, although increasing access to health insurance could help more people overall access to prescription medicines.

* While the bill sets up a regulatory path for generic versions of expensive biologic drugs, it also grants brand-name biologics exclusive sales for 12 years. That is a substantial shift from the 5-7 years proponents had sought.

* Efforts to close the Medicare "doughnut hole" could also impact generic drug use. Because Medicare patients now pay full price for a certain period under the coverage gap, a number of patients switch to available generics until coverage kicks back in and the industry says some customers then stay with a generic even when coverage returns.

PHARMACY BENEFIT MANAGERS

* Pharmacy benefit managers, which administer prescription drug benefits, face more disclosures. Under the bill, companies such as Medco Health Solutions Inc, Express Scripts Inc and CVS Caremark Corp must give the Department of Health and Human Services information about rebates they get from drugmakers for medications sold through retail and mail-order pharmacies compared to those through Medicare drug plans.

* The sector was not targeted with any new taxes under the Senate bill, but Wall Street analysts are still concerned given the uncertainty that a tax could be added during House-Senate negotiations.

NURSING HOMES

* Nursing homes, which care for patients who are not quite sick enough for a hospital, would see a 1-year delay of a new payment system that would affect how they classify patients and receive reimbursement to 2011 instead of 2010.

* However, provisions that limit how many patients a therapist can oversee at one time would start in 2010 and could affect costs and staffing at nursing homes. Such facilities are run both by nonprofit organizations as well as companies such as Skilled Healthcare Group Inc and Kindred Healthcare Inc.

http://www.reuters.com/article/idUSTRE5BK3XA20091222