WASHINGTON — The Senate Finance Committee Tuesday began the last, and so far the most crucial, piece of writing legislation to overhaul the nation's health care system — and quickly demonstrated how tough a task lawmakers face.
Chairman Max Baucus, D-Mont., revised key elements of the carefully crafted compromise that he announced only a week ago. The 13 Democrats and 10 Republicans took more than three hours to make their opening statements expressing their views. Committee members offered 564 amendments.
Sometimes, they seemed almost awed by their mission. "This is our opportunity to make history," Baucus said. Other times, they expressed concern about a wide variety of issues, notably whether middle- and lower-income consumers could afford the coverage they'd be required to buy under his bill.
The committee, which hopes to finish its work by the end of this week, is the latest stop in a months-long process that still lacks a clear finish line. Everything done in Senate Finance may be changed again on the Senate floor, or later in a House of Representatives-Senate conference committee. Any final legislation is months away.
So far, three committees of the House and the Senate Health, Education, Labor and Pensions Committee have produced their versions of health care legislation, all written largely by Democrats. Each includes a government-run alternative to private health insurance coverage, or a "public option."
House leaders are trying to merge their three bills into one, and a floor vote is expected soon. House Speaker Nancy Pelosi, D-Calif., has said that the public option will pass the House, setting up a likely showdown with the Senate, where many think a public option can't pass. The Finance Committee is expected to back co-ops, or nonprofit member-run companies, as an alternative to a public option.
Once Senate Finance is done, its work will be combined with the Senate Health committee's measure, and the full Senate will consider a single bill, subject to amendments. If that passes, a House-Senate conference, or negotiating committee, will write a final version. It then would go to each chamber for final passage. If each chamber approves the final version, it would need only President Barack Obama's signature to become law.
It's but a single way station on a very long road, yet the Finance Committee is being watched closely because Baucus and two other committee Democrats negotiated for months with three Republican members in search of bipartisan compromise. Though those talks broke down last week, hope remains that Democrats can find some GOP support.
Sen. Charles Grassley, R-Iowa, the committee's top Republican and one of the six negotiators, indicated that would be difficult. "The cry of impatience has won out," he said.
However, Sen. Olympia Snowe, R-Maine, another negotiator, sent strong signals Tuesday that she's still willing to talk, listing a series of concerns but indicating a desire for compromise. Afterward, Senate Majority Leader Harry Reid, D-Nev., called her remarks "brilliant."
Snowe's vote could be needed badly. Democrats now control 59 seats in the 100 member Senate, and 60 votes are needed under Senate rules to break procedural deadlocks. While Massachusetts Gov. Deval Patrick, a Democrat, is expected to fill the seat of the late Sen. Edward Kennedy soon, 91-year-old Sen. Robert Byrd, D-W.Va., suffered a setback Tuesday when he fell at his home and was taken to a hospital.
The key committee flashpoint Tuesday involved affordability, as senators from both parties signaled that unless they can go home and assure their constituents that their health care costs won't skyrocket, this bill is going nowhere.
Health insurance costs have been soaring. According to the Kaiser Family Foundation, during the past 10 years, the average health-care premium for family coverage has gone up 131 percent, to $13,375. The average worker contribution has soared 128 percent, to $3,515.
"We have to do better on affordability in this bill," said Sen. Charles Schumer, D-N.Y.
Baucus' revised plan, which adopts amendments offered mostly by Democrats, takes a number of steps aimed at easing those concerns.
He originally wanted to impose a 35 percent excise tax on insurance policies costing more than $8,000 for an individual and $21,000 for families. His change would raise the tax to 40 percent and increase the limits for most retirees and people in high-risk jobs to $8,750 for individuals and $23,000 for families.
Baucus also proposed making it easier for lower-and-middle-income families to get tax credits that would help them buy coverage, and would cut in half to $1,900 the penalty for higher-income families who don't buy insurance. Virtually all Americans would have to buy coverage.
The revenue lost by his amendment would be made up from the bill's projected $49 billion budget surplus over 10 years, Baucus said. The bill's total cost: $774 billion, paid for by taxes, fees and projected savings, notably from Medicare.
Lots of concerns remained. Sen. Ron Wyden, D-Ore., whose bipartisan "Healthy Americans Act" alternative health-care bill would promote competition in the private marketplace, said that the Baucus bill doesn't do enough to promote competition.
Sen. Jay Rockefeller, D-W.Va., said he and others will offer public option amendments. Rockefeller said that anything can happen once lawmakers start negotiating and, in effect, swapping votes.
"Everything changes once the voting starts," he said.
Democrats are united on this much: They want a bill, and they're supported by a president who's made health care his top priority. So there's little prospect that the Finance Committee will bog down in a stalemate.
A Senate rule change, approved earlier this year, would allow health care measures to proceed with 51 votes after Oct. 15. For months, Democrats have said they don't want to pass this bill that way, because changing the health care system shouldn't be strictly a partisan matter — if only because an unpopular plan could wound the party's candidates next fall.
On Tuesday, however, Reid seemed to begin smoothing the way for doing it with only 51 votes. He praised Snowe, but added, "Despite all our efforts to reach across the aisle, Republicans have chosen not to be part of the discussion. They want, obviously, to maintain the status quo. The bottom line is that we have to act, and act now."
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