Health-care votes expected today in Senate

Washington Post

WASHINGTON — Senators prepared to cast their first votes today on health-care reform, but even as partisan divisions hardened and contentious amendments stacked up, Democrats increasingly expressed optimism that they would succeed in passing a bill before Christmas.

The intitial amendments offered illustrated the legislation’s vast scope and lingering vulnerabilities. The first, co-sponsored by Sens. Barbara Mikulski, D-Md., and Olympia Snowe, R-Maine, would increase preventative health-care for women at a 10-year cost of $940 million. One aim of the measure is to blunt concerns raised last month when an independent commission recommended that women undergo mammograms less frequently.

The second amendment, authored by Sen. John McCain, R-Ariz., would strip out the bill’s primary revenue source, nearly $500 billion in Medicare cost savings. Although AARP and other seniors’ groups have argued otherwise, Republicans are attacking the cuts as a threat to current benefits that could eventually shorten lives.

“They’ve paid all their working lives into the Medicare trust fund, and now they’re in danger of having $483 billion cut out of it, which would eventually lead to rationing of health care for seniors in order to fund a new, government-run health care system in America,” McCain told reporters.

Other flashpoints expected to reach the floor in the form of amendments would target provisions in the bill related to abortion and illegal immigrants. Senate Majority Leader Harry Reid, D-Nev., said debate could continue through the weekend. “I want people to feel that they’ve had an opportunity to understand the bill, offer whatever amendments they think will improve it,” he told reporters Tuesday.

Republicans are targeting key sections of the bill, including the nearly $400 billion in tax increases that would finance the legislation’s 10-year, $848 billion cost. GOP lawmakers also are expected to propose significant changes to medical malpractice laws.

To manage the expected deluge of Democratic amendments, Reid and other leaders are urging their colleagues to focus only on their top priorities for floor consideration.

One pending proposal would increase federal funding for residency training to relieve the cost burden on large teaching hospitals in states like Florida, California, Pennsylvania, Illinois and New York. It is sponsored by Sen. Charles Schumer, D-N.Y.

, the measure would provide $2 billion in additional funding over 10 years to create an extra 2,000 residency slots nationwide.

Another group of Senate Democrats, including Sens. Sherrod Brown of Ohio, Jay Rockefeller of West Virginia and Robert P. Casey Jr. of Pennsylvania, is pushing improvements to the State Children’s Health Insurance Program. And a group of moderates, including Sens. Tom Carper Delawae, Kent Conrad of North Dakota and Mark Warner of Virgnia, is crafting language to strengthen cost-cutting programs.

Centrist Democrats, who are likely to decide the fate of the bill, appeared to be reassured by a Congressional Budget Office report released Monday refuting insurance industry claims that the Senate bill would add thousands of dollars to the average family’s insurance bill. The CBO found that Reid’s package would leave premiums unchanged or slightly lower for the vast majority of Americans who get coverage through their jobs.

Average premiums would rise in the relatively small and already costly individual market, where self-employed people and others buy policies directly from insurers. But the higher premiums would pay for better coverage, the CBO said, and most people in that market would receive hefty new federal subsidies that would leave them paying far less under the legislation than they would under current law.

Warner called the report “a step in the right direction” but said “there’s more that could be done” to rein in health care costs.

Conrad, chairman of the Budget Committee and a fiscal hawk, said the report offered “reasonably good news,” but added that he has deployed aides to look for ways to help the approximately 13 million people in the individual market Senate Majority Leader Harry Reid, D-Nev. “That decision should not be made by some bureaucrat, a member of Congress or someone they’ve never met.”

However the amendment doesn’t specifically address mammograms or spell out what additional services would be covered, leaving that to the discretion of the HHS secretary. The Congressional Budget Office said the amendment would cost $940 million over a decade.

Last month, a government- appointed but independent panel of doctors and scientists said women generally should begin routine mammograms in their 50s, rather than their 40s. Then, in an apparent coincidence, the American College of Obstetricians and Gynecologists said most women in their 20s can have a Pap test every two years — instead of annually — to catch slow-growing cervical cancer.

Neither the task force, which provides advice to government officials who may or may not act on it, nor the doctor’s group sets federal policy.

But the recommendations could not have come at a worse time for majority Democrats, especially Senate leaders trying to hold together the 60 votes required to advance the health-care overhaul.

“We know that some in Washington have wanted government-run health care for years. And it’s hard to escape the conclusion that these same people saw the current economic crisis as their moment,” said Minority Leader Mitch McConnell, R-Ky. “Earlier this year, some in the administration said that a crisis is a terrible thing to waste. Americans are hoping this bill isn’t what they meant. But they’re concerned it is.”

The legislative struggle is expected to last for weeks in a test that pits GOP senators determined not to give ground against Senate Democrats intent on delivering on Obama’s signature issue.

Dozens of amendments are likely to be offered, with the measures seemingly designed as much to court a skeptical public as to reshape Reid’s 2,074-page bill.

The Congressional Budget Office has estimated that 31 million uninsured individuals would receive insurance if the bill were enacted, many of them assisted by federal subsidies. The legislation would be paid for through a combination of cuts in projected Medicare payments, a payroll tax on the wealthy and taxes on drug makers, medical-device manufacturers, owners of high-cost insurance and others.