Bidding for support from Democrats as well as a single Republican, the chairman of the Senate Finance Committee gaveled open a long-awaited debate over health care Tuesday with fresh plans to reduce costs on working-class families and impose new obligations on the insurance industry.
"This is our opportunity to make history," said Sen. Max Baucus, D-Mont., who announced he was adding $50 billion to draft legislation to help those who would be required to purchase insurance.
After months of delay caused by ultimately unsuccessful bipartisan talks, most committee Republicans praised Baucus before launching into attacks on the legislation he advanced late last week.
Sen. Jon Kyl, R-Ariz., called the measure a "stunning assault on our liberty" and cited a requirement for individuals and families to buy insurance. Sen. Charles Grassley of Iowa, the senior Republican involved in the private negotiations, said the Senate Democratic leadership had imposed a mid-September deadline, "causing the end to our bipartisan work before it was done." He called it an absurd move, "utterly and completely appalling."
The Republican whom Baucus has courted most assiduously, Sen. Olympia Snowe of Maine, said noncommittally the legislation was "a solid starting point — but we are far from the finish line."
Aiming for week's end
The panel is the fifth and last of the congressional committees to review President Barack Obama's call for sweeping legislation to reduce the ranks of the uninsured, expand protections for those already covered and generally reduce the ruinous growth in medical costs nationwide.
Baucus has said he hopes the panel can complete work by week's end, although more than 500 amendments were pending to the 10-year, nearly $900 billion bill.
It was unclear whether the committee would debate Baucus' decision not to permit the government to sell insurance in competition with private industry. Many liberal Democrats favor the idea, saying it is essential to hold down costs, but some moderates inside the party are opposed, as are all Republicans.
Baucus' bill calls instead for nonprofit co-ops to compete with private industry.
Approval of legislation by the Finance Committee would clear the way for action within a week or so on the Senate floor. Across the Capitol, majority Democrats are working on the same timeline as they push for a vote in the House.
So far, all four committees to vote on the issue have done so strictly along party lines, and Republican leaders have worked hard to avoid helping the Democrats and Obama gain a significant accomplishment. But Baucus' oft-stated desire for bipartisanship pushed his bill toward the political center, to the consternation of fellow Democrats, and the changes he unveiled seemed designed to appeal to critics within his own party as well as to reach out to Snowe.
Sweetened subsidies
The most significant would sweeten the subsidies for individuals and families with incomes up to four times the government's poverty level — $43,320 for individuals and $88,200 for a family of four. In addition, Baucus called for lower out-of-pocket medical costs for some lower-income families, and recommended making it easier for those who cannot afford the coverage offered by employers to qualify for federal subsidies so they can purchase individual policies.
To hold down costs for older consumers, he also reduced the ability of insurance companies to charge more for coverage on the basis of age, from five times the base rate to four times.
Baucus also decided to reduce the penalty for families who defy a proposed mandate to purchase coverage, from $3,800 to $1,900.
Additionally, he rewrote the bill stating that individuals who currently have coverage against catastrophic medical costs need not purchase more comprehensive insurance.
The revisions would significantly alter a proposed tax on high-cost insurance policies, a measure that has drawn particular opposition from organized labor and liberal Democrats. Baucus said he would exempt from the tax policies sold to "high risk" workers, such as fire fighters.
At the same time, he raised the level of the tax to recoup some of the revenue that would otherwise be lost.
Nearly half the Democrats on the committee had served notice they would attempt to revise the proposed tax, and Baucus' decision there and on the subsidy levels was a bow to political reality as he tries to push his bill through the panel.
Chilly reception
According to information distributed by the committee, he also incorporated a half-dozen changes backed by Snowe, on a variety of issues, on issues ranging from small businesses to Medicaid.
Despite the concessions, Baucus drew a chilly reception from one Democrat, Sen. Jay Rockefeller of West Virginia, who criticized the proposal last week.
Rockefeller echoed criticism often uttered by Republicans, saying that Baucus' bill would break Obama's pledge that no one would be required to switch insurance. "Millions of children will lose the coverage they have under this bill," Rockefeller said. "This is wrong."
Rockefeller referred to a provision that would result in many children being funneled into a so-called insurance exchange for coverage. As envisioned in Baucus' bill — and Obama's plan, as well — the exchanges would be established to offer individuals and families coverage at a price they can afford. Insurance companies who sell policies in the exchange would be barred from denying coverage on the basis of pre-existing conditions and would face limitations on the premiums they can charge.
The federal subsidies would be available for policies sold in the exchange.