Members of the Senate Finance Committee filed more than 500 amendments to Chairman Max Baucus’s health care reform bill, setting the stage for a markup next week that will lay bare differences between the parties on overhauling the health care system.
Two very different visions of health care reform emerged from the wave of amendments, which the committee posted online Saturday.
Republicans want a less-costly bill with fewer taxes, no government insurance option or nonprofit insurance cooperatives, medical liability reform, loosened restrictions on flexible savings accounts and no unfunded mandates on the states.
Some Democrats are looking to strengthen the co-ops, and others want to replace it with a government insurance option. They want to boost the amount of tax credits available to low- and moderate-income people to purchase insurance, and change the 35 percent excise tax on insurers that offer high-end plans.
The amendments provide a first look at the priorities – and possible breaking points – for the senators.
Sen. Olympia Snowe (R-Maine), who is the likeliest Republican vote, proposed a “safety net fallback plan” in which a nonprofit government corporation would offer coverage in any state where affordable coverage was unavailable to 95 percent of residents. She wants to boost the threshold at which insurance plans would be taxed for people over 55, and reduce the penalty for failing to comply with the individual mandate.
Snowe signed onto several amendments with Democrats, including one extending small business tax credits to nonprofits.
Democrats from four of the highest-cost states – Chuck Schumer of New York, Robert Menendez of New Jersey, Maria Cantwell of Washington and John Kerry of Massachusetts – proposed a series of changes to the excise tax. They would boost the threshold from $8,000 to $9,800 for an individual and from $21,000 to $25,000 for a family, and raise the tax from 35 percent to 40 percent.
Sen. Chuck Grassley (R-Iowa) and Senate Minority Whip Jon Kyl (R-Ariz.) proposed striking the more than $90 billion in fees on the on insurers, medical device makers, pharmaceuticals and clinical laboratories.
Kerry and Schumer want to establish an employer mandate, which Baucus shunned in favor of requiring companies to defray the costs of providing insurance tax credits to employees who qualify for the assistance.
Sen. Jay Rockefeller (D-W.V.), who has been highly critical of the Baucus plan, filed the most amendments. He wants to expand Medicaid to 150 percent of poverty, up from 133 percent; create one national insurance marketplace known as an exchange, rather than a series of state exchanges; and limit the out-of-pocket health care costs for all individuals.
Rockefeller joined with Sen. Orrin Hatch (R-Utah) to prevent the Children’s Health Insurance Program from being folded into the exchange.
Rockefeller did not propose creating a public insurance option, despite the issue being most closely identified with him. That was left to Schumer and Cantwell, who submitted two amendments dealing with the public option.
In turn, several Republicans introduced amendments requiring lawmakers and federal employees to use the public option if one is enacted.
Sen. John Ensign (R-Nev.) wants to strike the word “fee” from the bill and replace it with “tax.” He also wants “transparency in czars,” and assurances non-smokers aren’t forced to subsidize smokers.
In perhaps a mild form of protest, Hatch proposed additional relief from the 35 percent tax on high-end insurance plans for any state that begins with the letter “U.”