564 amendments proposed to Baucus plan

Highlights, not all 564, are listed below


Source: Bloomberg.com

Sept. 21 Senate Finance Committee members signaled an aggressive effort to reshape health-care legislation proposed by Chairman Max Baucus, drafting 564 amendments for consideration when the panel meets this week.

Members of both parties want to make a host of changes to legislation designed to lower costs and expand coverage to the uninsured that Baucus introduced last week. They include expanding tax subsidies for low-income people to buy coverage, eliminating a proposed $215 billion tax on high-value health plans, and setting up a government-run insurance program to compete with private industry.

Baucus Plan Overview

Requires almost all Americans to have insurance or pay a penalty, expand Medicaid and provide subsidies to help millions of low-income people get coverage through an online exchange.

The nonpartisan Congressional Budget Office says his plan would lower the budget deficit over 10 years. It utilizes nonprofit cooperatives rather than a government program to compete against insurers, and drops a mandate that all employers provide health care to workers.

To pay for his plan, Baucus seeks savings in programs such as Medicare, the federal insurance plan for the elderly, and new taxes. He’s proposing a levy on costly “Cadillac” health plans and about $13 billion in fees on insurers, medical-device manufacturers, drugmakers and clinical laboratories.

Amendments proposed

Senator Olympia Snowe, a Maine Republican would create a government entity to provide insurance in any state unless coverage is deemed affordable to at least 95 percent of the residents. Coverage is judged unaffordable if the cost of premiums exceeds a percentage of a person’s income, ranging from 3 percent for those at 133 percent of the poverty level to 13 percent for those at 300 percent of the poverty level and above.

Public Option
Senator Jay Rockefeller, a West Virginia Democrat, is proposing to replace the nonprofit cooperatives with a government-run plan. Democratic senators Charles Schumer of New York and Maria Cantwell of Washington favor setting up a public program, with rules that require the Medicare-like system to compete on a more level playing field with private industry.

Rockefeller also wants to require that a series of insurance market regulatory changes -- including a ban on coverage exclusions for pre-existing conditions -- apply to plans offered by self-insured employers.

He wants to increase the number of uninsured who would qualify for Medicaid coverage. Baucus supports boosting the threshold for coverage to 133 percent of the poverty level; Rockefeller wants to lift that to 150 percent.

Tax Subsidies
Democratic Senator Ron Wyden of Oregon is seeking tax subsidies for insurance purchases available to those earning as much as 400 percent of the federal poverty level, rather than 300 percent as in the Baucus plan. Poverty guidelines for 2009 are $10,830 for an individual and $22,050 for a family of four, according to the Department of Health and Human Services.

Senator Robert Menendez, a New Jersey Democrat, is joining three other Democrats in a proposal to ensure that anyone below the 400 percent threshold who is utilizing either a subsidy or tax credit will pay no more than 10 percent of their income before getting the aid. Baucus has a maximum of 13 percent of income for some consumers at the top end of a sliding scale.

Baucus’s proposed new tax on high-valued insurance plans would be pared back under a proposal by Senator John Kerry, a Massachusetts Democrat. While Baucus imposes a 35 percent excise tax on plans valued at $8,000 for individuals and $21,000 for family coverage, Kerry wants to raise the threshold to $9,800 for individuals and $25,000 for families. He would offset the lost revenue by raising the excise tax to 40 percent and closing corporate tax loopholes.

Republican Changes

On the Republican side, lawmakers are taking aim at tax increases and industry fees. Senator Charles Grassley of Iowa, the top Republican on the committee, wants to eliminate $13 billion in fees that would be imposed on the insurance, pharmaceutical, clinical laboratory and medical-device sectors. He would offset that by tapping funds approved as part of this year’s economic-stimulus measure that haven’t yet been spent.

Senator Mike Enzi, a Wyoming Republican, wants to block any expansion of Medicaid that results in cost increases for states. Senator Orrin Hatch, a Utah Republican, wants to cut the Medicaid expansion altogether, as well as the cooperatives -- which under Baucus’s proposal get $6 billion in federal start-up funds.

Jon Kyl of Arizona is offering a requirement that legal immigrants show proof they have lived in the U.S. for at least five years before getting government help to buy insurance.

Baucus has the benefit of numbers in his favor. The committee is comprised of 13 Democrats and 10 Republicans. He and two other Democrats -- Kent Conrad of North Dakota and Jeff Bingaman of New Mexico -- could be a decisive swing bloc of votes against changes if many of the matters are otherwise decided on party lines.