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Three Possible Changes to the Senate Finance Health Reform Bill

Janice Simmons, for HealthLeaders Media, September 21, 2009

Fasten your seat belts: It's going to be a lively week with the Senate Finance Committee as it gears up Tuesday to consider 564 amendments to the healthcare reform bill introduced by panel chairman Max Baucus (D-MT) last Wednesday.

The amendments touch nearly every aspect of the bill--meaning a very different version could be emerging from Finance. This bill, when completed and finally passed, will be merged with the healthcare reform bill passed in July by the Senate Health, Education, Labor and Pensions (STEP) Committee.

Here are three larger areas that could see changes as the committee marks up the bill:

Public insurance option. The current bill, called America's Healthy Future Act, doesn't have a public insurance option. It was excluded after Baucus convened a bipartisan group of senators on the Finance Committee and decided as an alternative to include options for state health insurance cooperatives, as initially proposed by Sen. Kent Conrad (D-ND).

One of the opponents of the co-ops is Sen. Jay Rockefeller (D-WV), who is chairman of the Finance Committee's Health Subcommittee. In a letter sent to Baucus and Senate Finance ranking minority member, Sen. Charles Grassley (D-IA), Rockefeller sharply criticized co-ops--saying it would be "irresponsible to invest over $6 billion" in the concept.

Instead, Rockefeller, who proposed an amendment, said that "inclusion of a strong public plan option in health reform was a must." The votes for a public option amendment may be there—depending on what Democratic moderates, such as Sen. Ben Nelson (D-FL), decide. The membership of the committee is 13 Democrats and 10 Republicans. Sen. Jeff Bingaman (D-NM), who was on Baucus' healthcare reform panel, said last week that he would support a public option if it's proposed.

Excise tax. The Chairman's Mark released last week imposes an excise tax on insurers if the aggregate value of employer sponsored health coverage for an employee exceeds a threshold amount. The threshold amount is $8,000 for individual coverage and $21,000 for family coverage for 2013. The tax is equal to 35% of the aggregate value that exceeds that threshold amount.

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