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Some States Getting Preferential Treatment in Senate Reform Bill, Critics Charge

Janice Simmons, for HealthLeaders Media, December 21, 2009

Neither a record two-foot snowfall in Washington nor the gloom of night kept the Senate from voting 60-40 Monday after 1 a.m. on the first procedural vote to move ahead the Senate's healthcare reform bill.

The vote puts the Senate in position to have a final vote on the bill by Christmas Eve—and provides both sides time to debate the new 384-page manager's amendment released by Senate Majority Leader Harry Reid (D-NV) on Saturday morning.

Not surprisingly, gone is any public insurance option and an option to permit uninsured individuals ages 55-64 to buy into Medicare. Included is the provision proposed earlier this month in which multi-state private insurance plans would be offered under contract with the federal Office of Personnel Management, with at least one of the plans being a nonprofit entity.

But the issue that is likely to trigger major discussions this week is whether certain states are getting preferential treatment in the bill to ensure votes. On Sunday, Republicans were quick to point out that provisions were included in the bill for at least one state—Nebraska—and several others whereby the federal government would agree to pay for additional Medicaid costs incurred when newly insured enrolled. Nebraska is the home state of Sen. Ben Nelson, a Democrat who had considered not voting with his party in part because of the abortion language in the bill.

Senate Minority Leader Mitch McConnell (R-KY) said on Sunday that "when you decide to do something one-party only and you have 60 votes, you're open for business." He added: "It creates a smelly proposition. It exposes every one of those 60 to extract some special deal for them at the expense of everyone else in the country."

Sen. Kent Conrad (D-ND), speaking on Fox News Sunday, downplayed the controversy, saying that his "state gets a special deal" and "virtually every state gets some kind of differential treatment based on their situation." He added that North Dakota and "the other frontier states" under the bill will "get an increase in their Medicare levels of reimbursement because we're the lowest states in the country—and that doesn't offend me at all. It's, in fact, fair."

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