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

Among other provisions included in the manager's amendment are:

Medical loss ratios. Large group market plans must spend at least 85% of their premium revenues on clinical services and quality activities; for the individual and small group market, the ratio is 80%.

Excessive rate increases. A health insurer's participation in the state exchanges will depend on its performance.

Expansion of delivery system reforms. The secretary of Health and Human Services would have authority to expand successful Medicare programs, such as payment bundling and other value based purchasing projects, and could incorporate private sector payment models into the Medicare accountable care organization program.

Pre-existing condition exclusions for children. Health insurers will be immediately prohibited from excluding coverage for children with pre existing conditions.

Testing new tort models. States will be eligible for grants to test alternatives to civil tort litigation that emphasize patient safety, disclosure of healthcare errors, and early resolution of disputes.

Medicare tax. The Medicare payroll tax increase would be increased to 0.9%, from 0.5% that was proposed earlier, for individuals earning more than $200,000 or families making more than $250,000.

Cosmetic surgery tax. The so-called "Bo tax," is being dropped in favor of a 10% tax on indoor tanning salons.

The next vote on the Senate bill is scheduled for Tuesday morning. The bill is unlikely to garner any Republican votes.

Sen. Olympia Snowe (R-ME), who voted for the Senate Finance Committee bill, said Sunday on "Face the Nation" that "we're treating it as if it's the legislative appropriations at the end of the year. It's like the last train leaving the station; we're going to dump everything in there."

She said the current bill is "more expansive" than the Finance Committee bill--including for instance a new provision of long-term care insurance. "It...is a whole new entitlement that frankly will turn in the red five years after the benefits begin."