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.
Numerous Democrats have complained that many middle income residents would be impacted by this threshhold, which they thought was too low. Senators from four of the states likely to be impacted—Senators Charles Schumer (D-NY), Robert Menendez (D-NJ), Maria Cantwell (D-WA), and John Kerry (D-MA)—have proposed a series of changes to the excise tax that would boost the threshold to $9,800 for an individual and $25,000 for a family, and raise the tax to 40%.
Employer mandate. In the bill released last week, Baucus dropped provisions that would establish an employer mandate; instead, companies would be required to defray costs of providing insurance tax credits to those employees who qualify for assistance. Kerry and Schumer have introduced an amendment to establish an employer mandate. The addition of an employer mandate would likely put the bill more in line with the versions passed by the House and the Senate HELP Committee.
With the House version, employers would be required to provide coverage if they have at least $250,000 in payroll. The companies would have to contribute 72.5% of their workers' premiums—or 65% for family coverage. Those companies would face a payroll tax, starting at 2% for companies with a payroll of $250,000 and increasing on a sliding scale to 8% for those with more than $400,000.
With the STEP version, employers with fewer than 25 employees would be exempt from so called pay or play requirements. Those with 50 or fewer fulltime employees that pay 60% or more of their premiums would get tax credits for up to three years to offset coverage costs. Larger companies (with more than 25 employees) that pay for less than 60% of premiums would face $750 annual penalties for each full time worker above the first 25.