Senate Democrats got a boost on Saturday night with the 60-39 vote to put the new healthcare reform bill into play on the Senate floor following Thanksgiving break.
Here are five senators who likely will be influencing the legislation beginning Nov. 30:
Sen. Harry Reid (D-NV) will be a major influence as the Senate majority leader—while working behind the scenes to get 60 votes together for the final bill.
Sen. Tom Harkin (D-IA), who has taken over the Senate Health, Education, Labor, and Pensions Committee from the late Sen. Edward Kennedy, has been an advocate of wellness and better health initiatives.
Sen. Mitch McConnell (R-KY), as Senate minority leader, has been a strong advocate of not ending but "changing the healthcare debate." He can be expected to rally his fellow Republicans around cost and tax issues related to healthcare reform.
Sen. Jay Rockefeller (D-WV), as a member of the Senate Finance Committee's Health Subcommittee, has pledged during the Finance Committee hearings to introduce numerous amendments to the bill ranging from Medicaid coverage to medical loss ratios. He has been a strong advocate of the public insurance option.
Sen. Christopher Dodd (D-CT), while head of the Senate Budget Committee, filled in this summer for his friend, Sen. Edward Kennedy, in shepherding the HELP Committee's healthcare reform bill to completion after weeks of work. He has often appeared with Sen. Reid in supporting the current bill.
Possibly missing in action on the Senate floor for part of the debate will be Sen. Max Baucus (D-MT), chair of the Senate Finance Committee. Baucus, whose mother is ill, was noticeably absent this past week when the Senate bill was introduced—although he was present on Saturday to cast his vote for moving the bill forward.
When the Senate reform bill was released the middle of last week, Senate Majority Leader Harry Reid (D-NV) maintained that he had the 60 votes needed to proceed with the healthcare debate in the Senate. When it came time to vote in a rare Saturday night session, his prediction proved true.
But can he guarantee that those votes will still be there when the Senate floor debate concludes—presumably by late December?
On Nov. 30, following a short congressional recess during Thanksgiving week, amendments will be permitted to be introduced on the Senate floor for what is now called the "Patient Protection and Affordable Care Act." Reid, charged with piloting the legislation through, said after the vote on Saturday that "we have the momentum to keep this process moving."
While "not all 60 senators in my caucus agree on every aspect of this bill," about 90% of the bill has agreement among Senate Democrats, Reid told reporters after the vote. "All Democrats do believe now is the time to make sure all Americans can access affordable health insurance."
It will be that 10% of the bill, though—which includes the public insurance option—that could be challenging and make or break acceptance of the bill. Four senators—Ben Nelson (D-NE), Blanche Lincoln (D-AR), Mary Landrieu (D-LA), and Joseph Liberman (I-CT)—had said that while they would vote to put the bill into play, they wouldn't go for a bill that contained the current public option.
In speaking on the Senate floor on Saturday, Lincoln specified that while she would vote to put the bill into play, "I am opposed to a new government-administered healthcare plan as part of comprehensive health insurance reform, and I will not vote in favor of the proposal that has been introduced by Leader Reid."
"Although [Sen. Reid] made a lot of progress in blending bills together, I don't think anybody thinks that this bill will pass as is," said Lieberman, on the Sunday morning NBC television show, "Meet the Press." "I voted last night, as 59 others did, to go ahead with the debate because I want us to begin not only debating healthcare reform, but doing something about healthcare reform."
"The public option, a government run insurance company ... [is something] people don't understand what it is, or what it's going to do. It doesn't offer free insurance. It won't get one more poor person insurance," Lieberman said. "It won't force one insurance company to give insurance to somebody who's got a pre-existing condition. And it won't even lower the cost of health insurance, which the advocates said it originally would."
However, this 60-member caucus has shown "unity throughout ... every time there's a major challenge, the caucus comes together for the good of the nation," said Sen. Charles Schumer (D-NY) on CBS' "Face the Nation." "This has been debated for a long, long time. And now the time is to act."
Sen. Sherrod Brown (D-OH), a strong supporter of the public option, said that in the end, "I don't want four Democratic senators dictating to the other 56 of us and to the country—when the public option has this much support—that it's not going to be in it."
He told CNN that in the end "I don't think they want to be on the wrong side of history—I don't think they want to go back and say on a procedural vote, I killed the most important bill in my political career."
In addition, the current Senate bill will be under pressure of Senate Republicans who want "not to end the debate—but change the debate," as Senate Minority Leader Mitch McConnell (R-KY) said Saturday. A frequent appeal expected from the Republicans during the debate is "to start over" with a new bill that will include areas, such as tort reform and insurance coverage that crosses state lines.
Also, Republicans likely will hone in on key tax provisions (such as taxes on devices or high-cost plans), which would go into effect immediately in 2010—while changes in insurance coverage, for instance, would not go into effect until 2014 or 2015. "The status for them will remain quo," said Sen. Robert Bennett (R-UT).
Reid knows that keeping the 60 votes will be a challenge, but he's showing an optimistic view. "We can see the finish line, but it is not there yet."
Just before America prepares for its most ceremonial meal, the federal government's disease agency released two maps showing rates for diabetes and, for the first time, rates for obesity on a county-by-county basis.
The maps show wide areas of the Southeast, Appalachia, and some tribal lands in the West and in the Northern Plains have the highest rates of diabetes and obesity. Rates of diagnosed diabetes exceed 10% in many counties within those areas, and some are as high as 15%. Obesity prevalence is more than 30% in those areas as well, according to the Centers for Disease Control and Prevention.
The highest rates for both diagnoses are found in Kentucky, Tennessee, and West Virginia, where 81% of counties have high rates of both diabetes and obesity. In the south, specifically Alabama, Georgia, Louisiana, Mississippi, and South Carolina, 75% of the counties have high rates of residents with dual diagnoses.
The CDC said that by zeroing in to see the picture in each county, epidemiologists can provide "public health officials with important data to assist them in developing targeted programs to reduce diabetes and obesity."
The maps reflect responses to a telephone survey conducted among a sample of 1.2 million adults 20 and over in all 3,141 counties. Respondents were asked to reply to the question: "Has a doctor ever told you that you have diabetes?"
To determine obesity, respondents were asked to report their height and weight, which was then calculated by the survey as a body mass index.
"The small-area estimates for obesity will be an important tool to help communities better understand and battle this serious public health problem," said William H. Dietz, MD, director of CDC's Division of Nutrition, Physical Activity and Obesity. "Communities are in the best position to prevent and reduce obesity among their citizens through innovative programs."
The maps show that counties with high obesity prevalence are highly correlated with counties with high diabetes prevalence.
Moderate Senate Democrats threatened to scuttle healthcare legislation if their demands aren't met, while more liberal members warned their party leaders not to bend. The dispute among Democrats foretells of a rowdy floor debate next month on legislation that would extend healthcare coverage to roughly 31 million Americans. Republicans have already made clear they aren't supporting the bill. One major sticking point is a provision that would allow Americans to buy a federal-run insurance plan if their state allows it. Moderates say they worry the so-called public option will become a huge and costly entitlement program and that other requirements in the bill could cripple businesses.
Democratic leaders finally moved their sweeping health bill to the Senate floor, where wheeling and dealing over major unresolved and divisive issues likely will shape the legislation before its next big test. A handful of Democrat centrists say they can't support the government-sponsored health-insurance plan—known as the public option—that is included in the bill. And Democrats are divided over abortion, an issue that nearly derailed the House earlier this month when it narrowly passed a health bill that blocked abortion coverage from federally subsidized insurance plans, including some run by private insurers. Another growing concern even as the bill progresses is the political heat on Democrats over expanded government spending amid rising unemployment and deficit concerns.
Leaders of the Church of Christ, Scientist, are pushing a proposal that would help patients pay a spiritual healthcare specialist for prayer by having insurers reimburse the $20 to $40 cost. The provision was stripped from the bill the House passed this month, and church leaders are trying to get it inserted into the Senate version. And the church has powerful allies there, including Sens. John F. Kerry (D-MA), who represents the state where the church is based, and Orrin G. Hatch (R-UT), who said the provision would "ensure that healthcare reform law does not discriminate against any religion." But opponents of spiritual care coverage—a coalition of separation-of-church-and-state advocates, pediatricians, and children's health activists—say such a provision would waste money, endanger lives, and, in some cases, amount to government-funded prayer.
The role of public hospitals in America has been remarkably consistent over the decades, in spite of healthcare policy debates, insurance trends, and shifting medical advice. They were centers of last resort, where the quality of care could be inconsistent and the finances often a disaster, but where the poor could always be served. But a deal struck last week between Los Angeles County and the University of California to rescue the Martin Luther King Jr. hospital followed a pattern set by many other public centers across the nation that have found that teaming with outside help can lead to more efficient operations, and often improved care. The Martin Luther King Jr. hospital, which cared for patients in the severely underserved South Los Angeles area, was closed in 2007 after a series of errors, some of them fatal. But under a proposal approved by the University of California Regents, the hospital, previously known as Martin Luther King Jr.-Harbor Hospital, will no longer be run by the county, but will be a nonprofit organization governed by a seven-member board of directors.
Anxious that Saturday's party-line Senate vote to open debate on a healthcare overhaul gives them little maneuvering room, Obama administration officials and their Congressional allies are stepping up overtures to select Senate Republicans in hopes of winning their ultimate support. The two moderate Republican senators from Maine, Susan Collins and Olympia J. Snowe, say Senator Harry Reid, the majority leader, reached out to them after he unveiled the Senate measure, encouraging them to bring forward their ideas and concerns. After the party-line vote of 60 to 39 on Saturday night to move to a full healthcare debate, including votes on significant amendments, both sides are acutely aware of the wavering in their ranks and are trying to figure out how to play the numbers.
Buoyed by their weekend victory on a vote beginning the healthcare debate, several Senate Democrats expressed optimism they could find a way to keep a government-run insurance plan in the sweeping bill. The public insurance option in the Senate's healthcare overhaul is so modest that it "will, at the end of the day, be where we end up,'" predicted Senator Chuck Schumer, a New York Democrat who is working with moderates to find a compromise. He spoke on CBS's "Face the Nation.'" Democratic leaders need to win over a handful of skeptical Democrats and Republican moderates, as they did on Saturday night to proceed with debate, to get the required 60 votes to end the debate sometime in coming weeks and get to a vote on final passage.
Worries that widespread screening for breast and cervical cancers can yield limited benefit and lead to unnecessary harm prompted decisions by two medical organizations to recommend less preventive testing. The American College of Obstetricians and Gynecologists announced revised recommendations for Pap tests, saying young women should begin getting the cervical-cancer screening test at a later age and at less frequent intervals than previously recommended. The news followed breast-cancer guidelines announced last week by a federally funded task force that created an uproar by saying women could wait until they are older to begin routine mammography screenings and have them less frequently than currently recommended. Critics said the changes may have been driven by efforts to control healthcare costs. Both organizations denied that notion, and rejected assertions they timed their announcements to coincide with the healthcare debate in Congress.
