Shortly after 7 a.m. this morning, the Senate passed its healthcare reform bill, the Patient Protection and Affordable Care Act (HR 3590), along party lines. The 60-39 vote marks the first time in more than a century that the Senate has voted on a Christmas Eve.
After 25 days of floor debate, the Senate adjourned for the year.
The bill, with a cost estimated at $871 billion over the next 10 years, contains no public option like the House bill. However, it does include provisions for mandated benefits. The next step for the bill will be reconciliation later in January.
Before the vote, Senate Minority Leader Mitch McConnell (R-KY) charged that the bill did "not do what it was supposed to," which he said was lower costs. He said that senators who voted for the bill "would get an earful" when they returned home for the holidays.
Senate Majority Leader Harry Reid (D-NV), citing a case from his state where insurance reform was needed, agreed that they would get an "earful," but that it would be of "wonderment and happiness."
For consumers, the most confusing part of the healthcare bill may be when—and if—they will see its benefits. Under the Senate bill, a slate of provisions designed to be immediately visible to consumers would kick in six months after the bill takes effect. But those changes wouldn't affect people who stay in employer health plans. For people who buy insurance on their own, the provisions would only have an effect when they buy a new policy. And one of the health bill's most widely debated features—a mandate that most Americans obtain health insurance or pay a fine—won't take effect until 2014.
Coming off a year in which his remodeling and custom home-building company saw two-thirds less business and had to lay off nearly half its employees, David Crane hopes next year brings an economic turnaround. But Crane worries about how much part of the health reform bill might cost him and other contractors. The Senate legislation requires construction firms with at least five full-time workers and annual payrolls of more than $250,000 to offer health insurance coverage to employees or face fines up to $750 per employee per year. Crane Builders employs seven people, and the company had expected to be exempt from the requirement just like many other types of small businesses that only face the requirements if they had at least 50 full-time workers during the previous year.
All the consolidation that took place in the healthcare industry in 2009 could have a surprising benefit for patients: greater strides toward efficiencies in customer service. That's because larger doctor practices that swallowed up smaller ones have deeper pockets to upgrade their information systems and other infrastructures, which the Obama administration is touting as part of healthcare reform and which studies have shown consumers are demanding. These upgrades include transferring medical records from shoe boxes and file cabinets to computer systems, as well as instituting a payment system that insurers increasingly use to tie how much doctors get based on their performance or their adherence to certain quality measurements.
After helping torpedo the Clinton healthcare plan 15 years ago, the pharmaceutical industry has largely held its tongue this time. The reason is it doesn't want to undermine an $80 billion deal with Democrats to help pay for an overhaul that could end up benefiting the industry. But liberal Democrats now have stepped up their fire against that deal, which may force the industry to up its financial ante. One key factor is a last-minute push by liberals to eliminate a gap in Medicare drug coverage that forces some seniors to pay a significant portion of the cost of their drugs.
Some of the biggest employers are warning that a provision in the Senate's proposed healthcare overhaul could lead to cuts in retiree benefits and a sharp reduction in reported earnings next year. Companies including Boeing Co., Deere & Co., MetLife Inc., and Xerox Corp. plan to lobby Democratic leaders to drop the provision, which would change the tax status of payments for retiree health benefits. Democrats identified the change as a way to help pay for the healthcare overhaul. It would raise about $5.4 billion over 10 years—a relatively small slice of the bill's overall cost—according to estimates. The AFL-CIO has joined the corporate giants in an unusual alliance to warn the provision would encourage companies to drop drug benefits for million of retirees.
The health reform votes in the Senate this week showed Democrats unwavering in the march to adopt a far-reaching overhaul of the healthcare system over united Republican opposition. The votes also marked something else: the culmination of more than a generation of partisan polarization of the American political system, and a precipitous decline in collegiality and collaboration in governing that seemed to move in inverse proportion to a rising influence of lobbying, money, the 24-hour news cycle, and hostilities on talk shows and in the blogosphere. Many senators said the current vitriol was unlike anything they had seen.
When Laura Davie's doctor suggested she go to the hospital next door for her first mammogram last year, she went online instead. Though she ultimately chose the facility her physician recommended, Davie used New Hampshire's HealthCost Web site to compare how much her insurer would pay various hospitals for the procedure. As employers continue to shift costs to workers through high-deductible health plans, consumers are starting to shop around. Even though Davie's relatively low deductible meant she would pay the same amount anywhere, she wanted to choose the least costly option to send a message to her employer and insurer.
Boston Scientific Corp., the world's biggest maker of heart stents, has agreed to pay $22 million to settle allegations the company's Guidant unit reportedly used clinical studies to pay kickbacks to doctors for using its products. Guidant paid physicians $1,000 to $1,500 each to participate in one of four studies it said were designed to assess the performance of pacemakers and defibrillators, the US Department of Justice said in a prepared statement. In reality, the company was paying doctors to select Guidant devices over competing products, the government said. Boston Scientific will enter into a corporate integrity agreement, which requires its cardiac rhythm management unit to disclose payments to doctors on its Web site.
Healthcare providers are rolling out a different sort of stocking stuffer: gift cards that can be used to pay bills and insurance premiums or for specific services at eye doctors and dentist offices. Blue Cross and Blue Shield of Florida might have the largest program, selling cards at more than 1,000 Winn-Dixie and CVS stores in the state. The providers selling them say they can make a good gift, but industry observers contend some cards may not be right for many consumers. In the BCBS program, with a $19 card, recipients save 10% to 50% on braces, dentures, crowns, fillings, oral surgery, and cosmetic dentistry; 20% off brand name and generic medications through most major pharmacies; and 10% to 60% on eye exams, glasses, and contacts. Its $59 card can be used to help pay a premium or toward access to health insurance.
