WASHINGTON — As their Finance Committee resumed work Tuesday on Chairman Max Baucus' health care overhaul legislation, Senate Democrats appeared to be dividing into three important camps: those solidly behind Baucus, D-Mont., those reluctantly leaning in his direction and a handful of wild cards, who'll wield great influence.
Baucus and four other Democrats sided with 10 Republicans Tuesday to kill a proposal to add a government-run "public option" health insurance program to his bill, and a similar proposal was defeated 13-10. Baucus thinks that the Senate never will pass a health-insurance overhaul that includes a public option.
Liberal Democrats, however, vowed to push a public-option amendment when the legislation reaches the full Senate floor.
"We are going to keep at this and at this and at this until we succeed, because we believe in it so strongly," said Sen. Charles Schumer, D-N.Y.
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Baucus is hoping that his panel will wrap up work on the bill this week. To get the votes he needs, however, he's sure to have to make more concessions, both in committee and on the Senate floor, without alienating the backers he already has.
For example, to appease committee Democrats with close ties to labor, Baucus might have to raise the dollar value of high-cost health care plans that will be subject to an excise tax. To keep moderate Democrats, he'll have to keep the cost of the package to $900 billion over the next decade. That might make it trickier to assuage Democrats who want to include more generous subsidies to help lower-income people. Further, a dozen or so centrist Democrats surely will raise concerns about the plan's cost when the bill reaches the full Senate.
While few, if any, Republicans are expected to support the bill, Baucus continues to press for bipartisan support.
His legislation would require most people to buy insurance and create exchanges in which individuals could purchase coverage. It would provide subsidies to help people buy health insurance. It also would expand Medicaid, the federal-state health insurance program for poor people and those with disabilities.
"The central challenge is making the pieces of health reform fit together so that at the end of the day, we contain costs and all Americans get quality, affordable coverage," said Finance Committee member Ron Wyden, D-Ore. "If you don't do that, what happens is you have this collection of various changes — nearly always ratified by powerful interest groups — that ... don't really significantly contain costs or reform health care."
Democrats hold a 13 to 10 advantage over Republicans on the committee.
Among the committee Democrats who are considered solidly behind Baucus' plan are Jeff Bingaman of New Mexico, John Kerry of Massachusetts, Kent Conrad of North Dakota, Maria Cantwell of Washington state and Robert Menendez of New Jersey.
Three others — Schumer, Jay Rockefeller of West Virginia and Debbie Stabenow of Michigan — have made tough demands on Baucus.
For example, Rockefeller and Stabenow opposed provisions in Baucus' original plan that would have taxed the insurance plans of many unionized workers in their states. Stabenow also has expressed concern that any overhaul must guarantee that insurance is affordable for middle-income workers.
Rockefeller and Schumer think that the current bill would be inadequate to force private insurers to bring down their premiums and change discriminatory practices. "There really isn't an alternative (to a public option) except for the status quo," Rockefeller said.
Rockefeller, Schumer and Stabenow are expected to side with Baucus when the final committee vote is called. Like other Democrats who would've drafted a bill different from the Baucus plan, they don't want to allow the opportunity to pass a health care overhaul to slip away as it did for former President Bill Clinton and Democrats in 1994.
Finance Committee moderate Thomas Carper, D-Del., is expected to be with Baucus in the end but might push for changes in the bill. In a sign of loyalty to Baucus as well as pharmaceutical manufacturers in his home state, he voted with the chairman to defeat an amendment that would've weakened a deal that Baucus, the White House and the drug industry struck on the industry's financial contribution to the cost of a health care overhaul.
Still another Finance group that Baucus must corral is the "wild card" Democrats, who, because of an array of pressures, haven't yet come to his camp. They include Wyden, who's warned that he might not vote for the bill unless it's beefed up to promote more competition among insurers and provide more affordable insurance to many Americans.
Sen. Blanche Lincoln, D-Ark., is in the wild-card category too, although she's been complimentary of the Baucus plan and is expected to support it. The reason: She's facing a tough re-election campaign. So far, she's carefully navigated committee votes, generally siding with her party but a few times casting her lot with Republicans.
Sen. Bill Nelson's position on the package is unclear. The Florida Democrat has failed in attempts to amend the bill to protect some Medicare Advantage beneficiaries from cuts. He also pushed unsuccessfully for larger discounts on drugs for Medicare beneficiaries than those that are in the deal that Baucus, the White House and the drug industry negotiated earlier this year.
Carper, Conrad, Lincoln and Nelson joined Baucus on Tuesday in voting down a public option.
The Finance Committee's bill must be melded with a separate version passed by the Health, Education, Labor and Pensions Committee that includes a government-run option and a mandate that insurers provide coverage. Once they're merged, Senate Democratic leaders such as Majority Leader Harry Reid of Nevada and Health Committee Chairman Tom Harkin of Iowa are likely to push for passage, probably in mid- to late October.
Expect the wild-card crowd to grow on the Senate floor, with Democratic moderates such as Evan Bayh of Indiana, Ben Nelson of Nebraska and Mary Landrieu of Louisiana.
Baucus continues to court Maine Republican Sen. Olympia Snowe, who's said that she still has a number of concerns about the bill, ranging from the mandate that individuals purchase health insurance to the question of affordability and the measure's cost. Her proposal to trigger the public health-insurance option only if coverage isn't affordable to 95 percent of a state's residents is likely to get more attention.
(Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy-research organization that isn't affiliated with Kaiser Permanente.)
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