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Dec. 14, 2009: All Senate Majority Leader Harry Reid (D-Nevada) wants for Christmas is 60 votes to approve the Senate’s health care reform legislation. However, finding common ground between liberal and conservative Democrats is proving extremely challenging for Sen. Reid. Indications were that a vote would be taken this past weekend, but a proposal to allow individuals ages 55 to 64 to buy in to the Medicare program has produced strong opposition from Sen. Joe Lieberman (I-Conn.) who is critical to the vote.
Sen. Reid’s challenge was not helped by a report released Dec. 11 that found that health care spending actually will grow slightly, not shrink, under health care reform. In fact, the report from the U.S. Health and Human Services Department says health care spending will grow more rapidly than if Congress does nothing. The failure of the legislation to bend the cost curve strengthens the House proposal of an Independent Medicare Advisory Commission. Much like the base closure commission, the IMAC could recommend a package of cost savings that Congress could overturn in total only by a super majority.
The report also says that the savings in Medicare over 10 years rely on specific policy changes which could lead to cuts in services. Sen. Kay Bailey Hutchison (R-Texas) has not been allowed to introduce her amendment repealing Medicare cuts in the legislation. There is no “pay for” provision, and at this point, Sen. Reid is not allowing votes on amendments.
According to the report, cuts in Medicare in the legislation would threaten the profitability of roughly one in five hospitals and nursing homes over the next decade. Simulations suggest that 20 percent of institutional medical providers would become unprofitable within a decade, and a possible result could be providers dropping participation in Medicare which would impact access to care.
The analysis from HHS’ Office of the Actuary looked at total public and private costs over the next 10 years. In contrast, the Office of Management and Budget focuses on the impact of the legislation on the federal deficit.
Other issues of concern surfaced last week including questions about provisions expanding the Community Living Assistance Services and Support Act, which helps fund long-term and home care. Eligibility, benefits and long-term solvency present problems. The HHS report predicts CLASS expansion would fail because premium costs would increase steadily due to a disproportionate number of enrollees with poor health. Senators also are working to ensure that no federal funds support abortions in any way.
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