Senate consideration of the Patient Protection and Affordable Care Act of 2009, H.R. 3590 – the health care reform bill assembled by Senate Majority Leader Harry Reid (D-NV) – has been a slow-moving process. Debate on the bill began on November 29 after the Senate, during a rare Saturday session on November 21, voted 60-39 along party lines to proceed to debate.  Getting the 60 votes to open up debate was a challenge. The struggle is finding a middle ground that satisfies enough moderates and liberals to secure the 60 votes needed to overcome a filibuster.  Thus far, over 300 amendments have been filed and just a little over a dozen have been voted on.
The bill put forth by Senator Reid is estimated to cost $848 billion over ten years and has many of the basic elements of the bills approved by the Senate Finance and Health, Education, Labor and Pensions Committees. H.R. 3590 would expand Medicaid, making it available to people with incomes below 133 percent of the federal poverty line (FPL), and establish a health insurance exchange where the uninsured could shop for coverage. Subsidies would be provided on a sliding scale to people with incomes up to 400 percent of FPL so that they could purchase health insurance in the exchange. The Children’s Health Insurance Program (CHIP), originally set to expire in 2013, would be extended through 2019. Individual and employer mandates are included, as well as consumer protections and insurance market reforms banning lifetime limits and denials of coverage for preexisting conditions. And, in a bold move Senator Reid also included a public insurance plan option with an opportunity for states to opt out if they do not want to participate. The public insurance option has been one of the more contentious issues during the health reform debate.

Human needs advocates have been focused on making sure no ground is lost on the affordability provisions and on making improvements to the bill through the amendment process. Two amendments of particular interest to advocates would strengthen health coverage for children and access to affordable coverage for lawfully residing immigrants.  An amendment introduced by Senator Bob Menendez (D-NJ) and five other Senators would give states the option to eliminate the five-year waiting period for lawfully residing immigrants who need access to Medicaid. Another amendment introduced by Senator Robert Casey (D-PA) would protect and improve CHIP by providing full funding for the program through 2019, setting a floor for income eligibility for children at 250 percent of FPL starting in 2014, guaranteeing Early Periodic Screening, Diagnosis, and Treatment (EPSDT) for CHIP children, and streamlining the enrollment process. It is unclear when the amendments will be voted on at this point. Part of the uncertainty has to do with an announcement made earlier this week.

In an effort to come to some consensus on the public plan option, ten Democratic Senators (5 moderates and 5 liberals) were assigned by Senator Reid to negotiate a compromise. On Tuesday, December 8 they announced that they had developed an alternative to the public insurance option.  Little details of the compromise have been divulged up until now, but the proposal is said to create a new system of private, national insurance plans to be administered by the Office of Personnel Management, the entity which manages health benefits for federal employees, and to open up Medicare to individuals ages 55 through 64. Currently Medicare is only open to people 65 and older. The new proposal has been sent to the Congressional Budget Office (CBO) for a cost estimate and debate on the bill has been suspended while the Senate waits for the CBO analysis.

Timing on the bill is unclear at this moment. Much will depend on the results of the CBO score and whether Senator Reid is able to garner the 60 votes needed for cloture. The Senate hopes to complete action on the bill before the holiday recess.

Subscribe: