Senators to start work on revised health care bill

[September 22, 2009]  WASHINGTON (AP) -- Senators challenging the latest proposed health care overhaul already have won concessions that include reducing a penalty for Americans who don't buy insurance, and hundreds of other changes are up for debate as a powerful committee takes up President Barack Obama's top domestic priority.

The Senate Finance Committee -- the last of five panels to have a say before the full Senate debates legislation -- will consider a 10-year, nearly $900 billion plan Tuesday by Chairman Max Baucus. The Montana Democrat has spent months striving for bipartisan common ground. Senators have filed 564 amendments, some of which would make major changes to his carefully crafted framework.

Ahead of the vote, Baucus labored to address serious concerns from fellow Democrats and a key Republican about insurance costs.

"We've come a long, long way to satisfying the affordability concerns," Baucus said after an evening meeting Monday with committee Democrats. He wants to finish committee work on his bill by the end of the week.

But Baucus faces the difficult task of keeping the 13 Democrats on board without moving so far to the left that he alienates Sen. Olympia Snowe, R-Maine, the only one of the panel's 10 Republicans considered a possible vote for the bill.

"It is probably the most important domestic legislation that many of us are going to be working on in our careers and it's very complicated. We want to do it right," Baucus said.

The Baucus plan would extend coverage to about 29 million Americans who lack it now, and end onerous insurance company practices, such as charging higher premiums for women and denying coverage to people in poor health. It would make almost everyone buy insurance or pay a fee, while expanding Medicaid to cover more low-income people and providing subsidies to many in the middle class. It would create new online exchanges where small businesses and people without government or employer-provided insurance could shop for plans and compare prices.

Release of the bill last week gave a boost to Obama's health care agenda after a summer of angry town hall meetings, though plenty of political and policy hurdles remain before Congress could send a bill to the president.

A number of committee Democrats had raised concerns about whether subsidies in Baucus' bill are generous enough to make insurance truly affordable for low-income people. There also are worries about a new tax on high-cost insurance plans, which critics fear would hit some middle-class workers, including many union members in risky occupations such as mining and police work.

Those concerns were shared by Snowe, whose support could become even more critical if legislation makes it to the Senate floor, where Democrats need 60 votes to pass the bill.

Senators offered multiple amendments on both issues and Baucus was incorporating some of the approaches in revised legislation he'll offer the committee. Baucus said he is considering lowering the penalty of up to $3,800 his bill would levy on households that don't buy insurance.

Sen. Kent Conrad of North Dakota, a key Finance Democrat, said Baucus also is looking at ways to allow more middle-class families to qualify for subsidies by limiting what they pay in premiums.

Senators are also considering adjusting the new tax on high-value insurance -- now set to hit plans valued at $21,000 for a family and $8,000 for an individual.

The changes could add to the cost of the bill, initially estimated at $856 billion over 10 years. But there is some wiggle room, since the original proposal generated more money than it spent.

Baucus' legislation is the most conservative, cheapest and closely watched of the health care bills in Congress. The Finance Committee has a moderate makeup that resembles the Senate as a whole, so legislation that passes Finance could find favor on the Senate floor.

Affordability is hardly the only sticking point. Liberals like Sen. Jay Rockefeller, D-W.Va., want to include a new public insurance plan to compete with the private market. Baucus included nonprofit co-ops instead, and Rockefeller plans to try to delete those and add a public plan. Committee Republicans, for their part, have readied amendments to strike core portions of the bill and replace them with GOP priorities such as caps on medical malpractice payouts.

If the Finance Committee approves the bill, Senate leaders would have to combine it with a more liberal version passed by the Health, Education, Labor and Pensions Committee before bringing legislation to the Senate floor. A similar process is happening in the House with bills passed by three committees there. House and Senate Democratic leaders are both aiming for floor action this fall. Obama wants to sign a bill this year.

House Speaker Nancy Pelosi reiterated that timetable during an appearance in Philadelphia on Monday after touring a hospital there.

"We will have legislation that will be passed in a matter of weeks, it will be signed in a matter of months by Barack Obama and it will have a very positive impact on America's families," Pelosi said.

And Pelosi again said the House couldn't pass a bill without a public insurance plan.

[Associated Press; By ERICA WERNER]

Associated Press writers Joann Loviglio and Ricardo Alonso-Zaldivar contributed to this report.

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