Last leg

Congress primed for fi­nal push to­ward re­form

Modern Healthcare - - The Week In Healthcare - Matthew DoBias

Af­ter a gru­el­ing leg­isla­tive ses­sion and a mad dash to the fin­ish line, law­mak­ers from both the House and Se­nate last week be­gan the process of meld­ing two sim­i­lar but widely di­ver­gent health over­haul pack­ages de­spite an out­come that should hold few sur­prises.

In a po­lit­i­cal ef­fort to cor­ral the 60 votes needed to move ahead with their bill, Se­nate leaders cut a num­ber of last-minute deals that could hand­cuff House mem­bers from push­ing for broad changes that are al­ready in­cluded in their bill.

House Democrats have been put in a po­si­tion where they have had to de­fend the pol­icy changes in their bill while fend­ing off ac­cu­sa­tions that the Se­nate’s bill will sim­ply trump their own.

Ma­jor dif­fer­ences hound the two leg­isla­tive pack­ages. For starters, the House bill is more ex­pen­sive, clock­ing in at $1.1 tril­lion over the next 10 years vs. the Se­nate’s $871 bil­lion bill. Pres­i­dent Barack Obama has said that he wants a bill that costs less than $900 bil­lion.

The House also in­cludes a mea­sure that would cre­ate a na­tional pub­lic health in­sur­ance op­tion—some­thing that has proved com­bustible in the Se­nate.

Other dif­fer­ences cen­ter on an em­ployer man­date—the House has one; the Se­nate does not—and an ex­pan­sion of the Med­i­caid pro­gram. The House’s ex­pan­sion is more gen­er­ous than the Se­nate’s.

The cham­bers also split on how to pay for the bill. The House in­cludes a tax on high wage-earn­ers, those in­di­vid­u­als mak­ing more than $500,000 per year or joint fil­ers mak­ing in ex­cess of $1 mil­lion. The tax is ex­pected to raise more than $460 bil­lion over 10 years.

The Se­nate’s pack­age, how­ever, re­lies on a

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