Senator Harry Reid (D-NV), Senate majority leader, wants to rush the Senate health care legislation through the process by July 27, 2009. It’s not hard to see why.
After 13 days of intense debate, the Senate HELP Committee just finished work on the Senate bill (The Affordable Health Choices Act) and reported it to the full Senate for consideration. During the Committee consideration of the bill, there were hundreds of amendments, dealing with topics ranging from abortions to funding jungle gyms. Much of the internal Committee debate received little attention in the major media. But the Committee’s decisions, if the Senate bill is enacted into law, will affect every American. Consider some of the key decisions:
Covering Abortion. (Mikulski Amendment #201 ) Sen. Barbara Mikulski (D-MD) offered an amendment that would require health insurers to include “essential community providers” in their networks. They would provide “preventive care services” for women. These entities include providers like Planned Parenthood clinics, which perform abortions. Few Americans would be comfortable knowing that federal dollars would be funding abortions. In effect, this policy is directly contrary to previous congressional funding restrictions on abortion payment, such as the Hyde Amendment. Republican Senators’ attempts to exclude abortions from the bill failed.
Financing Neighborhood Construction. (Coburn Amendment #49 ) To foster creation of healthier communities, the Senate Committee bill would provide federal community transformation grants to state and local governments. However, the legislation offers only broad guidelines as to where the money can go and does not limit the size of the grant. Sen. Tom Coburn (R-OK) offered an amendment that would prohibit the use of grant money to build and maintain sidewalks, parks, bike paths, or street lights. Other federal programs already direct money toward these projects. Dollars designated for improving the health care system, Coburn argued, could be spent on far more constructive areas, such as increasing access to health care. Remarkably, Coburn’s amendment failed on a straight party-line vote, meaning taxpayers’ hard-earned dollars can wastefully go towards projects that are already funded by the federal government.
Expanding Bureaucracy. (Coburn amendment #110) The Committee bill grows the size of the government significantly – it creates new administrations and places immense power in the hands of certain bureaucrats. Sen. Coburn’s amendment would have prevented the expansion of government and runaway federal spending by maintaining the current number of bureaucrats. His amendment was defeated. Even as the nation’s unemployment approaches ten percent, the federal bureaucracy will expand.
Expanding Welfare Eligibility. (Coburn Amendment #205) Medicaid is a poorly-performing welfare program. Ideally, it should be reformed, not expanded. Sen. Tom Coburn (R-OK) introduced this amendment to ensure that the Committee bill’s provisions do not expand Medicaid eligibility standards and attempt to increase the number of Medicaid enrollees. State and federal budgets are already heavily strained, and the increased burden of covering the cost of more Medicaid services would be unbearable for taxpayers in many states. Coburn’s amendment failed. This means that the federal government and states, both already in budget crises, will be forced to spend even more on Medicaid.
A Taste of Their Own Medicine. (Coburn Amendment #226) For many liberals in Congress, a new public health insurance plan, to compete against private health insurance, is an absolute “must” for health care reform. Virtually all independent analysts estimate that, given the special advantages of taxpayer subsidies and regulation, that the competition would be rigged, and millions of Americans with private health insurance today would be dumped by their employers into the new public plan. Sen. Tom Coburn (R-OK) proposed an amendment that would require all members of Congress and their staffs to enroll in the newly-created public health insurance plan. This means that they would be required to give up their private insurance coverage (nationwide there are 283 plans competing for federal employees’ dollars), which is today provided through the popular and successful Federal Employees Health Benefits Program (FEHBP). With many members of Congress openly willing to create incentives that would drive Americans out of their existing private coverage, Sen. Coburn put his colleagues to a test. Although 10 Senate Democrats voted against it, the Coburn amendment passed by one vote. Taxpayers should watch very closely whether this amendment is preserved or buried.
Higher Taxes and Doctors Payment Cuts. (Roberts Amendment #207 , Roberts Amendment #208) Senator Pat Roberts (R-KS) offered two amendments that would have prevented the government from raising taxes, increasing the individual mandate penalty, or decreasing payment rates to Medicare providers to cover the cost of subsidies given to low-income individuals for their insurance premiums and out-of-pocket costs. Otherwise, under the Senate bill, taxpayers would have to shoulder the burden of increased taxes, and physicians would be vulnerable to even lower government reimbursement rates for practicing in Medicare. Both amendments failed.
Blocking Anti-Rationing Amendments. (Roberts Amendment #1 , Coburn Amendment #9, Enzi Amendment #7) The Committee bill calls for an increased role of comparative effectiveness research (CER). A number of Senators fear that federal officials could use the data to determine payment, treatment, and coverage decisions, subordinating professional medical judgment in the treatment of patients to regulatory or budgetary considerations. These three amendments would have prohibited the use of CER to mandate coverage, deny care, or ration. CER, if used as a rationing tool, would obviously interfere with the traditional doctor-patient relationship. All three amendments failed on straight party-line votes. You can learn more here.
The giant Senate and House health bills would impact the personal lives of 300 million Americans. Ordinary citizens should understand that these measures are not merely focused on ways to control costs and expand coverage; they touch on how and what kind of care Americans will get, and under what circumstances they would get it. The disposition of these Senate amendments is just one indication of how members of Congress really feel about some of the most contentious issues in health care policy. It is time for every American to read these bills.
This post was co-authored by Julius Chen.