WASHINGTON — Health care reform took a major step closer to becoming a reality late last month when Democrats in the Senate were able to muster the necessary votes to block a Republican filibuster and move their proposal forward.
The procedural vote, which was held shortly after 1 a.m. on a Sunday night, saw all 58 Democrats and two independents vote to cut off the Republican filibuster. It opened the door for the Senate bill to go to a Christmas Eve vote in which it was expected to pass by the same 60-40 margin.
“Our bill will bring needed relief to millions and millions of Americans who wake up every day without health insurance, or wake up every day afraid they are going to lose their health insurance,” said Senate Majority Leader Harry Reid (D., Nev.).
President Obama, who has said he hopes to sign the final bill into law before his State of the Union address, called the Senate’s decision to move health care reform a “big victory for the American people.”
The measure must now be reconciled with the health care reform bill passed by the House of Representatives in November. Observers note that there are major differences between the two proposals.
Despite predictions by some experts that the Senate version is likely to survive the reconciliation process virtually intact, House Speaker Nancy Pelosi (D., Calif.) has said she will not just accept the Senate bill as written. That could lead to problems down the line as some Senate Democrats have warned that they could turn against the bill if changes made during negotiations with the House are not to their liking.
The most glaring difference between the bill passed in the House and the proposal that was expected to clear the Senate last month is the so-called public option.
Included in the House bill, the public plan did not survive debate in the Senate. Instead, the Senate created health insurance exchanges through which uninsured individuals and small businesses would be able to shop for health care coverage.
The exchanges would be private, nonprofit entities. The idea is that by pooling their resources, the self-employed and unemployed would be able to buy less-expensive insurance.
In addition, the Senate bill would sharply expand Medicaid — the federal/state health program for the poor — and create tax subsidies to help low- and middle-income people comply with a new mandate to carry insurance.
The measure would generally leave the established employer-based health insurance system intact, but larger companies would be required to pay a fee to the government if they did not offer affordable insurance to employees and if the employees later sought government help in paying for insurance.
Last-minute additions to the Senate measure toughened restrictions on insurers. Starting this year, they would be barred from denying coverage to children with preexisting conditions. That provision would apply to adults starting in 2014.
To pay for the program, the measure would cut $480 billion in payments to Medicare providers over the next decade.
The Senate bill also would impose billion of dollars in new fees on insurers, medical device makers, pharmaceutical makers and others. And it would establish a tax on insurers offering high-value health policies.
Advocates of community pharmacy say the Senate measure provides at least one thing they were looking for — a ban on the reimportation of prescription drugs.
“The U.S. distribution system is already one of the safest in the world, and we are pleased that the Senate acted to preserve the system,” National Association of Chain Drug Stores president and chief executive officer Steve Anderson says.
However, White House officials say that the issue of reimportation may not be completely dead.
Speaking on the CNN program “State of the Union,” White House aide David Axelrod said the president, who has gone on record as supporting some reimportation, is likely to push for the practice after the health care reform bill is finished.
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