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Health reform is a done deal

That’s the word from several senators, at least as of last night. The last holdout, Ben Nelson of Nebraska, is reportedly on board after a lengthy negotiating session that ended late Friday.

The bill is currently being read to the entire Senate on request from GOP Senators, after which the vote will be taken – sometime around 5 o’clock this afternoon. The price for Nelson’s vote was $45 million; the US Senator forced the Federal government to pay for the entire cost of the Medicaid expansion for his home state of Nebraska.
Who would’ve thought Nebraska would need even more pork, or that the Senator would feel no shame in forcing taxpayers from other states to pay for his vote. Since 1983, Nebraska has received more from the Federal government than it has paid in taxes; Nelson’s extortion will skew the numbers in favor of his voters even more.
Things could break down, there could be defections from the ranks of the theoretically-committed, Lieberman could decide he’s not done grandstanding, the House and Senate could run into difficulties in reconciliation, a meteor could hit the earth…suffice it to say there’s a lot that could derail passage, but there’s the beginning of a whiff of inevitability about reform, enough to make it very difficult for anyone to stand in the way of the bill.
In broad terms, the bill will result in a national health insurance exchange where individuals and some small businesses will shop for insurance, provide subsidies to help low-income people buy insurance and expand Medicaid. There are numerous pilot programs to evaluate different forms of reimbursement, cuts in Medicare reimbursement to specific provider groups, elimination of the use of medical underwriting and other ‘risk selection’ tools by insurers, and a host of excise taxes, fee cuts, and other funding mechanisms to help pay for the bill.
I’ll be taking a deeper dive into the bill tomorrow – but I won’t read the entire thing.

One thought on “Health reform is a done deal”

  1. There’s a lot of talk these days of the dysfunctionality of the Senate, blah, blah, blah. Indeed, it is functioning just as it was designed, as a brake on the radical and impulsive tendencies of the House, regardless of the party in power.
    Joe highlights the absurd power of Ben Nelson, which points to where the true dysfunction lies — in the way we elect Senators. House members represent districts that are proportionate to population, and with some marginal variances district-by-district, that gives them an equally proportionate access to constituents, interest groups and fund-raising cash.
    But in the Senate, there are just two per state, each running for election in different cycles. Those in low-population states generally have fewer ways to raise money to run. So they are practically obligated to raise money from interest groups that may have little to no stake in their states. And the scale heavily tilts in favor of the incumbent, even more so than usual.
    A Senate candidate from New York could probably raise the $50 million they need to run just by dialing numbers in the 212 area code (Manhattan). Lobbying interests in agricultural or resource-heavy states probably have little sway with Senators from places like that.
    Conversely, a Senator from, say, Kansas, would still need to hit up interests on Wall Street or among the HMOs because there just aren’t enough Kansas-based lobbying groups to raise cash from.
    I honestly don’t know the solution to this problem, but until we find one, we will find difficult legislation held hostage by Senators from low-population, mostly rural states, since they disproportionately must fund-raise, and therefore be beholden to, lobbying interests outside their own borders.

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Joe Paduda is the principal of Health Strategy Associates




A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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