On September 23, 2009, the Senate Finance Committee continued its markup of the Baucus health bill, the “Chairman’s Mark” , of the America’s Healthy Future Act of 2009.
While fewer than ten amendments were voted on at the September 23rd mark up of the bill, there are still more than 500 filed. Senator Max Baucus (D-MT), Chairman of the Senate Finance Committee, says he wants to complete the mark-up of the conceptual language (not the actual bill language) by the close of business on September 25th.
Senators made a number of key decisions concerning the deliberations on the bill itself and policy issues that would affect millions of Americans. Of note are six major Senate decisions:
- Transparency of the Bill Language Itself. ( Amendment C4). Senator Jim Bunning (R-KY) offered an amendment that would have required that actual legislative text, as well as a final Congressional Budget Office (CBO) estimate of the cost of the bill, be posted for 72 hours on the Senate Finance Committee website for public review before the Senate Finance Committee could vote on its final passage. Senator Bunning, along Senators Olympia Snowe ( R-ME) and Pat Roberts (R-KS) strongly supported this amendment, citing Americans’ desire for transparency in the process and the need to obtain an accurate cost analysis from CBO. The Bunning amendment was defeated on a largely party-line vote, with all Senate Democrats – with the exception of Senator Blanche Lincoln (D-AK)- voting against it. Opponents offered a number of objections, including the fact that the Senate Finance Committee was under no such previous expectations, and that most Americans would not be able to understand the legislative language anyway. Senator Baucus and the Senate majority instead voted to post the “conceptual language” and a “complete cost analysis from CBO” ahead of the Committee vote on final passage.
- Patient Access to Physicians in Medicaid and Medicare. ( Cornyn D2 and D4). Senator Cornyn (R-TX) offered two amendments to protect the doctor –patient relationship in Medicare and Medicaid. Under the first Cornyn amendment (D 2) , the Senator proposed that the Secretary of HHS must certify that at least 75 percent of the physicians in the United States would accept Medicaid patients before the proposed mandatory Medicaid expansions are implemented. The Cornyn amendment failed on a voice vote. Senator Cornyn’s second amendment ( D-4) would provide that physicians would have a positive payment update for their Medicare reimbursement under the Medicare program beyond 2011. The idea behind the amendment was to ensure seniors’ access to Medicare services. The second Cornyn amendment also failed on voice vote.
- Benefit Cuts In Medicare Advantage. Senator Orrin Hatch (R-UT) offered an amendment( D7) that provided that if the Medicare funding reductions in the Medicare Advantage program , as proposed under the Chairman’s mark, were to result in a loss of benefits for seniors using Medicare Advantage, those provisions would be nullified. The Hatch amendment failed (9-14). Senator Baucus offered an alternative to Hatch’s amendment, which provided that no statutory benefits to Medicare beneficiaries would be cut. It is worth noting that many health policy analysts, as well as CBO, have indicated that payment reductions in Medicare Advantage plans, which offer richer benefits than those required of traditional Medicare, would result in benefit reductions. Nonetheless, Senator Baucus’ alternative amendment passed (14-9).
- Reforming Medical Liability Laws (Ensign Amendment D4, Cornyn Amendment D13, and Kyl Amendment C25) Senators John Ensign (R-NV), John Cornyn (R-TX), and Jon Kyl (R-AZ) all offered amendments to advance medical liability reform to lower health care costs at the state and federal level.
- Senator Ensign’s amendment sought to reward states for enacting medical liability reform by providing an increased federal Medicaid payment by adjusting the Federal Medical Assistance Percentage (FMAP) increase for children covered under the Medicaid program. Ensign proposed that the additional federal cost of the Medicaid increase for this purpose would be offset by reducing eligibility under the Federal Poverty Level threshold for health care tax credits for health care coverage under the provisions of the Chairman’s mark. The Ensign amendment was defeated in a procedural vote.
- Senator Cornyn’s amendment would have required any state receiving funding from the federal government for Medicaid to limit claimable non-economic damages in medical liability cases to $1 million or less. The Cornyn amendment was also defeated in a procedural vote. Senator Kyl’s amendment was similar to the Ensign and Cornyn amendments. It was also defeated in a procedural vote.
In addressing key issues of transparency, Medicare benefit cuts, and medical liability reform, members of the Senate Finance Committee, just like their counterparts in the House Ways and Means Committee, are making and clarifying their intentions on health care policy. While the Senate mark-up continues, ordinary Americans will have the opportunity to see clearly what the majority of Senators have in mind. Actions speak louder than rhetoric.
Erica Suares and Kathryn Nix of the University of Wisconsin, an intern in the Center for Health Policy Studies contributed research for this post