The Senate’s health care bill became law earlier this week, but the fight against a government overhaul of our nation’s health system continued in the Senate. Senators voted on many amendments to the reconciliation bill passed by the House as a “fix” to the massive Senate health bill, H.R. 3590.

This process proved extremely important, since it underscored some very key policy issues that have surfaced in the national debate. Forget what lawmakers say; look instead on how they act. Votes on key issues tell a big story. Consider the following policy issues:

Medicaid For Congressmen: CBO and other experts estimate that more than 30 million Americans will secure health care coverage under the recently enacted health care legislation. But there is one little problem: Roughly half of those will be covered, not under private health insurance, but under Medicaid, a poorly performing welfare program that indisputably delivers low quality care. Even though Medicaid is a mess, Congress voted to extend Medicaid coverage to 16 million more Americans by 2019. If Congress thinks Medicaid is the right option to cover millions of their fellow citizens, then House and Senate members should not mind enrolling in it themselves.

Senator George Lemieux (R-FL) thus proposed an amendment that would require members of Congress to get their health insurance coverage through Medicaid instead of the popular and successful Federal Employees Health Benefit Program (FEHBP). Evidence shows that Medicaid is not only costly, but can also result in reduced health outcomes. Needless to say, the enrollment of millions of Americans in Medicaid, including those who previously had private coverage, is a terrific idea, but not for the Senators. The Lemieux amendment was rejected by a vote of 59-40.

Protecting Medicare Advantage: President Obama has said , repeatedly, if you like the coverage you have today, you should be able to keep it.

Senator Orrin Hatch (R-UT) agreed, and presented an amendment that would remove cuts to the Medicare Advantage program if the bill would result in more than one million seniors losing Medicare Advantage coverage. Under the Medicare Advantage program, seniors are given the option to receive Medicare benefits through private insurance plans, allowing beneficiaries to obtain additional benefits, realize more cost savings, and contain more control over their care than other Medicare enrollees. According to the Center for Medicaid and Medicare Services, Medicare Advantage provided beneficiaries with an average savings of $90 per month through lower deductibles, premiums and co-payments. Sen. Hatch’s amendment would protect senior citizens enrolled in the program, allowing them to continue to enroll and realize its superior benefits.

The Senate majority was not interested. The Hatch amendment was tabled by a vote of 56 to 42, with 2 abstaining.

Freedom for States to Chart Their Own Course: Senator Kay Bailey Hutchison (R-TX) introduced an amendment to give states the ability to opt out of any provisions of the health care bill. Notwithstanding President Obama’s denials to the contrary, the bill is a federal takeover of healthcare. It not only trumps states’ authority, but also hurts the states financially. Among other things, it mandates a costly Medicaid expansion, which states would pay for through increased administrative and benefit costs beginning in 2017. Additionally, it imposes individual and employer mandates on residents of every state and sets strict restrictions on states in managing health insurance exchanges. States should not be forced to follow federal policies that undermine their traditional authority. They should retain the final authority to make law governing health insurance markets and exchanges, insurance regulations, and the management of their Medicaid programs.

The Senate majority did not agree. The Hutchinson amendment was tabled a vote of 58 to 41, with 1 abstaining.

Protecting Jobs. Senator Susan Collins (R-ME) proposed an amendment that would address employment concerns and job loss expected from the bill. The bill contains penalties that discourage businesses from hiring or retaining employees. Beginning in 2014, any business over 50 employees that does not offer health insurance to its employees shall be fined. Consequently, the bill discourages medium-sized businesses employees from hiring and retaining employees or expanding. The high tax penalties for employers will greatly influence business decisions and may ultimately result in discrimination against low income workers. Sen. Collins amendment would provide an exemption from these penalties for firms that hire workers who were previously unemployed. The Collins amendment would have granted relief to employers and help lower unemployment rates.

But, no the majority of the Senate did not agree. The Collins amendment was tabled by a vote of 58 to 41, with 1 abstaining.

Stopping Entitlement Growth. Entitlement cost growth poses an enormous fiscal challenge, and it would make sense to address the current entitlement programs before creating new ones.

Senator John Thune (R-SD) offered an amendment to repeal the CLASS Act, which establishes a new long term care entitlement program. To qualify, individuals must have contributed to the program for five years prior to receiving benefits.
The CLASS Act is another example of federal expansion in health care. Insurers argue that the benefits are too modest to protect Americans needing nursing home care or 24-hour assistance. Furthermore, it represents another budgetary gimmick employed by Obama and Democrat leaders to delay the negative impact on the federal deficit past the initial 10-year window and to double-count savings from the bill. Sen. Thune’s amendment, however, was rejected by a vote of 55 to 43, with 2 abstaining.

Stop Taxing Investments. Senator John Cornyn (R-TX) offered an amendment to strike the controversial 3.8 percent Medicare tax on investment income. As shown by the Heritage Foundation, raising investment taxes during a recession discourages investing in the economy. Less investment will lead to less economic productivity, slower economic growth, weaker wages, higher unemployment, and lower household wealth. The impact of the investment tax would not only be felt by the rich—it will extend to all Americans who benefit from business investment.

The Senate majority does not agree, and voted to table the Thune amendment by a vote of 52 to 46, with 2 abstaining.

Rick Sherwood currently is a member of the Young Leaders Program at the Heritage Foundation. For more information on interning at Heritage, please visit: