President Obama has unveiled his new proposals, which are for the most part the old proposals with a few fixes made to the Senate bill. Jonathan Co
February 22, 2010

President Obama has unveiled his new proposals, which are for the most part the old proposals with a few fixes made to the Senate bill.

Jonathan Cohn has the rundown.

The White House has published President Obama's proposal for a House-Senate compromise on health care reform. You can download the official summary here. More material is available at the White House website.

To be clear, Obama is not introducing an entirely new health care plan or even a mostly new health care plan. In fact, strictly speaking, he's not introducing a health care plan at all. He is, instead, proposing a set of changes to the bill that the Senate passed in December. If both chambers pass these changes--and if the House passes the Senate bill--health care reform will become law.


Here are some highlights, in addition to the ones reported earlier.

The Benefits Tax: By far, the biggest substantive divide between the House and Senate bill was on financing, since the Senate bill placed a tax on benefits and the House bill did not. In January, congressional leadership had agreed with the White House to modify the Senate tax, so that it would have a higher threshold and so that collective bargaining plans had a few extra years of exemption, on the theory that unions needed more time to adjust their contracts. But critics attacked that deal (not unreasonably) as a special interest giveaway. So now the White House is proposing simply to delay implementation for everybody, rather than union plans alone. This means collecting less revenue in the first decade. But it doesn't mean sacrificing the tax's projected ability to control costs, which is what economists, including the ones who work at the Congressional Budget Office, care about.

Affordability: The House bill offered more assistance to low-income people buying coverage through the insurance exchanges. Obama is proposing to improve the Senate's financial assistance, so that it more closely approximates the House's numbers.

The Donut Hole: Relative to the Senate bill, the House bill offered more prescription drug relief for seniors, filling in more of the "donut hole" in Medicare Part D coverage. Obama would like the final bill to do the same as the House bill.

Medicare Advantage Plans: The Medicare program famously pays private insurers serving beneficiaries too much money, at least in eyes of most experts. The Senate bill sought to reduce those payments, but the House bill sought to reduce them more. Obama would move the number closer to the House's.

Consumer Protections: In general, the House bill applied consumer protections to all insurance plans, while the Senate bill left many of them exempt. Obama would like the final reform bill to use the House model.

Ben Nelson's kickback has been dumped, but no public option was added. A new poll released today by the PCCC and Credo find that the public option is liked much more than the Senate Bill.

My pal mcjoan at DailyKos has some info too:

There are additional Medicare and Medicaid waste, fraud, and abuse measures, many of which were proposed by Republicans in committee. Other offsets include lower Medicare Advantage payments, an additional $10 billion from PhRMA, extending the payroll tax and Medicare hospital insurance tax to unearned income, and a couple of tax loopholes will be closed. The revenue provisions would all easily fit into a reconciliation bill.

The public option is not included, and the Nelson abortion language remains. And a major element that's been key for the House, and which earlier leaks from the White House indicated would be included isn't there: the national exchange. It's possible that they couldn't figure out how to jam that in to a reconciliation package, and the insurer oversight proposal could help bridge the gaps created by not having a federal exchange.

The strong message from the White House is that they are prepared to use reconciliation to pass this bill, with Pfeiffer reiterating their need for an "up or down" vote on reform, breaking a Republican filibuster as needed.

There's ongoing discussion in Cedwyn's diary.

Ezra Klein checks it out and says:

There's not a lot of policy news in the president's new health-care plan. The changes are pretty much what we expected: more money going to subsidies (which are now being referred to as "the largest middle class tax cut for health care in history"), an excise tax that kicks in later and affects fewer plans, a new Health Insurance Rate Authority to oversee premium increases and reject them if they're unfair, the elimination of the Nebraska deal, and so on. There's no public option, nor any significant retrenchment. In fact, the cost of the bill has increased by $75 billion, the result of more generous subsidies.

Digby adds:

The big show on Wednesday will probably be to publicly corner recalcitrant Dems into supporting the bill and to make the Republicans look bad, a la the Obama appearance at the GOP retreat last month. It remains to be seen as to whether or not any of that will work. I'm skeptical.

The president knows he has to get something passed on health care. It's frustrating for progressives to sit and watch no public option being included or an expansion of Medicare.

I do like Rep. Grijalva's comments on this process via email:

I and many other progressives would enthusiastically support the bill if a public option, which would provide insurance industry competition and greatly reduce the deficit, were a higher priority. I am also concerned that affordability credits are not sufficient for many working Americans who often have to choose between health care and other equally basic expenses each month. Insurance industry regulations in the bill could be stronger, and I will look carefully at the outcome of final negotiations on this point.

I look forward to finalizing a reform package that will give all Americans adequate, reliable health care access. Although the president’s bill does not include certain elements that I consider fundamental to successful reform, I applaud his commitment to the issue and fully expect to work with other lawmakers to produce a strong final product that we can be proud of.”

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