The Senate health committee's pretty good health reform.

How to fix health policy.
July 15 2009 6:12 PM

Pretty Good Health Reform

The Senate health committee's bill notches a tad below the House version.

Click here for a guide to following the health care reform story online.

Sen. Chris Dodd. Click image to expand.
Sen. Chris Dodd

The Senate health, education, labor, and pensions committee (also known as Ted Kennedy's committee) passed a health care reform bill this morning on a party-line vote, 13-10. (Here's the section-by-section summary.) The bill is not quite as good as the House bill introduced yesterday, but it's almost certainly better than the bill the Senate finance committee is working on, which may be introduced later this week. As with the House bill, the most important part of the Senate HELP bill is the public option—a new government program created to compete with private health insurers. Let's focus on that.

In the Senate HELP bill, the public option is called the "community health insurance option," presumably to downplay that it's a government program. (Still, to avoid confusion, let's call it the public option.) As in the House version (text, section-by-section summary), the public option is required to set premiums sufficiently high to cover all the program's costs, and doctors and hospitals cannot be compelled to participate, as the American Medical Association fretted they might be. As in the House bill, the public option would compete with private-insurance plans within a newly created health insurance exchange. The Senate HELP committee bill calls this the "American health benefit gateway," presumably to inspire stirring mental images of covered wagons rolling westward from St. Louis circa 1842.


Like the House bill, the Senate bill is too restrictive in providing access to the public option. The House bill won't allow you to buy a public-option health care policy (or to participate in the exchange at all) if your employer already offers you decent health care and your premiums don't exceed 11 percent of your income, which is quite a lot. The Senate is a bit stingier, disallowing employees paying up to 12.5 percent of their income in premiums. On the other hand, the Senate bill, unlike the House bill, doesn't mandate the creation of three public-option plans, with an option for a fourth, offering increasing levels of coverage (presumably at increasing prices). That's simpler, more egalitarian, and less likely to annoy private insurance companies (to whom I prefer to leave the gold-plating).

As I write this, the Senate HELP committee has not yet made public the bill's actual text, so I can't provide more details just yet. But like the House bill, the HELP bill appears to merit the term reform.

[Update, July 16, 11:20 a.m.: The text of the bill remains unavailable. According to a press aide for the HELP committee, the staff is still writing up the 160-plus  amendments inserted by the very same committee Republicans who voted against it. Ah, bipartisanship.]

[Update, July 17, 2:30 p.m.:The text of the bill is still unavailable. But Slate's Christopher Beam sheds some light  on what a few of those Republican amendments are, and posts an Excel file listing some but not all of the amendments offered and whether they passed or failed.]

Timothy Noah is a former Slate staffer. His  book about income inequality is The Great Divergence.


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