Sen. Harry Reid's health reform striptease.

Sen. Harry Reid's health reform striptease.

Sen. Harry Reid's health reform striptease.

How to fix health policy.
Nov. 18 2009 6:58 PM

Harry Reid's Striptease

What we know about the Senate's "blended" health care bill, and what we don't.

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

Harry Reid. Click image to expand.
Senate Majority Leader Harry Reid

Sen. Harry Reid was set to unveil his "blended" health care reform bill on Nov. 19. The Congressional Budget Office was expected to release its analysis of the bill on Nov. 18, but it wasn't yet available on the CBO's Web site, and my attempts to get the CBO to tell me when it would make the analysis public were unavailing. (In its defense, I was having cell phone trouble and therefore couldn't leave a message.) Perhaps Reid didn't want to be upstaged, since the full CBO analysis of the bill couldn't really avoid telling you a lot about what the bill actually contained.

To keep everybody interested, Democratic leadership aides released to the press some top-line data from the CBO analysis. The bill would cost $849 billion over 10 years, but that would be more than offset by taxes and various savings, principally in the Medicare program, so overall the bill would reduce the deficit by $127 billion during that same period. That's $18 billion more than CBO's projected 10-year savings from the House bill and $46 billion more than CBO's projected 10-year savings from the Senate finance committee bill. The $849 billion figure is below President Obama's (somewhat arbitrary) demand that health reform not cost more than $900 billion over 10 years.

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In other news, CNN reported that lobbyists have thus far spent $600 million trying to influence the health reform bill.

Also, Richard Foster, chief actuary of the Centers for Medicare and Medicaid Services, replied to my column from earlier this week about CMS analysis of the House health reform bill. At my request, he also explained why his 2003 estimate of the 10-year cost of the Medicare drug benefit, shortly before it was enacted, was way too high. To read it, click here and scroll down to the bottom.

Stay tuned.

Update, 8:30 p.m.: The bump and grind continues. The Hill reports that Sen. Ben Nelson, D-Neb., said the Reid bill has some sort of prohibition on taxpayer-funded abortions through the exchanges, and that the prohibition is worded differently than in the House's Stupak amendment. But neither Nelson nor the Hill seems to know any details. In the Huffington Post, Ryan Grim reports that the Reid bill nonetheless requires that at least one plan within the exchange must cover abortion. And multiple sources report that the bill, as promised, includes a public option with an opt-out provision for states that don't want to participate.

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Update, 9 p.m.: The Senate bill would extend coverage to 31 million of the roughly 45 million uninsured, saith the Washington Post, as compared with the House bill, which would extend coverage to 36 million. The Medicare payroll tax would be raised from its current flat rate of 1.45 percent to 1.95 percent  for families earning more than $250,000, saith the New York Times. This would raise $54 billion. An excise tax on so-called "Cadillac" health plans would apply to family plans valued at more than $23,000, compared with a $21,000 threshold in the House bill.

Update, 9:25 p.m.: The feather boa drops, and the bill text  is revealed.

Update, 9:30 p.m.: The wording on the abortion amendment is extremely complicated, but on first glance it seems to be similar to the Capps amendment that the House (and the U.S. Conference of Bishops) rejected, i.e., abortions may be funded in subsidized health insurance policies only if elaborate procedures are followed to segregate federal dollars from the dollars used to fund the coverage.

Update, 9:50 p.m.: The public option is described in Section 1323, where it is dubbed the "community health insurance option." States may opt out of this option by passing a law prohibiting it. Premiums must be sufficient to cover the health insurance option's costs. The Department of Health and Human Services negotiates rates paid to doctors and hospitals, but it can also hire a private nonprofit entity to perform this function. These "may not be higher, in aggregate, than the average reimbursement rates paid by health insurance issuers offering qualified health plans through the exchange."

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Huh. But didn't the CBO and CMS say the House version of the public option, which is quite similar, would have to charge premiums that were slightly higher (4 percent higher, according to CMS) because its private competitors would use the public option as a dumping ground for less-healthy customers?

The community health insurance option would be supervised at the state level by a public or private nonprofit entity that would make recommendations to HHS on how to run the community health insurance option.

Well, that was quite a show. I'm spent. More tomorrow.

Update, Nov. 19: The CBO has released  its analysis.

E-mail Timothy Noah at chatterbox@slate.com.