WASHINGTON – As a Senate committee prepares to vote today on a closely watched plan to overhaul health insurance, senior Democrats are squaring off against key industry groups over how many people will ultimately be covered by the bill.
The showdown, fueled by estimates that as many as 17 million people would remain uninsured under the legislation, threatens to shadow the health debate as party leaders prepare to bring bills to the floors of the House and Senate in coming weeks.
Consumer advocates, health providers, insurance companies and others who have provided momentum for the Democratic drive for health legislation are pushing to cover almost all of the roughly 40 million Americans and legal immigrants who lack coverage.
But a series of compromises designed to control costs and minimize burdens on consumers has led to cutbacks in the number of uninsured who would be covered by the bill expected to emerge today from the Senate Finance Committee.
That has provoked alarm among hospitals and insurers, who have made universal coverage a condition of their support for this year’s drive to pass health care legislation. The insurance industry Monday stepped up its critique, warning the legislation now moving through Congress would accelerate the rise in premiums.
Leading Democrats are defending the Senate Finance Committee’s approach, which would save money by limiting federal subsidies to help people buy insurance. Many believe that is a necessary trade-off, even though it means the health legislation would fall short of a key goal of President Barack Obama and his congressional allies to cover all Americans.
“I’d like more (insurance coverage),” said Connecticut Sen. Christopher Dodd, a liberal Democrat who shepherded a companion health care bill through the Senate health committee this summer in place of the late Sen. Edward M. Kennedy, D-Mass. “But that’s a pretty good start. … Senator Kennedy was a great advocate of the idea that you do the best that you can.”
Rep. Henry Waxman, D-Calif., the House Energy and Commerce Committee chairman and a leading author of the House Democratic health care bill, also said compromises in how many people will be covered may be necessary. “The effort to reform health care is a balancing act,” he said Monday. “And we are limited in how much money we can spend.”
Liberal lawmakers and consumer groups have long nurtured dreams of covering all Americans. More recently, universal coverage has emerged as a key goal of insurance companies and health care providers, who would gain tens of millions of new customers. Hospitals would benefit as the number of uninsured patients receiving free care diminishes.
Industry leaders and health care experts also see universal coverage as critical to making other changes to the health care system, such as prohibiting insurers from denying coverage for pre-existing medical condition and restraining growth in premiums.
“The larger the insurance pool, the better able you are to spread risk,” said Peter Harbage, a health care consultant who has advised Democrats in Washington. “If you have universal coverage, you will have the most efficient system and best achieve affordable coverage.”
Congressional Democrats have agreed on a series of steps to expand coverage, including a new mandate requiring most Americans to get insurance and billions of dollars of new federal subsidies to help low- and moderate-income people pay their premiums.
But under pressure to control federal health care spending and keep the 10-year cost of legislation under $900 billion, the Senate Finance Committee bill limited those subsidies.
The legislation being voted on today includes $463 billion in subsidies over the next decade and would result in 94 percent of Americans having health insurance coverage, according to an estimate by the nonpartisan Congressional Budget Office.
Some 83 percent of Americans have health insurance today.
In addition to devoting less money to subsidies to help people buy insurance, the Senate Finance Committee scaled back fines on those who do not buy insurance, as many lawmakers expressed concern the penalties were too severe. The current bill would gradually phase in the fines over five years and limit them to $750 per person or $1,500 per family.