With support from a lone Republican, a key Senate committee Tuesday approved a middle-of-the-road health care plan that moves President Barack Obama's goal of wider and affordable coverage a giant step closer to becoming law.
Maine Republican Olympia Snowe said she was laying aside misgivings for now and voting to advance the bill, a sweeping $829-billon, 10-year health care remake that would help most Americans get coverage without creating a new government insurance plan. "When history calls, history calls," said Snowe.
Finance Committee Chairman Max Baucus, D-Mont., called his bill "a commonsense, balanced solution." A distance runner, Baucus has endured months of marathon meetings to get this far. It's not the finish line.
Health care legislation is expected to be on the Senate floor the week after next, said a spokesman for Majority Leader Harry Reid of Nevada. But it won't be the Baucus bill. Reid will combine the Finance version with a more liberal proposal from the health committee - with unpredictable results.
The vote in the Finance Committee was 14-9, with Snowe joining all 13 Democrats in support. In a sign of long political battles ahead, every other Republican voted against it.
The ultimate fate of the legislation hinges on how lawmakers decide dozens of unresolved issues, from letting government sell insurance to abortion coverage. Even some senators who voted for the Baucus bill said they have concerns it will deliver on providing access to affordable coverage for all.
As Snowe made clear, "My vote today is my vote today. It doesn't forecast what my vote will be tomorrow."
The Baucus plan would, for the first time, require most Americans to purchase insurance and it also aims to hold down spiraling medical costs over the long term. Questions persist about whether it would truly provide access to affordable coverage, particularly for self employed people with solid middle class incomes.
The Finance Committee's top Republican, Chuck Grassley of Iowa, gave voice to the GOP's concerns about the bill, saying it was "moving on a slippery slope to more and more government control of health care."
"There's a lot in this bill that's just a consensus that needs to be done, but there are other provisions of this bill that raise a lot of questions," Grassley said, contending the legislation would mean higher costs for Americans.
The committee approval marked a personal victory for Baucus. Four other congressional committees finished their work before August, and for months all eyes had been on the Finance panel, whose moderate makeup most closely resembles the Senate as a whole.
Snowe kept Washington guessing about how she would vote until she announced it late in the debate Tuesday. Democrats, aware that Snowe could be the only Republican in Congress to vote for their health care overhaul, have spent months addressing her concerns about making coverage affordable and how to pay for it.
The committee's centrist legislation is also seen as the best building block for a compromise plan that could find favor on the Senate floor.
One of the biggest unanswered questions is whether the legislation would slow punishing increases in the nation's health care costs, particularly for the majority who now have coverage through employers. The insurance industry insists it would shift new costs onto those who have coverage.
Congressional Budget Office Director Douglas Elmendorf, under questioning by Republican senators, acknowledged that the bill's total impact on the nation's health care costs is still unknown. The CBO has been able to establish that the legislation would reduce federal government deficits, but Elmendorf said his staff has not had time to evaluate its effects on privately insured people. Government programs pay about half the nation's annual $2.5 trillion health care tab.
Once the Finance Committee has acted, the dealmaking can begin in earnest with Senate Majority Leader Harry Reid, D-Nev., working with White House staff, Baucus and others to blend the Finance bill with a more liberal version passed by the Health, Education, Labor and Pensions Committee.
Baucus' bill includes consumer protections such as limits on copays and deductibles and relies on federal subsidies to help lower-income families purchase coverage. Insurance companies would have to take all comers, and people could shop for insurance within new state marketplaces called exchanges.
Medicaid would be expanded, and though employers wouldn't be required to cover their workers, they'd have to pay a penalty for each employee who sought insurance with government subsidies. The bill is paid for by cuts to Medicare providers and new taxes on insurance companies and others.
Unlike the other health care bills in Congress, Baucus' would not allow the government to sell insurance in competition with private companies, a divisive element sought by liberals.
Last-minute changes made subsidies more generous and softened the penalties for those who don't comply with a proposed new mandate for everyone to buy insurance. The latter change drew the ire of the health insurance industry, which said that without a strong and enforceable requirement, not enough people would get insured and premiums would jump for everyone else.
A major question mark for Reid's negotiations is whether he will include some version of a so-called public plan in the merged bill. Across the Capitol, House Democratic leaders are working to finalize their bill, which does contain a public plan, and floor action is expected in both chambers in coming weeks. If passed, the legislation would then go to a conference committee to reconcile differences. ---
Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.
(Copyright 2009 by The Associated Press. All Rights Reserved.)