"Senate Health Bill Reduces Deficit By More Over Time," by Jonathan Chait
"Peter = Robbed, Paul = Paid," by Jonathan Cohn
Legislative language for the Senate bill has been available for just over twelve hours, a preliminary Congressional Budget Office assessment for even less than that. And, already, it's clear that the fine print requires, well, some fine analysis. But before we get to that, let's take a step back and ask the simple question: Should we be happy about this bill? The answer depends entirely upon your frame of reference.
If your standard for comparison is your ideal health care reform, then of course this will be disappointing. Like every bill that's moved through Congress, this one would leave millions uninsured even after full implementation--and leave millions with coverage facing substantial, although generally not crippling, financial burdens. It would introduce some reforms to the delivery system and, according to the official cost estimates, generate budget surpluses over time. But it's not going to radically turn American health care into a paragon of cost efficiency.
Now, that sort of nirvana was never in the cards. The more relevant comparison is to the House bill. And there the verdict is more mixed. The Senate bill has the excise tax on expensive insurance policies and the independent Medicare commission, two tools that--at least in the eyes of most experts--can make a significant dent in overall health care spending. That's an advantage. On the other hand, fewer people would end up with health insurance and those with health insurance wouldn't have the same level of financial protection.
You can see this most plainly in the total dollars the respective bills propose to spend on expanding Medicaid and subsidizing the purchase of private insurance through the new insurance exchanges. The House bill allocates more than $1 trillion, before you begin netting out savings, employer contributions, and the like. The Senate bill stops at around $900 billion. (And that doesn't account for the extra money the House bill puts towards boosting provider payments in Medicaid, an under-appreciated virtue of that plan.)
But, again, the Senate was never going to pass the House bill. Realistically, the question going forward was whether Majority Leader Harry Reid could improve what came out of the Senate Finance Committee--and move it closer to what the Senate Health, Education, Labor, and Pensions Committee produced. And there it seems pretty clear that he did, mostly. The early consensus among experts (and, again, this is pending further analysis) is that the new Senate bill boosts financial support for people purchasing health insurance overall. And, of course, it has a public insurance plan.
It's not huge progress. But given the political pull to the right from conservative Democrats and independent Joe Lieberman, any progress is an accomplishment. And Reid clearly deserves credit for that.