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Senate Passes Healthcare Overhaul, Compromise with House Bill Looms

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In a rare Christmas Eve session, the Senate passed its sweeping healthcare reform legislation this morning by a vote of 60 to 39, along party lines. The $871 billion Senate bill must now be reconciled with the House bill after Congress reconvenes in January. We speak with Trudy Lieberman, contributing editor to the Columbia Journalism Review, and Rep. Raul Grijalva (D-AZ), co-chair of the Congressional Progressive Caucus. [includes rush transcript]

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This is a rush transcript. Copy may not be in its final form.

JUAN GONZALEZ: In a landmark vote, the Senate passed its sweeping healthcare reform legislation this morning. Vice President Joe Biden presided over the session.

    VICE PRESIDENT JOE BIDEN: Yeas are sixty; nays, thirty-nine. HR 3590, as amended, the Patient Protection and Affordable Care Act is passed.

JUAN GONZALEZ: Biden presided over the Senate session, the first to be held on Christmas Eve in more than a century. This morning’s vote was strictly along party lines and came after Democrats cleared a third and final procedural hurdle on Wednesday to end a Republican filibuster.

Before the vote tally, Senate Minority Leader Mitch McConnell criticized the bill.

    SEN. MITCH McCONNELL: This debate was supposed to produce a bill that reformed healthcare in America. Instead, we’re left with party-line votes in the middle of the night, a couple of sweetheart deals to get it over the finish line, and a truly outraged public. A problem they were told would be fixed wasn’t. I guarantee you that people who voted for this bill are going to get an earful when they finally get home for the first time since Thanksgiving. They know there is widespread opposition to this monstrosity.

    And I want to assure you, Mr. President, this fight isn’t over. In fact, this fight is long from over. My colleagues and I will work to stop this bill from becoming law. That’s the clear will of the American people, and we’re going to continue to fight on their behalf.

JUAN GONZALEZ: Senate Minority Leader Mitch McConnell of Kentucky. After he spoke, Senate Majority Leader Harry Reid took the floor and lauded the historic nature of the bill.

    SEN. HARRY REID: We certainly don’t have, Mr. President, the luxury of waiting until America becomes the only developed nation on earth where you can die for lack of health insurance. We already bear that blemish. That’s why we’re bringing security and stability to millions who have health insurance and bringing health insurance to millions who have none.

    Mr. President, could we have order?

    VICE PRESIDENT JOE BIDEN: The Senate will be in order.

    SEN. HARRY REID: What we will do is ensure consumers have more choices and insurance companies face more competition. We’ll stand up for those greedy insurance companies that deny healthcare to the sick and drive millions to bankruptcy, to foreclosure, and to sometimes even worse. We’ll add years to life of Medicare, which will add years to the life of seniors. We’ll trade a system that demands you pay more and get less for one in which you will pay less and get more. As we do all this, we’ll slice our children’s deficit in dramatic fashion.

    We may not completely cure this crisis today, or tomorrow, but we must start toward that end. We must strive for progress and not surrender for want of purity. Our charge is to move forward. This is a tradition as old as this republic, one that has always comprised interests and opinions as diverse as the people who populate it. Our founding fathers did not promise to form an infallible new nation. They promised instead to promote the general welfare as we move toward a more perfect union. They valued progress. Our nation’s earliest leaders promised not absolute happiness, but only the pursuit of that goal. They valued opportunity. And like other new programs that improved the lives of many and were since strengthened to improve even more — programs like Medicare, Medicaid, Social Security — progress and opportunity are what this historic bill represents.

AMY GOODMAN: The $871 billion Senate bill must now be reconciled with the House bill once Congress goes back into session. Democrats are hoping to be able to present a bill to President Obama to sign before his State of the Union address in late January or early February.

Well, Trudy Lieberman is the contributing editor to the Columbia Journalism Review. She blogs on healthcare at cjr.org and joins us here in our firehouse studio.

Welcome to Democracy Now!


AMY GOODMAN: Can you explain, what does this bill do and what doesn’t it do?

TRUDY LIEBERMAN: There’s a lot of confusion among the public about how they’re going to be helped or hurt by the bill.

Very simply, people who have insurance right now are probably not going to see very much change from the bill. In fact, what they are going to see, as the years go on, are probably increasing premiums, and a lot more of the cost is going to be shoved onto them through high-deductible plans and co-payments and co-insurance that are probably quite high. So they’re not going to see a lot.

The people who will see some benefit from this bill are those who are uninsured right now. Some 47 million people are uninsured. This bill does not cover all of those 47 million people, including immigrants who are here illegally. What it will do is cover some portion of the uninsured, and that is still to be worked out between the House and the Senate, by giving them subsidies, paid for by taxpayers, to buy health insurance in the open market. And they will be able to do that through this gigantic shopping service, brokerage service, if you will, called the exchange, where a variety of policies will be offered.

There are so many questions, however, about the affordability for people who will get the subsidies, because there will always be somebody over the line who will not qualify for a subsidy and will have to buy insurance on their own, because there will be an individual mandate. And the mandate means that people who do not have coverage from an employer or through Medicare or Medicaid have to buy coverage from a private insurance company.

JUAN GONZALEZ: And the penalty for not buying the insurance in the Senate version? And also, if you could talk a little bit about — wasn’t — the mandate issue was one of the big debating points between Barack Obama and Hillary Clinton in the Democratic —-


JUAN GONZALEZ: —- in the Democratic presidential primaries, with Obama opposing a mandate.

TRUDY LIEBERMAN: Right. During the campaign, Hillary Clinton supported the individual mandate for everyone, and the President supported a mandate only for kids. He says we have to require coverage of kids, but not everybody else. So, obviously, somewhere along the line, the administration changed their position on this.

And so, you ask about the penalties. The penalties are not very steep. And the members of Congress knew that if they made those penalties too high, they would have a revolt on their hands. On the other hand, they’re not high enough, in some people’s view — surely the insurance companies’ view — to bring people into the risk pool to spread the risk. At its maximum, the penalty will be $750 several years from now. It starts out at about $95 and then grades up. The House penalties are somewhat different. So it will be very interesting to see what happens, whether people will just take the penalty, which is not very much, or do they buy an insurance policy which could cost them $15,000 a year for a family policy by then.

JUAN GONZALEZ: One of the — in terms of how the bill would affect the majority of the population, one of the things that you’ve written about that, I haven’t seen anywhere else, is this whole issue of how premiums will be affected by wellness programs and how insurance companies will use that to penalize certain employees. Could you talk about that?

TRUDY LIEBERMAN: Yeah, that can happen. What’s written into the bill are incentives to encourage better health behavior, better cholesterol levels, lower body mass index, and so forth. So what’s going to happen is an employer can set certain targets, that you have to have a BMI, say, below twenty-six or twenty-five, whatever they decide, cholesterol will be lower than —-

AMY GOODMAN: BMI being body mass index?

TRUDY LIEBERMAN: Body mass index -— cholesterol levels below x amount. And employees will have to check in, weigh in every year, so to speak, and those that don’t meet the targets very well may be penalized, in terms of the price of insurance. We see employers also —-

JUAN GONZALEZ: And the individual employer would set this?


JUAN GONZALEZ: So you’re going to have a whole industry of consultants just to get the employers -—


JUAN GONZALEZ: — to figure out the best way to determine how their employees will meet the criteria.

TRUDY LIEBERMAN: Right now, the employers can have a 20 percent differential in premiums between so-called healthy employees and unhealthy employees. That can go up to 30 percent in the bill, under the Senate bill, and up to 50 percent down the road, if the Secretary of HHS and other administration officials decide that’s what’s necessary.

The employers want the flexibility to penalize, if you will, or reward, depending on what side of the fence you’re on, healthy workers versus unhealthy workers. So those people who can’t meet those targets will be paying more premiums than people who can. So they can look forward to, again, as I said earlier, higher premiums down the road.

AMY GOODMAN: Trudy Lieberman, what about the Cadillac plans? This is the taxing of the Cadillac plans, something unions have been very much opposed to —-


AMY GOODMAN: —- because often they have traded higher wages for better healthcare plans, and now this possibility of taxing them.

TRUDY LIEBERMAN: Well, historically, that’s what happened. Workers have given up wages for better healthcare benefits. This has been going on for decades. That could end very quickly with this excise tax that will be placed on the so-called high-end plans, which will force the insurance companies and the employers to offer their workers lesser plans with lesser benefits.

And, of course, when you do that, that leaves more people underinsured. And I think most people believe, in this bill, we’re going to see a lot of under-insurance taking place both in the individual market and on the employers’ side. So the people who have these plans may well lose them down the road. This is also a contentious issue between the House and the Senate and will have to be resolved in the conference.

JUAN GONZALEZ: The other big issue was importation of prescription drugs. How has that fared in the Senate bill versus the House bill? And what are the prospects for that?

TRUDY LIEBERMAN: Well, as listeners may recall, that Barack Obama was for reimportation and negotiated drug prices under the Medicare program. In the Senate bill, neither of those things will happen. In the House bill, those provisions are still part of the House bill. But the money is that the Senate bill will prevail on most issues, so I think it’s probably not going to happen that those two things will be in the final bill.

AMY GOODMAN: Senator Lieberman and the effect he had on the Senate bill? And any relation, Trudy Lieberman?

TRUDY LIEBERMAN: No, no relation.

AMY GOODMAN: What about his effect?

TRUDY LIEBERMAN: He was very influential. In fact, he was really the pivotal person to kill the public plan in the Senate. In my post on cjr.org, I said he was probably the best lobbyist the insurance industry — and the doctors and the hospitals — could have had, because neither of those two groups of stakeholders were keen on a public plan. And I think that point has been forgotten.

In the end, Lieberman held all the cards, and he said that he would not provide the sixtieth vote if a public plan were part of it. Obviously, he is from Connecticut. Connecticut is the insurance capital of the world — or of America. And I’m sure he was listening to his constituents in the insurance industry that did not want a public plan.

AMY GOODMAN: We’re — sorry, we’re also joined by Democratic Congress member Raul Grijalva, joining us from — well, he represents the Tucson area of Arizona, and he is the co-chair of the Congressional Progressive Caucus.

Welcome to Democracy Now!, Congress member Grijalva. Can you talk about how you’re going to reconcile what the Senate just did moments ago with the House plan?

REP. RAUL GRIJALVA: Yeah, thank you. Good morning.

I think that reconciliation is going to be a very difficult process. I’m glad that we’re going to have a formal conference where there will be an opportunity to try to fundamentally change what is in the Senate bill.

And there’s four or five cornerstones that are vital. Trudy just mentioned one, having to do with the reimportation issue, the repeal of the antitrust provisions that are in the House bill but are not in the Senate bill. And, of course, what is the public presence? What is the public option? What is going to be that mechanism that many of us fought, as one of the last battles in the House, to assure that we keep this whole process with a public presence that keeps it accountable and honest? A mandate that merely does not provide alternatives for people, to many of us, is destined for difficulty, if not failure. And so, you know, there’s points of reconciliation that are going to be very, very difficult.

I think, you know, the President said that, you know, he’s shown that he can make unpopular decisions. Well, you know, now it shifts over to many of us in the House that are faced with keeping the ball rolling, per se, in terms of healthcare reform and extending coverage to millions of people, as is being touted in the Senate bill, or holding — holding the line on some of the issues that we felt were vital to moving healthcare reform in some legitimate direction in this country. So it’s going to be a difficult process, to say the least.

And we hope that the conference, that our leadership in the House hangs tough, hangs tough on the things that were bitterly negotiated, on the things that we felt had to be part of a package in order for many of us to go along with it. So, we’re back in that position where I don’t consider it nine-tenths of a loaf. Do you take part of a loaf, or do you hold out and insist that some of the points that are vital to us are part of the package? And that’s the tough road ahead.

JUAN GONZALEZ: Well, Congressman, you mentioned this nine-tenths a loaf. This is what President Obama now, in several interviews now in the past few days, has been saying, that he got 95 percent of what he had originally said he wanted in this bill. Is your reading of that, of his estimate, accurate in terms of what he got versus where he started on healthcare reform more than, well, two years ago, before he —-


JUAN GONZALEZ: — during the presidential primaries?

REP. RAUL GRIJALVA: Well, when we — the whole discussion started around the issue of universality, that we had to have some universal system that included a strong government presence, a public option, a public presence, and assuring that we would keep insurance companies honest in the delivery of healthcare in this country. That part is out. And I thought that was central, that was the heart of it. Once single payer was off the table, we were left with defending and promoting a segment of it, which was the public option.

With that out, with having mandates but no public option, with antitrust being eliminated in the Senate, with the tax surcharge being gone, with taxing health benefits for working folk, you know, one can judge the percentages the way one can, but I see this as — the Senate bill as a step back from what the House did. And so, the reconciliation process and the process of conferences is going to be vital to try to restore what I believe were some of the initial promises and commitments that many of us made to the American people at the beginning of this healthcare reform debate.

JUAN GONZALEZ: We have Trudy Lieberman here, who’s been following this very closely, saying that she doesn’t have much hope that your version will prevail over the Senate version, that most of the Senate version will end up being in the final bill. Your reaction to that?

REP. RAUL GRIJALVA: Well, there’s some validity, obviously, to that statement. You know, the sixty-vote threshold is something that is difficult to get, and then you put into the hands of one or two senators, whether it’s Nelson, Lieberman or whomever — you give them an inordinate amount power to be able to dictate the content of even what comes out of conference. So, you know, he’s — some of the senators have stated, if these things are — we put back in, then we’re going to — we can’t support it. And I think we have to be strong in our presence, saying if these things are not in, we will have a difficult time supporting it.

AMY GOODMAN: Congressman —-

REP. RAUL GRIJALVA: And it’s not a question of who blinks first. I think there is also going to be public opinion that weighs into this conference process.

AMY GOODMAN: Congressman Grijalva, can you see yourself not voting for this bill, ultimately?

REP. RAUL GRIJALVA: If it comes out that what we are basically doing -— and it’s a difficult question, Amy, no question, no doubt about it — but if I end up being confronted with merely rubberstamping what the Senate does, with no changes in terms of public accountability or a public option or a public presence in that plan, if we don’t move up the dates to make sure that coverage begins immediately, if we don’t really tighten down on the regulatory and put some teeth beyond what we’re going to do with private insurance companies, and we’re just replicating and just rubberstamping what the Senate did, yeah, I would have a very difficult time voting for it.

AMY GOODMAN: In just ten seconds, wrap-up comment, Trudy Lieberman, and when this bill would go into effect if it were passed?

TRUDY LIEBERMAN: Most of the provisions would take effect in 2014 under the Senate bill. A couple of minor provisions will take effect immediately. And there is some provision for people who don’t have insurance now to go into high-risk pools with some subsidization to help them buy insurance.

AMY GOODMAN: We’re going to leave it there. Trudy Lieberman, thanks for being with us —-


AMY GOODMAN: —- contributing editor to the Columbia Journalism Review, blogging on healthcare at cjr.org. And Congressman Grijalva, co-chair of the Congressional Progressive Caucus, we’d like to ask you to stay with us, because we’re going to look at immigration and the number of immigrants who are being detained now around the country.

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