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What's New In The Baucus Health Care Pitch?


From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.


And I'm Noah Adams.

Lawmakers returned to work on Capitol Hill today with health care, of course, at the top of the agenda. President Obama met with the Senate majority leader, Harry Reid, and House Speaker Nancy Pelosi one day before his address to a joint session of Congress.

In the meantime, four congressional committees have completed work on health overhaul bills with only Democratic votes. The fifth and potentially most influential, the Senate Finance Committee, is the only one trying to reach a bipartisan compromise.

NPR's Julie Rovner joins us now from Capitol Hill to lay out the landscape. Hi, Julie.


ADAMS: The Senate Finance Committee is also the only one, I understand, that has failed so far to complete its bill.

ROVNER: That's right, they are. And they are still trying to figure out if they can get something. They have this Gang of Six that's working at it. It's not the whole committee. It's three Democrats and three Republicans: Chairman Max Baucus of Montana, Kent Conrad of North Dakota, Jeff Bingaman of New Mexico are the Democrats. Then Chuck Grassley, the top Republican, Mike Enzi of Wyoming and Olympia Snowe of Maine are the Republicans.

They have been behind closed doors pretty much all summer, hoping to get a bill that can be embraced by the rest of the committee - hopefully, the rest of the Senate. And it's been anything but easy. The Democrats say that Baucus is going too far to please Grassley. Republicans don't want Grassley in particular to sign on to what they see as a Democrat's bill. They want to keep this a partisan exercise and hopefully an unsuccessful effort that they can use to win seats in next year's elections, much as they did back in 1994.

ADAMS: And so today we actually have an idea what they've been talking about - it's a proposal offered over the weekend by Senator Baucus. You've gotten a copy. Tell us a bit about it.

ROVNER: Well, we don't have the actual total numbers attached, but we've been told by staff that it would cost something under $900 billion over 10 years. That's a lot less than some of the other proposals we've seen in the House and the other Senate committee that's already acted.

Like the other bills, it would create something called a Health Insurance Exchange where small businesses and individuals who don't get insurance on their job could buy coverage. There'd be tax credits and subsidies for people with low incomes to help them purchase insurance, although these wouldn't be as generous as in some of the other bills.

And there's much more emphasis in this bill than in some of the other bills on changing the payment systems for doctors and other health care providers to weed out unnecessary care and to pay more for higher quality care. That's something that the members of the Finance Committee have really been talking about a lot over these past six or seven months.

ADAMS: Now, most of the controversy has surrounded not just how much the bills would cost, but how they would be paid for. I guess the same issue is true in this case.

ROVNER: Yes, that would be correct. This is the committee, remember, that had wanted to tax a high-end health insurance to help pay for it. That was something that then-candidate Obama campaigned against, and that got ruled out by Democratic leaders earlier this summer. It left a rather large hole for the committee to fill.

One aide described the search for ways to pay for the bill as turning over the sofa cushion and looking for quarters.

In the end, their proposal seems to be pretty egalitarian in the way it would be paid for; takes a little something from everyone including patients. Much has already been made in the last few days of a new fee that would be charged to insurance companies, and that is in there. Two fees, actually: one on those so-called Cadillac plans, another more broad-based fees on all health insurers.

But the proposal doesn't just single out the health insurance industry. There's also new fees that would be paid by drug makers, makers of medical devices, clinical laboratories and even non-profit hospitals would have to demonstrate they're actually serving their communities.

ADAMS: And the patients - how would the patients pay?

ROVNER: Well, wealthy seniors would pay more because the bills would raise their premiums for Medicare prescription drug coverage. The bill would also limit how much people could put away tax-free into those flexible spending accounts, and it would limit some of the things those accounts could be used to pay for. So, really, everybody would have to give a little bit of something in this bill.

ADAMS: And how's the reaction so far?

ROVNER: Well, so far I've only actually talked to Chairman Baucus. He said that the other senators have some changes that they want to make. He wants those suggestions on by paper by 10 o'clock tomorrow morning so the group can meet again tomorrow afternoon.

I think he wants to try to get a deal done before the president's speech tomorrow night. He's trying to use that as a wedge. But there have been lots of those deadlines that have come and gone. We'll have to see if this is just one more of those deadlines.

ADAMS: Thank you, Julie.

NPR's Julie Rovner from the Capitol.

ROVNER: Welcome. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Noah Adams, long-time co-host of NPR's All Things Considered, brings more than three decades of radio experience to his current job as a contributing correspondent for NPR's National Desk., focusing on the low-wage workforce, farm issues, and the Katrina aftermath. Now based in Ohio, he travels extensively for his reporting assignments, a position he's held since 2003.