The House is expected to consider the Senate-passed health care reform legislation, the Patient Protection and Affordable Care Act (H.R. 3590) as the first step of a two-step strategy to complete the legislation later this week, although an exact time remains uncertain. The House Budget Committee voted 21 to 16 earlier today to send the health care legislation to the House Rules Committee. The Rules Committee is expected to meet Thursday to draft new language for the reconciliation bill, compiling a package of fixes to the $875 billion measure that passed the Senate on Christmas Eve.
Earlier this week, House Speaker Nancy Pelosi (D-CA) said that the final bill would be posted online for 72 hours, meaning that a final vote is not likely until March 20, at the earliest. One reason for the delay in voting is that the Congressional Budget Office has not released its score of the bill, which some attribute to the fact that the tweaked bill may have a price tag over $1 trillion. A secondary option that the House may take advantage of is an action called “deem and pass,” in that the House would avoid a direct vote on the Senate bill and instead, the Senate bill would be “deemed” passed if either the rule is adopted or the accompanying package of fixes, those contained in the reconciliation bill, is passed.
According to congressional sources there is an expectation that any changes to the Senate bill contained in the reconciliation bill would include an increase in subsidies, an expanded Medicare payroll tax on wealthier families, increased aid to states to cover Medicaid expansion, and a delay in taxing high cost insurance plans.
The Congressional Budget Office (CBO) released its revised estimate last week of the Senate’s health care bill, (
HR 3590), the
Patient Protection and Affordable Care Act (PPACA), passed on December 24, 2009. The revised estimate reflects a later enactment date, includes all amendments, and makes some technical adjustments from the previous estimate prepared on December 19, 2009. The CBO and the Joint Committee on Taxation now estimate that, on balance, the direct spending and revenue effects of enacting H.R. 3590 as passed by the Senate would yield a net reduction in federal deficits of $118 billion over the 2010–2019 period. Congressional leaders are also waiting for a cost estimate of the President’s proposal. One additional concern is that some of the budgetary offsets that may be used for a health care reform bill are in the
American Workers, State, and Business Relief Act of 2010 (
HR 4213), the tax extenders bill that the Senate approved Wednesday, which could affect final passage of the Tax Extenders legislation.
The President’s plan would expand Medicaid up to 133 percent of the federal poverty level. Under his proposal, the federal government would fully fund the cost of services for the expansion population from January 1, 2014, through 2017. In 2018 and 2019, the federal government would pay 95 percent of the cost and in 2020, and thereafter, it would pay 90 percent. According to Administration staff, the definition of newly eligible would follow the language of the Senate bill.
Finally, the health care overhaul bill will probably be combined with a student loan proposal as it may be able to attract additional votes. The proposal would make the federal government the sole originator of the student loans, which some members of Congress believe is less costly to taxpayers than subsidizing banks to loan money to students. While the House passed identical legislation (HR 3221) last year, the possibility of a filibuster in the Senate has resulted in its attachment to the health care overhaul bill. Additionally, Congress can only pass one reconciliation bill each fiscal year meaning that if the student loan overhaul bill is not attached, it would have to be passed through normal Senate procedures. Additionally, the student loan proposal would generate an estimated $67 billion in savings over the next 10 years, making the bill more attractive from a fiscal point of view.