Telling Congress to “finish its work,” President Obama on Wednesday urged both chambers to schedule a vote on final health care overhaul legislation in the coming weeks. While Obama did not outline a specific roadmap for reform, it is widely believed that the plan for going forward involves first having the House of Representatives vote on the Patient Protection and Affordable Care Act (H.R. 3590), the bill the Senate approved in December, and then passing via budget reconciliation a package of changes to that bill reflected in the estimated $950 billion proposal Obama unveiled on February 22. While Obama did not specifically mention reconciliation, he seemed to sanction this approach, stating that a health care reform bill: “deserves the same kind of up-or-down vote that was cast on welfare reform, the Children's Health Insurance Program, COBRA health coverage for the unemployed and both Bush tax cuts – all of which had to pass Congress with nothing more than a simple majority.” The controversial budget reconciliation process requires a simple majority vote, but is subject to strict limitations about what matters can be included in a reconciliation bill.
Obama further remarked that his proposal “incorporates the best ideas from Democrats and Republicans.” Specifically, the President’s legislative blueprint borrows a number of elements from the Senate-approved bill, including the requirement that most Americans obtain health insurance coverage, the creation of a health insurance exchange, penalties on large employers that fail to provide affordable health insurance, the imposition of an excise tax on high-cost “Cadillac” insurance plans, and the lack of a public insurance option included in the more expansive House-passed Affordable Health Care for America Act (H.R. 3962). Obama’s plan also includes popular elements contained in both bills, such as the ban on preexisting condition exclusions and certain lifetime and annual coverage limits in health insurance plans.
In a letter to Congress, Obama signaled his willingness to consider certain GOP proposals, including allocating $50 million to fund state initiatives designed to reduce medical malpractice costs; allowing certain high-deductible insurance plans to be offered in the health insurance exchange; increasing Medicaid reimbursements to doctors in certain states; and permitting medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other federal programs.
At this point, it is unclear whether the House has enough votes to pass the Senate bill, and whether the Senate can garner 50 votes to proceed with reconciliation, with Vice-President Biden supplying the tie-breaking vote. Republicans are expected to be united in their opposition, leaving Democratic leaders with little margin for opposition within their own caucus.
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