15 Oct, 09 | by BMJ
Few people outside of Washington have heard of Olympia Snowe, the senator from Maine. But on Tuesday, she became the most important person in healthcare reform. Her vote in the Senate Finance Committee gave the Obama Administration its first bipartisan victory on healthcare. The Senate Finance Committee approved a healthcare reform bill by a vote of 14 to 9, with Olympia Snowe casting the only Republican vote in favour of the bill.
The passage of the Senate Finance bill has been the most closely scrutinised of all the committee processes because the Finance Committee has jurisdiction over the biggest cost drivers in American healthcare – Medicare and Medicaid – as well as over the preferential treatment of employer sponsored health insurance through the tax code. The Chairman of the committee, Max Baucus, had also made it clear over the summer that his bill would represent a compromise that might just go far enough to succeed.
With the Senate Finance committee’s vote, Tuesday became a small moment in healthcare reform history. It marked the first time ever that healthcare reform bills had been passed by all five Congressional committees that are responsible for healthcare legislation: three in the House of Representatives and two in the Senate. The Finance Committee bill now disappears behind closed doors along with the bill passed by the Senate Health, Education, Labor and Pensions (HELP) committee in the summer. Senate majority leader, Harry Reid, has the task of combining the two bills into one compromise bill. Now the tough decisions have to be made.
The Finance Committee bill does not include a public plan to compete alongside private plans in a health insurance exchange. The HELP committee bill does. The public plan is an idea that many Democrats, including the President, have been committed to but is something that no Republicans support, not even the very moderate Olympia Snowe. Snowe has backed a gentler version of the public plan that involves a public option being triggered under certain circumstances where the health insurance market within a state is failing to meet people’s needs for coverage. This difference of opinion between the two bills is the thorniest for Harry Reid to resolve but there are other tricky issues. Should there be an employer mandate to provide health insurance coverage? How many employees does a company need to have to be subject to the mandate? How stiff should the penalty be for individuals who refuse to buy health insurance, even when there is an affordable plan?
Yesterday’s vote seemed momentous to people who pay attention to the intricate details of this incredibly complex legislative process. But it is only one small step towards healthcare reform in America and there are many stumbling blocks to come. Once Harry Reid’s job is done, the bill will be sent to the entire Senate for a vote. If the bill is passed in the Senate, there will then be two bills – one passed by the Senate and one by the House of Representatives. These have to be reconciled until there is only one bill that can be signed by the President. The irony is that, even if the bill makes it to the President’s desk, all this hard work will still leave 25 million Americans without health insurance.
Vidhya Alakeson is a former Harkness Fellow in Healthcare Policy based in Washington DC.