With the votes to pass health care in the Senate a fait accompli, everyone has turned their attention to the conference committee, and the numerous knotty issues involved in reconciling the House and Senate bills and arriving at something that can pass both chambers.

Democratic Senators spent the weekend vowing that whatever comes out in conference must materially look like their bill, or it will not be able to pass the Senate (conference reports can be filibustered). Kent Conrad offered a sample of this argument on MSNBC:

“I think the reality is also very clear: If in overall dimension and context this bill isn’t close to the Senate bill, there will be no way to get the 60 votes here,” said Conrad, who also rejected the notion of the House being forced to simply accept what the Senate is expected to pass this week.

But John Conyers released a statement saying that major changes needed to be made before the bill would be acceptable to him. I’ve included it at the bottom of this post. But let’s set out the key issues Conyers wants changed:

• Affordability: Conyers argues for more generous subsidies to make health insurance affordable.

• Medicaid expansion: The House bill has Medicaid expanded to 150% of the federal poverty level; the Senate bill stops at 133%. Conyers wants the House version in the final bill.

• Public option: As expected, Conyers argues for a public option to compete with private insurance companies.

• Repeal of the insurance industry’s anti-trust exemption: We will see if the repeal was not inserted into the Senate bill to secure Ben Nelson’s vote. Harry Reid has talked strongly about repealing the anti-trust exemption, and the House bill had it included. There’s every opportunity to include it in the final bill.

• Excise tax: unions and progressive leaders are pushing strongly for the House’s version of financing, dropping the excise tax on high-end insurance plans that financed part of it and substituting it with a surtax on millionaires. Sen. Debbie Stabenow also noted today that the excise tax should be relaxed or eliminated. The White House has said that the excise tax is a major cost control component of reform, so they’ve staked some of the bill on it. In addition, Ben Nelson has objected to the House surtax on millionaires, saying “that would break” his promise to vote for the bill.

Crucially, Conyers added that the House has a role to play in constructing this legislation:

“Lastly, I am troubled that some Senators believe that the House must accept the majority of the concessions embodied in this Senate bill. My message to the these Senators is this: Just as it took compromise to pass your bill last night, so now will it require additional compromise to successfully reconcile your legislation with the House. The Constitution established a bicameral legislature so that neither body would dominate the other.

There will be another interested party in the room – the executive branch. All along, President Obama has said to get to conference and he would iron out the wrinkles. Rep. Elijah Cummings (D-MD) said today that the President will need to get personally involved in the deliberations. So whatever decisions get made will reflect the goals of the President, not just the Congress.

Here’s Conyers’ statement:

“Last night’s vote in the Senate should be applauded for what it was:
an affirmative statement by that body that comprehensive health care reform legislation should not be held captive any longer by a select few.” “As this legislation moves towards its constitutionally mandated reconciliation with the House of Representatives, I also want to make it clear that, in my mind, this bill does not adequately address many of the problems that plague our current system. Without material changes, this legislation will be reform in name only.”

“In order to pass the House of Representatives, a final health care must have universal affordability and competition to the American people. Additionally, it should be financed by those with the ability to pay and not by working class Americans lucky enough to receive quality health coverage through their employers.”

“I supported the House bill because it included serious provisions aimed at helping individuals who currently cannot afford to purchase health care by providing subsidies and expanding Medicaid to 150 percent of the Federal Poverty Level. The Senate bill passed last night does not ensure this same level of affordability; there are fewer subsidies and the expansion of Medicaid is not as extensive.”

“Similarly, I supported the House bill because I believe that it is immoral to continue to allow the private health insurance industry to operate without any real checks on its ability to charge unaffordable premiums and deny needed care. That is why I believe competition, as provided through a national Medicare-like public health insurance option and the repeal of the industry’s antitrust exemption, is a necessary component of true reform.”

“The sole remaining ‘competition’ provision that remains in the Senate’s bill is woefully insufficient. These multi-state non-profit plans run by the Office of Personnel Management will not be transparent; they will not have a built in network of doctors; they will not allow us to move away from the wasteful fee-for-service system that inflates costs; and they will not attract a risk pool big enough to create real savings and efficiencies for consumers.”

“The American people have already experienced private non-profit health insurance. It hasn’t worked in the past and there’s no reason to think it’s the answer now. Relying on private insurers to police other private insurers is like asking the fox to guard the hen house.”

“Additionally, the excise tax levied on certain “Cadillac”employer-based health care plans in the Senate legislation must be altered. For years, many workers chose to forgo wage increases in exchange for helping their employers offer comprehensive health care plans. The Senate’s efforts to tax these plans will hurt working families and it contradicts the President’s pledge that individuals who like the health coverage they have will be able to keep it. I strongly support the House’s approach to financing health care: an excise tax on the incomes of extremely wealthy Americans.”

“I look forward to working with the Senate and House Leadership to ensure that the final health care bill address these core principles of affordability, competition, and progressive financing.”

“Lastly, I am troubled that some Senators believe that the House must accept the majority of the concessions embodied in this Senate bill. My message to the these Senators is this: Just as it took compromise to pass your bill last night, so now will it require additional compromise to successfully reconcile your legislation with the House. The Constitution established a bicameral legislature so that neither body would dominate the other.

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