Senate Majority Leader Harry Reid introduced his health care reform bill in the Senate late Wednesday, a measure that would expand coverage to nearly all Americans at an estimated cost of $849 billion over 10 years.
The bill, which combines elements of proposals passed by the Senate Finance Committee and the Senate Health, Education, Labor and Pensions Committee, is designed to make health insurance more accessible and more affordable. Preliminary guidance from the Congressional Budget Office estimates the bill would expand coverage to 94 percent of Americans.
After briefing Democratic senators behind closed doors, Reid appeared smiling and relieved at an evening press conference to talk up the bill. "It will save lives. It saves money and it's not going to add one dime to the deficit," Reid promised. "In fact, quite the opposite," estimating the deficit would actually be reduced by more than $100 billion through tax increases, cost savings in Medicare and preventative care, among other things.
"What's not to love about this bill?" asked Sen. Chris Dodd (D-Conn.).
But the real question is whether Reid and his fellow Democrats can deliver on the promises they made Wednesday.
According to senior Democratic aides and a document distributed to senators who met with Reid, the bill would:
-- Require individuals to get health insurance and parents to insure their children. Penalties on individuals who aren't covered will phase in from $95 per year to $750. Employers with more than 50 workers would have to offer insurance or pay a penalty for each worker who buys coverage through a health insurance exchange;
-- Provide a tax deduction for small businesses for up to 50 percent of the cost of covering employees;
-- Reform insurance company practices, making it illegal for insurers to drop or deny coverage based on the cost of care or pre-existing conditions. It would also let parents keep their children on their insurance through age 26.
The proposed health insurance exchanges, to be in place by 2014, would act as marketplaces where consumers could buy private insurance, coverage through non-profit co-ops, or take advantage of a public insurance option if they're eligible. States can opt out of of the public option under the Senate bill.
To pay for the estimated $849 billion cost of expanding coverage, the bill cuts Medicare spending by nearly $500 billion and raises revenue through penalties, fees on medical device makers and pharmaceutical companies, and through a new five percent tax on elective cosmetic surgery. It also levies a 40 percent tax on high-dollar "Cadillac" insurance plans, costing $8,500 for individuals and $23,000 for a family, and increases the Medicare payroll tax a half-percent on income over $250,000 for families.
All of the sticking points that existed before Reid introduced his bill remained in the measure he unveiled on Wednesday.
Organized labor opposes a tax on "Cadillac" insurance plans. On the public option, Sens. Bernie Sanders of Vermont and Roland Burris of Illinois have said they they would not vote for a bill without a mandatory public option. Sanders said Wednesday night, "We're still working on it."
Sen. Ben Nelson (D-Neb.) earlier threatened to withhold a vote to even debate the bill because of the opt-out provision for states. On Wednesday he noted that the opt-out is still in, and said he needs to spend time reading the entire bill this week before committing to any votes.
On the two most contentious issues -- abortion funding and access of illegal immigrants to the insurance exchange -- Reid's bill differs significantly from the House measure.
Although the House-passed bill allows illegal immigrants to pay for insurance through the exchange with their own money, the Senate bill says they have no access to the exchange at all.
On abortion, the Reid bill does not go as far as the restrictive House amendment, which bans direct or indirect funding for abortion coverage in the new exchanges. The Senate language stipulates that no federal funding may be used for abortion services, but it also requires each state exchange to offer at least two insurance options for women -- one with abortion coverage and one without. The bill also states that abortion coverage can be offered through the public option if the Secretary of Health and Human Services can certify that no federal funds are used to cover or perform the procedure.
Sen. Barbara Boxer (D-Calif.) called the abortion language "a masterful job" and Sen. Barbara Mikulski (D-Md.) said she could live with it. But Nelson called the abortion language "pretty sketchy," and the National Right to Life Committee blasted it as "totally unacceptable."
Republicans promised a fight over Reid's bill. "It's going to be a holy war," Sen. Orrin Hatch (R-Utah) told The New York Times.
The Congressional Budget Office is expected to release its evaluation of the Reid bill Thursday, and Sen. Dick Durbin of Illinois predicted a vote on moving to debate by Saturday.
After his press conference Wednesday night, but before his bill was introduced, Reid was so ebullient that he embraced his fellow senators in a narrow, crowded hallway, hugging Democrats Dodd and Tom Harkin of Iowa and prompting Chuck Schumer (D-N.Y.) to ask, "Whose side are you on?"
With so many interests to please, it's a good question.