Finance Committee Prepares to Debate Baucus's Healthcare Plan

Sen. Max Baucus arrived alone last Wednesday to unveil what was supposed to have been a collaborative, bipartisan healthcare bill. He was smiling, maybe because as a marathon runner he's familiar with solitary races. For whatever reason, he sounded optimistic. He all but promised that his proposal would be able to win Republican support when the Senate Finance Committee, which he chairs, starts debating it tomorrow.

Republicans and some of the Democrats on his committee quickly criticized the proposal. Still, what seems to have gotten lost in the reaction is not that people can find things they don't like in the plan but rather how much it shares with two other proposals—the House bill and the Senate Health Committee bill—that came out this summer. As Elizabeth McGlynn, a top health policy expert at Rand, says, "The bottom line is that it is very similar . . . with respect to the approaches to expanding insurance coverage."

All three bills would give subsidies to lower-income Americans to help them buy insurance. All would expand Medicaid to cover more of the poorest Americans. All would stop insurance companies from denying coverage because of pre-existing conditions. All would set up exchanges to let people comparison-shop for policies.

But there are also glaring differences. On the question of how to make the insurance market more competitive, the Baucus bill doesn't set up a government-run health insurance plan, the so-called public option. Instead, it puts up $6 billion to start health cooperatives, which would be run by consumers, not the government. It also takes a much different approach to raising money to pay for itself. The House bill would tax people making more than $350,000. The Baucus bill would tax insurance companies on their most expensive insurance plans—any costing more than $8,000 for an individual or $21,000 for a family—and make medical-device makers, insurers, and some other industry groups pay more in fees. But there also concerns that the taxes on expensive plans could be passed on to regular middle-class workers in the form of higher premiums.

Baucus put the cost of his bill at $856 billion. That's significantly cheaper than the House's version, which tops $1 trillion, but apparently is still too much for Baucus's Republican colleagues on the Senate Finance Committee, none of whom have endorsed it. Iowa Sen. Chuck Grassley, who had been a lead Republican negotiator with Baucus, complained about being "pushed aside" by the Democratic leadership. Meanwhile, President Obama pressed ahead last Thursday with a rally at the University of Maryland, and followed it up with a blitz of television interviews on Sunday.

But Baucus seems to think, or at least is publicly saying, that he can bring Republicans on board. That will be tested in his committee this week. So far, Baucus, a centrist, has tried to strike middle-ground positions on divisive issues, leaving both sides asking for more changes. "Some want more," Baucus said, referring to progressive groups that have attacked him for dropping the public option. "Some want less. I think it's a very good beginning." But rather than bringing people behind him, it's just making a lot of people angry.

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