Narrow vote sees US Senate approve motion to debate Reid health reform bill

In a narrow vote, US Senate Democrats voted on Saturday night (November 21) to begin the official debate and amendment process for a health care reform bill sponsored by Senate leader Harry Reid (Democrat, Nevada), to overhaul the country's health care system. The vote split entirely on party lines with 60 Democrats voting to break the Republican filibuster supported by 39 party members in the Senate.

Several Democrats who may ultimately vote against the bill supported cloture to end debate on the Motion to Proceed. These included Senators Ben Nelson of Nebraska and Bob Casey of Pennsylvania, the only Democrats in the Senate who call themselves pro-life and pro-abortion Senator Kent Conrad of North Dakota, who joins them in wanting Stupak-like amendment to ban the abortion funding.

A full Senate debate on health care reform bill, which would extend insurance coverage to people who lack it, crack down on insurance company practices that deny or dilute benefits and curtail the growth of spending on medical care nationally, will now begin on November 30, and is likely to be bruising - as well as involve a number of compromises, observers note The House of Representatives narrowly passed its own version of the reforms earlier this month (The Pharma Letter November 9).

Senator Reid says his $849 billion bill would extend coverage to another 31 million people, or 94% of eligible citizens. The legislation, which was outlined in a 2,074-page document, is said by Democratic aides to reduce deficits by $127 billion over a decade and by as much as $650 billion in the 10 years after that. However, Republicans say it will be too expensive, and have vowed to block it. Fewer than 60 votes for the initial measure would have left the bill vulnerable to Republican delaying tactics, says the UK's public broadcaster, the BBC, in its coverage of the event.

Next steps

On November 30, Senators will return from the USA's Thanksgiving recess to debate and propose amendments to the bill

At least three weeks later, Senators will vote on final bill. If passed, a conference committee will be set up to reconcile Senate and House bills. Both chambers will vote on a final version which, if voted for, President Barack Obama will sign into law. A White House spokesman said President Obama was "gratified that the Senate has acted to begin consideration of health insurance reform legislation," the BBC reported

Speaking after the vote, Mr Reid said he was looking forward to the coming debate and to "finally bringing quality health care to the American people."

But Republican Senate leader Mitch McConnell said he would continue to oppose the motion. "The American people are asking us to stop this bill and we're going to do anything and everything we can to prevent this measure from becoming law," he said. Republican leaders believe that the plan's true cost is about $2,500 billion over a decade.

'Senator Reid's claim that the cost is $848 billion is the ultimate Washington gimmick, at taxpayers' expense,' said Senator Charles Grassley of Iowa, the top Republican on the Finance Committee, reported by Bloomberg.

Under the Senate bill, most Americans would have to have health insurance, while private insurers would be banned from refusing to provide insurance because applicants had pre-existing medical conditions. Insurance would be made more affordable with subsidies available to help those in lower income bands, the Democrats say.

People would also be able to take part in new insurance market places and be able to choose to buy government-sold insurance from 2014, a provision intended to help regulate the prices charged by private companies. Large companies would be required by law to provide coverage to staff. The costs would be covered by government cuts on future Medicare spending.

Mr Reid's bill differs to the House bill in that he calls for an increase of a half percentage point in Medicare payroll tax for people with an income of over $200,000 per annum - rising to $250,000 for couples. There is also a tax on high-value insurance policies that is not contained in the House version of the bill.

Won't measurably improve system, says Business Roundtable

As providers of health care insurance to more than 35 million Americans, the members of Business Roundtable said in a statement just ahead of the vote: 'Based on our experience and research, the current health care reform proposal being considered by the Senate will not effect the needed changes to measurably improve the American health care system. Specifically, two of the bill's provisions will increase costs for employers and, in so doing, threaten the coverage of 177 million Americans who obtain insurance through the workplace: the government-run plan and the new taxes on devices, drugs and insurance. The employer costs associated with these items will jeopardize not only millions of workers' coverage, but also the competitiveness of America's companies in the global marketplace. We are also concerned that the current proposals miss several key opportunities to reduce costs, most notably medical liability reform.

PhRMA stands by its commitment to health reform

Also before the vote, the Pharmaceutical Research and Manufacturers of
America (PhRMA) senior vice president Ken Johnson made the case for health reform and reaffirmed PhRMA's commitment to supporting this effort, in an editorial in POLITICO.

He argued that health reform, if done in a smart way, can benefit patients, the economy and the nation. Mr Johnson also made the point that health reform must support medical progress and innovation, and reminded readers that cutting-edge medicines have dramatically increased life expectancy in America and improved the quality of life for patients with devastating diseases such as cancer, heart disease and diabetes.

"What's crucial now is that we remain focused on the important goal of enacting comprehensive health care reform this year. In life, we get precious few opportunities to fundamentally improve the lives of people across our great nation. Working together, this is our chance," Mr Johnson wrote.