The U.S. Senate continues to debate the health care reform legislation unveiled by Senate Majority Leader Harry Reid (D-NV) on November 18. Senators from both parties have filed hundreds of amendments to date, but fewer than 20 have been brought to the floor for a vote. Only a half dozen or so of those had been agreed to by the time Skyline News went to press. It is expected that amendments will continue to be brought to the floor until Majority Leader Reid files his “Managers Amendment.” That will include changes individual Senators requested that Sen. Reid has agreed to in return for securing votes for passage. As previously reported by GNYHA, the motion to even begin debating the health reform overhaul package received the minimum votes needed. Ensuring 60 votes for final passage has been—and continues to be—an extremely difficult process for Senate leadership.

The Senate continues to grapple with the public insurance option issue, though Sen. Reid made news last week when he announced that broad consensus had finally been reached on how to structure the offering. Ten liberal and moderate Democratic senators crafted the plan, which was designed to break the impasse within the caucus and represent a workable compromise measure. Limited details were available at press time, but GNYHA has learned that part of the agreement would require the Office of Personnel Management to negotiate with plans nationwide to offer affordable private options (similar to the Federal Employees Health Benefits Plan). And, a Medicare buy-in option would be made available to individuals aged 55–65.

GNYHA continues to work on a number of issues, including a reduction in the amount of disproportionate share hospital cuts (DSH); significant new funding for residency positions; protections against harmful geographic variation proposals; the elimination of the Independent Medicare Advisory Board; a delay of the medical device tax until 2013 (and a gross receipts tax structure); extension of the FMAP relief provided through the stimulus (and a maintenance of effort to keep the money in Medicaid); enhanced FMAP for Medicaid expansion populations; and critical changes to the readmissions policy.

Once Reid’s “Managers Amendment” is filed and accepted, the Senate will move to hold a final vote on the bill. Reid and the White House have been targeting passage by the Christmas recess. If the bill passes and there is a conference committee to reconcile differences between the bills the House and Senate passed, it is expected to be small and act extremely quickly. Otherwise, it is anticipated at this point that the House would simply be forced to pass the Senate’s bill, despite considerable differences in the coverage provisions and DSH cuts.