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By Sarah Foster
Posted 1:00 AM Eastern
December 21, 2009

Watch Live: U.S. Senate Debates Health Care Insurance Overhaul

WASHINGTON – Majority Leader Harry Reid has scheduled 1 a.m. Monday for the first of several votes he needs to get his ObamaCare health bill passed by the Senate by Christmas Eve.

That’s “shortly after Sunday Night Football ends and most Americans are in bed,” says Dan Holler at the Heritage Foundation's blog, The Foundry.

Introduced Saturday morning, the senators will have had less than 38 hours to understand the 383-page manager's amendment to H.R. 3590: Patient Protection and Affordable Care Act, which Holler reports introduces several new concepts into the health care debate. For starters:

A scheme that gives the Office of Personal Management immense power in administering what amounts to a multi-state public plan;
How much a state “opt-out” of abortion coverage in the legislation erodes the long-standing Hyde-amendment;
The budgetary impact of ELIMINATING the physician reimbursement fix; and,
Multiple new taxes, federal regulations and sweet-heart deals aimed at certain states like Nebraska.

Here’s the schedule:

-- Monday, Dec. 21 – 1 a.m. – Vote to invoke cloture (i.e. end debate) on the manager’s amendment that was introduced Saturday. 60 votes are needed.
-- Tuesday, Dec. 22 -- 7 a.m. – Vote to approve the manager’s amendment. A majority vote is needed, 51 votes.
-- Tuesday, Dec. 22 -- 8 a.m. – Vote to invoke cloture on the original Reid substitute amendment (H.R. 3590: the 2,074-page bill). 60 votes are needed. --
-- Wednesday, Dec. 23 -- 2 p.m. – Vote to approve the Reid substitute amendment. A majority vote is needed.
-- Wednesday, Dec. 23 -- 3 p.m. – Vote to invoke cloture on the underlying bill. 60 votes are needed.
-- Thursday, Dec. 24 -- 9 p.m. – Vote to approve the underlying bill (i.e. the Senate’s version of Obamacare). Only 51 votes are necessary for passage.

That’s if all goes according to plan, and it may not be a completely done deal. Reid claims to have the 60 votes needed since Nebraska Senator Ben Nelson – long a holdout – gave his nod of approval and thanks, having been offered a deal for the federal government to pay Nebraska’s share of an expansion of Medicaid.

But reportedly there are still four Democrats, perhaps others, who have not announced that they will vote for cloture, though they could be balanced out by a few liberal Republicans who could decide to vote yes.

Winners and Losers

Dennis Smith, analyst at Heritage Foundation reports that in Reid’s amendment Hawaii, Massachusetts, Nebraska and Vermont are clear winners, granted special favors in time for Christmas at the expense of other states. The amendment expands Medicaid eligibility and inserts State Children’s Health Insurance Plan (SCHIP) rules into the exchange.

According to Smith: “While all the other states will lose the extra federal financing for new Medicaid eligibles after 2017, full federal financing will continue for Nebraska. Hawaii gets funding for Disproportionate Share Hospital (DSH) payments that it gave up years ago to expand Medicaid eligibility. Ironically, $18.5 billion in cuts to the DSH program in all the other states help finance the rest of the health care legislation.”

Since Massachusetts and Vermont have already expanded Medicaid eligibility, they would not benefit from new federal financing under the original legislation. But the Reid amendment will substitute federal funds for state funds.


“Who are the losers?” asks Smith -- All the other states.

“According to the Congressional Budget Office (CBO) analysis of the Reid amendment, total state funding for Medicaid and SCHIP will increase by $1 billion compared to the original legislation. Clearly if total state spending goes up and spending for a few favorite states goes down, then all the other states are picking up the tab.”

CBO’s “Mirage”

The CBO analysis plays a significant roll in the ongoing Senate debate. Indeed, Reid would not release his amendment until the CBO had looked it over and passed judgment, which was that the amended Reid plan would reduce the federal budget deficit by $132 billion over the period 2010 to 2019.”

Heritage Foundation’s James Carpetta calls such a conclusion a “mirage” and the bill itself a “budget buster.”

“As CBO notes, the bill presumes that Medicare fees for physician services will get cut by more than 20 percent in 2011, and then stay at the reduced level indefinitely,” writes Carpetta. “There is strong bipartisan opposition to such cuts. Fixing that problem alone will cost more than $200 billion over a decade, pushing the Reid plan from the black and into a deep red.

Peter Sepp, Vice President of Communications for the National Taxpayers Union, told NewsWithViews a Congressional Budget Office report "lends a cloak of legitimacy" to legislation. CBO scores are not mandatory, but can be requested by the sponsor and Reid had said that any health care bills and amendments would need a CBO score.

Sepp said the CBO is “scrupulous” in its work, “but part of the problem is that these bills are written in a way that the CBO can make only certain assumptions about their impacts and provisions. If you proscribe certain limits on how the bill will operate, well of course it’s going to get a good CBO score. You can make assumptions inside the bill that are completely unrealistic and stupid, but the CBO can’t say that. They can only say: ‘Based on the projections in this bill we believe the cost will be X.’”

Melt the Phone Lines

Last week, in a Conservative Call to Action, on, Rep. Michele Bachmann (R-Minn.) called on Americans to “melt the phone lines” of their representatives in Congress. She was talking about a just-discovered stealth bill, then-pending in the House, on the federal take-over of the financial services sector of the economy – but urged similar action on the other major bills, such as Reid’s health care measure, and to keep the pressure up all week by phoning their offices every day.

Bachman asked: “Is it too much to ask your listeners to pick up the phone Monday through Friday and call their congressmen and senators and say ‘No, you cannot have the government do this’? Is it too much to drive to their district office and take five of your friends with you and ask for a meeting with one of the staff there? Those are the actions that will kill these bills!”

Organizing for America and other leftwing organizations are doing just that, though for the opposite reason. They have phone banks set up so their activists can contact Senate offices and perhaps get through to the senators themselves during the debate because they know how important this item is to their agenda.

Conservative groups, too, are urging their members and allies to keep those email and faxes and phone calls pouring in for entire debate – and make those phone calls. And it does work, says Bachmann.

If the schedule goes as expected, the final bill on health care will be Christmas Eve. But as NewsWithViews reported, there is a possibility the action won’t stop there.

Sepp suggested that it would not be surprising if Reid called House Speaker Nancy Pelosi on the phone as soon as the cloture vote is completed Monday morning and saying: “Look. We’ve done all the heavy lifting; it’s just a matter of another day or two until we get it passed, so you better make plans to call your people back.

“[The House] might be there ready and waiting for the passage vote literally an hour after the Senate does its job on Wednesday [or whenever the final vote takes place].”

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Sepp also worried that while a number of both Republicans and Democrats just want to spend Christmas with their families, “there are a lot of Democrats who will do anything to get this through. So the momentum may be with them if this goes so late into next week.”

Selected Earlier Stories

1 - Sarah Foster: Will Congress Give America ObamaCare for Christmas? Dec. 19, 2009
2 - Cliff Kincaid: Vatican Engineered Victory for Pelosicare. Nov. 10, 2009
3 - Dennis Cuddy: Obamacare? Sept. 19, 2009
4 - Jim Kouri: Critics Say Obama-Care Prescription for Fraud and Abuse. Sept. 11, 2009
5 - Sarah Foster: White House sued for online 'Snitch' Box. Sept. 1, 2009
6 - Jim Kouri: Americans Skeptical Over Obama's Health Care. July 21, 2009
7 - Joel Turtel: Obama's Health Care Death Lists Coming Your Way. July 18, 2009
8 - Jim Kouri: Health Care Report: Americans Paying More for Less. July 3, 2009
9 - Jim Kouri: Obama's Health Plan Poses Danger to American Freedoms. Jan. 13, 2009

Additional Information / Sources

1 - The Foundry Blog: Heritage Foundation
2 - Manager's Amendment to H.R. 3590
3 - H.R. 3590: Patient Protection and Affordable Care Act. Introduced by Sen. Harry Reid Nov. 19. Originally a bill dealing with first-time homebuyers credit for veterans which passed the House Oct. 8, it is now the vehicle for the version of health care reform currently being debated by the Senate.
4 - Rep. John Dingell: H.R. 3962: Affordable Health Care for America Act (“PelosiCare”)
5 - TNA Staff: Republicans Promise Procedural Resistance to Health Care Legislation: The New American, Dec. 17, 2009
6 - Martin Anderson: Creating a Health-Care GM: Providence Journal, Dec. 10, 2009
7 - Centers for Medicare and Medicaid Services: Estimated Impact of Health Care Reform Proposals Actuarial Studies: Updated Dec. 16, 2009. PDF links to reports on the four bills.

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Sarah Foster is a researcher and freelance writer:











Sepp suggested that it would not be surprising if Reid called House Speaker Nancy Pelosi on the phone as soon as the cloture vote is completed Monday morning and saying: “Look. We’ve done all the heavy lifting; it’s just a matter of another day or two until we get it passed, so you better make plans to call your people back.