MicEvHill.Com - Pathway Cleared for Senate Passage of Landmark Health Care Reform Bill

Senate is Viturally Assured of Passing Landmark Health Care Reform Bill by Christmas Eve

The Senate moved a step closer to passing a landmark health care reform bill this morning when it approved the first of three p

rocedural motions, invoking cloture on a catch-all "Manager's Amendment" to the measure. The Senate invoked cloture on the "Manager's Amendment" by a party-line vote of 60-40, with no votes to spare. Today's vote, cast in the pre-dawn hours of Monday morning, virtually assures that, absent the death or illiness of one of the 60 Democrats in the Senate, sometime before Chrismas Day, the Senate will pass the measure and send it on its way to what promises to be a contentious January conference with the House of Representatives.

The Senate is using H.R. 3590, a tax measure that the House of Representatives passed earlier in 2009, as the vehicle for considering its health care reform bill. Senate Majority Leader Harry Reid (D-NV) submitted a substitute for the tax bill earlier this month. Late last week, Reid proposed his catch-all "Manager's Amendment" to that substitute. The "Manager's Amendment incorporated a number of compromises into the bill that were sufficient to enable him to win 60 votes in favor of the measure.

Summary of Immigration Provisions
The package of amendments that the Senate is considering contains a number of provisions relating to immigrants' access to health insurance. Its immigration-related provisions are substantially similar to those that were contained in a bill that the Senate Committee on Finance approved earlier this year in its version of the Senate's health care reform bill. However, there are some changes around the edges.

As was the case with the Senate Finance Committee-reported version of the health care reform measure, the bill that the Senate is considering would exempt persons who are not lawfully present in the United States from the measure's general mandate that virtually everyone living lawfully in the United be covered by a qualified health insurance plan or face tax penalties for failure to comply. The bill currently on the Senate floor also mirrors the Finance Committee bill's provision that would make legal immigrants eligible for health care affordability tax credits without regard to a waiting period. And although there is a slight change in the phraseology, the new bill generally would bar aliens who are not lawfully present in the United States from using their own funds to purchase health insurance products that are listed on the Health Insurance Exchange that the bill would create. The bill that the Senate is considering would establish a new citizenship and immigration status verification regime that would exist in order to ensure that persons who are not lawfully present in the United States do not receive health insurance products and benefits from which they are barred. It would rely on the recently enacted Children's Health Insurance Program reauthorization bill's mechanism for verification. It would subject everyone who purchases health insurance through the exchange, benefits from an exchange plan, or receives an affordability tax credit, to a citizenship and immigration status verification using the new regime.

Pathway Cleared By Cloture Vote
The pathway for cloture on the Senate health care reform package was cleared on Saturday, December 19, when Senator Ben Nelson (D-NE) agreed to support the Senate health care reform bill. Up to that point, it was widely believed that Senator Nelson was the last Democratic holdout in the Senate. His commitment to support the measure arrued Majority Leader Harry Reid of the 60 votes he needed to break a GOP filibuster and pass the landmark measure. The Senate confirmed that belief at 1:00 am EST this morning when it voted to b

reak the GOP filibuster on the "Manager's Amendment". Two more cloture votes are set for the coming days. If Republicans use all of the time that is alloted to them, the vote on final passage of the measure will occur at 7:00 pm EST on Christmas Eve.

Rejection of the Menendez State Medicaid Option Proposal
Should the Senate, as is now expected, pass the health care reform bill, it will do so without including within it a key immigration-related proposal that has been advanced by Senator Bob Menendez (D-NJ). The Menendez proposal would have permitted states to waive a provision in current law that bars most legal immigrants from the Medicaid program until they have been in the United States for five years or more. Majority Leader Reid yesterday refused pleas from pro-immigrant advocates and Senator Menendez to include the provision, known as the State Medicaid Option proposal, in the final version of the health care reform bill that he has put before the Senate. The Majority Leader's decision deals what could be a fatal blow to efforts to expand legal immigrants' eligibility for the Medicaid program as part of the landmark health care reform bill.

Majority Leader Reid's decision did not become known until 8:35 am EST on Saturday morning, when he unveiled and then submitted his "Manager's Amendment" to the Senate's health care reform bill. The Majority Leader promptly filed three cloture motions on the Manager's Amendment, the Reid Substitute, and the underlying bill. It is the first of these three cloture motions that will be voted on in the wee hours of Monday morning.

The "Manager's Amendment" to the Senate health care reform bill is 383 pages long. It contains numerous changes to the health care reform bill that are designed to enable him to assemble 60 votes to shut down debate on the bill and bring it to a vote on final passage. Inclusion of the Menendez proposal in the catch-all package would have ensured that if the Senate passed the health care reform bill, the measure would have contained the Menendez proposal expanding legal immigrants' eligibility for the Medicaid program.

The only hope now for the Menendez State Medicaid Option proposal is for the House and Senate to include it in the final conference agreement on the bill, despite the fact that it was not in either the House- or Senate-passed versions of the bill. Sources indicate that Majority Leader Reid pledged during yesterday's caucus of Senate Democrats that he would ensure that the Menendez proposal is included in the final bill that emerges from a January House-Senate conference committee on the health care reform bill. However, the Majority Leader's pledge is viewed by some insiders as an empty promise since such a maneuver would violate both House and Senate rules and subject the conference agreement to procedural obstacles.

Senator Menendez unveiled his State Medicaid Option amendment several weeks ago, and it had been waiting ever since in a cue of more than 400 amendments that had been filed to the health care reform bill. Menendez wasjoined in filing his amendment by Senators Jay Rockefeller (D-WV), Jeff Bingaman (D-NM), and Dick Durbin (D-IL).

Other Immigration-Related Amendments
The Menendez Medicaid State Option amendment was one of at least five immigration-related floor amendments to the Senate's health care reform bill that had emerged in recent weeks. Three of the other four amendments, sponsored by Senators John Ensign (R-NV) and Jeff Sessions (R-AL), were decidedly less generous to immigrants. In the end, none of the amendments were ever offered to the bill on the Senate floor.