The Senate Committee on Finance on Tuesday approved the Baucus Health Care Reform bill, doing so by a vote of 14-9. All 13 Democrats on the Committee voted in favor of the proposal, as did one Republican, Senator Olympia Snowe (R-ME). Tuesday’s action was but a formality, however. Even as the vote was being cast, Senate Majority Leader Reid (D-NV) was working to put together a compromise bill that melds the work of the Senate Committee on Finance with the bill that the Senate Committee on Health, Education, Labor, and Pensions approved earlier this year. He hopes to have the bill ready for the full Senate’s consideration during the week of October 26, 2009.
The measure that the Senate Finance Committee has approved would reform the health insurance industry by mandating certain types of coverage in all policies, place mandates on individuals to purchase health insurance, penalize individuals who fail to purchase it, subsidize the cost of purchasing health insurance for some low-income imdividuals and families, and place restrictions on immigrants' access to health insurance.
Summary of Immigration- and Refugee-Related Provisions The bill that the Senate Finance Committee approved contains a number of immigration-related provisions and impacts. More specifically, the bill would:
Health Insurance Mandate. mandate that legal immigrants (along with U.S. citizens) either purchase health insurance or be subject to a tax penalty;
Treatment of Illegal Immigrants Under Mandate. exempt illegal immigrants from the mandate to purchase health insurance;
Illegal Immigrants and Health Insurance Exchanges. bar illegal immigrants from purchasing health insurance in state or federal health insurance exchanges;
Health Insurance Exchanges and Mixed Families. permit illegal immigrants to purchase health insurance in the exchanges for their U.S. citizen or LPR children;
Legal Immigrants and Affordability Credits. permit legal immigrants to receive affordability tax credits to help them pay for health insurance without regard to the five-year waiting period under the law for Medicaid and the Children's Health Insurance Program (CHIP);
Illegal Immigrants and Affordability Credits. bar illegal immigrants from receiving affordability tax credits to help them purchase health insurance;
Legal Immigrants with Expiring Immigration Status. bar legal residents from receiving affordability tax credits to help them purchase health insurance if their legal status will expire within a year;
Calculation of the Federal Poverty Level. exempt illegal immigrants from the calculation of the Federal Poverty Level for the purposes of the bill; and
Citizenship and Immigration Status Verification. impose an immigration status verification regime on all persons --- citizens and noncitizens, alike -- seeking to purchase health insurance.
Immigration-Related Amendments Offered During the Markup Senate Finance Committee Chairman Max Baucus (D-MT) released both a brief summary and a detailed summary of his health care reform proposal on September 16, 2009. The Baucus proposal, referred to as "the Chairman's Mark," consisted of conceptual language; not legislative language.
Senators on the Committee promptly filed 564 amendments to the Chairman's Mark, including at least 11 immigration-related amendments. Like the Chairman's Mark, all of the amendments that were filed were conceptual and did not include actual legislative language. Seven of the immigration-related amendments that were filed to the Baucus Chairman's mark sought to restrict immigrants' access to health care and four sought to expand their access.
The Committee held eight markup sessions, considering amendments to the Chairman's Mark during six of those eight sessions. In the end, the Committee only took up four immigration-related amendments during its seven markup sessions, all of which sought to restrict immigrants' access to health care.
The following are the four immigration-related amendments that were offered during the markup of the bill:
GRASSLEY PHOTO ID AMENDMENT. Senate Finance Committee Ranking Republican Charles Grassley (R-IA) offered an amendment on Wednesday, September 30, 2009, that would have amended Title 19 of the Social Security Act to require an applicant (or the parent or guardian in the case of a child under the age of 18) to present at the time of application for Medicaid or CHIP benefits government-issued photo identification and that identification must be authenticated with the issuing agency.
The Debate on the Grassley Photo ID Amendment was vigorous. Senator Jon Kyl (R-AZ) joined Senator Grassley in speaking in favor of the amendment. Speaking against the amendment were Senators Bob Menendez (D-NJ), Jeff Bingaman (D-NM), and Debbie Stabenow (D-MI).
The Committee rejected the Grassley Photo ID Amendment by a party-line vote of 10-13.
KYL PHOTO ID AMENDMENT. Senate Minority Whip Jon Kyl (R-AZ) offered an amendment on Wednesday, September 30, 2009, that would have required photo identifications for persons seeking to make use of affordability tax credits to subsidize the purchase of health insurance under the bill. The Committee rejected the Kyl Photo ID Amendment by a party-line vote of 10-12, with Senator Maria Cantwell (D-WA), abstaining.
GRASSLEY FIVE YEAR WAITING PERIOD FOR AFFORDABILITY TAX SUBSIDY AMENDMENT. Senate Finance Committee Ranking Republican Charles Grassley (R-IA) offered an amendment on Wednesday, September 30, 2009, that used as one of its offsets a requirement that legal immigrants be barred from receiving health care affordability tax credits under the health care reform bill for five years after their entry.
The Committee rejected the Grassley five-year Waiting Period Amendment by a vote of 10-13.
KYL FIVE-YEAR WAITING PERIOD AMENDMENT. Senate Minority Whip Jon Kyl (R-AZ) offered an amendment on Thursday, October 1, 2009, that would have required legal immigrants to wait five years after entering the United States before they can make use of a tax credit in the bill to help individuals purchase health insurance.
Senators Robert Menendez (D-NJ) and Jeff Bingaman (D-NM) spoke against the amendment. Senator Kyl was the only one who spoke in favor of it.
The Committee rejected the Kyl Five-Year Waiting Period Amendment by a vote of 10-13.
Next Steps and Outlook Now that the Senate Committee on Finance has approved its version of health care reform legislation, the next step in the legislative process is the preparation of a bill for consideration by the full Senate. This will require that the Senate Finance Committee bill be merged with the bill that was produced by the Senate Committee on Health, Education, Labor, and Pensions; the legislative counsel's office will have to produce actual legislative language reflecting the merged bill; and the Congressional Budget Office will have to "score" the bill to determine what its impact would be on the federal budget deficit.
The process of getting the bill to the Senate floor, alone, is expected to take about two weeks. Once the bill is on the Senate floor, the Senate is expected to have it under consideration for several weeks.
At the same time that this process is playing out in the Senate, the House of Representatives is expectd to undertake a similar process.
Regardless of what language is included in the text of the bill that is brought before the full Senate, the big issues in the bill will likely have to be fought on the Senate floor, which likely will have to vote on numerous amendments. These big issues include such matters as the cost of the measure, whether the bill will contain a public option, how abortion will be treated under the bill, what the manner and amount of subsidies for lower-income Americans to help them purchase insurance will be, how immigrant access to health insurance and health care will be restricted, and what the reimbursement rates under the Medicare program will be continue to cast a large shadow over the ultimate fate of the measure. Any one of these issues could torpedo the bill in the Senate, where a 60-vote majority may well be necessary in order to move the bill to final passage.
The Senate is expected to take up the measure during the week of October 26. However, the most optimistic predictions for the bill's progress is for the process of producing a bill for the President's consideration will to continue well into December.
Committee voted in favor of the proposal, as did one Republican, Senator Olympia Snowe (R-ME). Tuesday’s action was but a formality, however. Even as the vote was being cast, Senate Majority Leader Reid (D-NV) was working to put together a compromise bill that melds the work of the Senate Committee on Finance with the bill that the Senate Committee on Health, Education, Labor, and Pensions approved earlier this year. He hopes to have the bill ready for the full Senate’s consideration during the week of October 26, 2009.
