MicEvHill.Com - Senate Passes Historic Health Care Reform Bill

Senate Passes Historic Health Care Reform Bill Containing Both Enhancement to Restrictions on Immigrants' Eligibility for Health Care, and Setting Up What Promises to be a Difficult January Conference
with the House of Representatives

The Senate today passed a landmark health care reform bill containing a number of significant provisions relating to both legal and illegal immigrants' access to health care. The Senate began this morning's vote on final passage of the measure at approximately 7:10 am EST, passing it at 7:20 am EST by a vote of 60-39. This morning's Senate action paves the way for the adjournment of the first session of the 111th Congress. The House is expected to reconvene the second session on Tuesday, January 12, 2010. The Senate is expected to convene one week later, on Tuesday, January 19, 2010.

Today's final vote on the health care reform bill was anticlimactic; the Senate had signalled its support for the measure last Saturday when Senator Ben Nelson (D-NE), who had been the last Democratic holdout for the measure, indicated his support for a compromise "Manager's Amendment" to the bill. The Senate invoked cloture on the "Manager's Amendment" in the pre-dawn hours of Monday, December 21, 2009, and then plodded through several more procedural votes over the ensuing three day leading up to this morning's passage of the measure.

As a general matter, the Senate-passed health care reform bill would require almost everyone living in the United States to purchase a qualified health insurance plan or face a tax penalty. It also would establish health insurance exchanges, on which private sector insurance companies would list their health insurance products; establish health affordability tax credits to help persons who cannot afford health insurance purchase it; expand eligibility for Medicaid to a greater number of lower-income persons; and institute a number of requirements on insurance companies with respect to the benefits that they must offer.

With regard to immigrants, the Senate-passed health care reform bill 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 States be covered by a qualified health insurance plan. The bill also would make legal immigrants eligible for the bill's health care affordability tax credits without having to wait for any length of time after entry to the United States. And, perhaps most controversially, the Senate-passed 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 Senate-passed health care reform bill would establish a new citizenship and immigration status verification regime that is designed 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 and subject everyone who purchases health insurance through the exchange, who benefits from an exchange plan, or who receives an affordability tax credit to the new citizenship and immigration status verification 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 on Monday morning when it voted to break the GOP filibuster on the "Manager's Amendment".

Rejection of the Menendez State Medicaid Option Proposal
The Senate passed the health care reform bill 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 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 put before the Senate. The Majority Leader's decision may well have dealt 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, December 19, 2009, 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.

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 a caucus of Senate Democrats last weekend 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.

Senate passage of its health care reform bill sets up what promises to be a difficult conference in January with the U.S. House of Representatives.