House Speaker Nancy Pelosi just released the health care reform bill she will introduce on the floor, in hopes of a final vote in the next week to ten days. You can read the text here. And while it will take a while to wade through all of the details--and uncover the inevitable surprises--we already have a pretty good idea of the basics, based on published reports and several House sources.
Like the bills that passed three House committees in the summer, this one will cover more people--and provide them with more protection--than the emerging counterpart in the Senate.
It will also include a stronger public insurance option, but one that is not as strong as it could be. In particular, the public plan will have to negotiate payment rates with providers in just the way private insurers do. This is in lieu of tying the plan's rates to Medicare. Although Pelosi and her allies tried, they were ultimately unable to round up the votes for that strong a measure.
(Note that, as in the Senate, the public option would be available only to individuals without access to employer-sponsored insurance. If you want to do something about that, though, you'll have to talk to Ron Wyden.)
For all of the talk about a public plan, the primary imperative for architects of the House plan was to change the bottom line. The original House bill paid for itself over the course of ten years, but in a way that began generating deficits in year eleven. It also included an adjustment to physician fees--what's come to be known as the "doc fix"--worth some $240 billion over ten years, that lacked financing of its own and pushed the bill's entire price tag to well over $1 trillion.
The new bill no longer includes the doc fix as part of the reform package per se. The House, like the Senate, will handle that as a separate piece of legislation. And after a furious back-and-forth with the Congressional Budget Office that extended into Wednesday evening, House lawmakers managed to assemble their proposals in a way that should, by CBO's estimation, reduce deficits (albeit quite modestly) over the long term.
In terms of cost, that should really be the takeaway point: That it pays for itself and, in the long run, actually starts to reduce federal deficits. But something tells me the media is going to get hung up on something else.
The cost of the coverage expansions--that is, the subsidies to help people buy private insurance plus the expansions of Medicaid for the poor--come in at just under $900 billion under ten years. But the cost of other improvements, including a boost in Medicaid reimbursement of primary care and prescription drug assistance for seniors, brings the total outlays closer to $1 trillion.
President Obama, of course, has said that the reform should cost around $900 billion. As such, there's bound to be a lot of complaining that the House went "over" Obama's threshold.
I'm not sure that's entirely true. It's perfectly reasonable to interpret Obama's $900 billion target--which he proposed in his September address to Congress-- as describing the cost of expanding coverage alone.
But, really, who cares? The issue here is whether the House produced a fiscally sound bill that puts health insurance within reach of most Americans while starting to reform the system. And, based on everything we're hearing, it does.
To be sure, the bill could be better still. It doesn't include the tax on high-benefit plans, which--although unpopular with unions and their allies--remains a smart way to finance coverage expansions and bring down overall health costs simultaneously. Indeed, if there's a weakness in the bill, it's likely that it still doesn't "bend the curve" as much as the Senate counterpart will.
But that really has to be placed in context of the bill's other elements, which are superior. Among the proposals on the table, it looks like the House version provides the most people with affordable access to medical care. It also pays for itself.
Barring surprises, again, the proper response shouldn't be criticism. It should be congratulation.
Update: The congratulations are already rolling in. Here's Ron Pollack, president of FamiliesUSA and longtime crusader for universal health care: "The House health insurance reform bill sets the gold standard for legislation that deserves to be adopted this year."
Note: We'll be posting more information on the House bill as it becomes available. If you're on twitter, you can look for updates at @jcohntnr.