World and Nation

Senate Bill Covers Fewer Than House Version, Costs Less

The Senate version of health reform legislation would cover 5 million fewer people than a companion bill passed by the House, but it would cost less, in part because Senate Democratic leaders said they believed they had to win support from fiscally conservative members of their party.

The Senate is expected to vote Saturday on whether to take up the legislation. The majority leader, Harry Reid, D-Nev., refused to say Thursday whether he had the 60 votes needed to clear that procedural hurdle.

While the guts of the Senate and House bills are similar, Reid devised a new method of financing coverage, not found in any other major health bill. His proposal would significantly increase the Medicare payroll tax for high-income people.

The Senate and House bills would provide coverage to millions of the uninsured by expanding Medicaid and subsidizing private insurance for people with moderate incomes.

The Senate bill would spend $821 billion over 10 years on Medicaid and subsidies. The House bill would spend 25 percent more: $1.03 trillion over 10 years.

A gulf separates the House and the Senate on the emotional issue of abortion.

Over the objection of Speaker Nancy Pelosi, D-Calif., the House adopted much stricter limits. Under the House bill, federal money could not be used “to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion,” except in case of rape or incest or if the life of a pregnant woman was in danger. Thus, a plan that received federal subsidies for low- and moderate-income people could not offer abortion coverage.

Under the Senate bill, insurers would not be required or forbidden to cover abortion. But, the measure says, in every part of the country, the government would have to ensure that there is at least one plan that covers abortion and at least one that does not.

The secretary of health and human services would decide whether a proposed new government insurance plan would cover abortion. If an insurer covers abortion, it could not use federal money to pay for the procedure. It could use only premiums paid by subscribers and would have to keep the money separate from subsidies received from the federal government.

Opponents of abortion describe this bookkeeping arrangement as a sham.

“It’s a shell game,” said Sen. Mike Johanns, R-Neb.

But Johanns said he doubted that the Senate would accept the stringent restriction adopted by the House.

“I don’t see it in the final bill,” Johanns said. “I don’t believe there are enough pro-life senators to break a filibuster to make this a part of the final bill.”

Supporters of abortion rights were pleased with the treatment of abortion in Reid’s bill. “It maintains the decades-long compromise of no federal funds for abortion, while allowing a woman to use her own private funds for her reproductive health care,” said Sen. Barbara Boxer, D-Calif.