Senator Max Baucus the Montana Democrat who is leading the effort to develop bipartisan health care legislation plans this week to unveil his mark" the proposal to be taken up by the Senate Finance Committee of which he is chairman. Mr. Baucus has said there must be some shared responsibility" between the states and the federal government but has not yet set a final number. And when he does lawmakers are certain to fight over it.Reaction to his plan could finally reveal whether the bipartisan six" subgroup that Mr. Baucus has been working with for months will stick together or whether Democrats will head off largely on their own.
The big question marks are two Republicans Senators Charles E. Grassley of Iowa and Michael B. Enzi of Wyoming. The third Republican Senator Olympia J. Snowe of Maine has sounded more upbeat about achieving a compromise.
Mr. Grassley and Mr. Enzi have good reason to avoid showing their cards. If it becomes clear that they will not vote for the bill Democrats will probably respond by dumping provisions that Mr. Enzi and Mr. Grassley won during negotiations.
Even if the group of six hangs together the broader 23-member Finance Committee will almost certainly end up fighting over a crucial component of the health care bill: a proposed expansion of Medicaid a topic that often divides lawmakers more by geography than by party.
Expanding Medicaid the state-federal insurance program for the poor has been a major issue in recent days as Mr. Baucus moved to finish his plan. Ms. Snowe whose vote is crucial has said it tops her list of concerns.
And for many members of Congress as well as for governors and state legislators around the country Medicaid expansion is even more important than issues like the public option" or illegal immigrants that have tended to get far more publicity.
Easy In Principle
Deciding to expand Medicaid is something of a no-brainer. After all a central problem with the current system is that insurance is expensive and the people who lack insurance are predominantly poor. Medicaid already covers about 60 million Americans.
But while expanding Medicaid would be a relatively cost-effective way to reduce the number of uninsured it would still be expensive. The Congressional Budget Office has estimated that Medicaid provisions in the House legislation would cost $438 billion over 10 years.
Although Mr. Baucus is proposing to spend less than that he has said that a part of the cost must be borne by the states. So while President Obama is intent on a national approach to revamping health care members of Congress must also consider their local interests.
That is what makes the Medicaid dispute so tricky especially when so many state budgets have been sapped by the recession.
As Goes Maine…
Ms. Snowe is particularly concerned about how much additional federal aid will go to states like hers that already offer relatively broad eligibility because such states will most likely get less new federal money than states with tighter Medicaid restrictions.
The House legislation as well as a Senate framework released by Mr. Baucus calls for raising the income eligibility threshold for Medicaid to 133 percent of the federal poverty level a figure that for 2009 translates to about $14400 for an individual.
A big change is that childless adults under age 65 who are now typically excluded from Medicaid will be eligible. So will many parents who now often face tighter restrictions.
Currently states must offer Medicaid to pregnant women and to children under age 6 from families with income under 133 percent of the poverty level. States must also offer coverage to children age 6 to 18 from families with income below the poverty line.
And though many states have set higher thresholds for children typically at more than 200 percent of poverty many parents of these children do not have coverage. Only 11 states cover parents earning more than 133 percent of poverty.
Experts estimate that roughly one-third of Americans who currently lack insurance earn less than 133 percent of the poverty limit a group of 10 million people who might join Medicaid under the proposed new rules.
Questions of Fairness
The House legislation initially called on the federal government to pick up the entire cost of the Medicaid expansion. But under recent revisions the states would have to pay 10 percent of the cost beginning in 2015.
Senator Dianne Feinstein Democrat of California has warned that her state could face $2 billion a year in additional costs. Senator Charles E. Schumer Democrat of New York has said states should not be punished for having spent more Medicaid in the past.
Ms. Snowe appearing Sunday on Face the Nation" on CBS pointed out that Maine is one of just a few states that already offer Medicaid to some childless adults. It would be unfair" she said to penalize states that are doing the right thing already."
Senator Max Baucus the Montana Democrat who is leading the effort to develop bipartisan health care legislation plans this week to unveil his mark" the proposal to be taken up by the Senate Finance Committee of which he is chairman. Mr. Baucus has said there must be some shared responsibility" between the states and the federal government but has not yet set a final number. And when he does lawmakers are certain to fight over it.Reaction to his plan could finally reveal whether the bipartisan six" subgroup that Mr. Baucus has been working with for months will stick together or whether Democrats will head off largely on their own.
The big question marks are two Republicans Senators Charles E. Grassley of Iowa and Michael B. Enzi of Wyoming. The third Republican Senator Olympia J. Snowe of Maine has sounded more upbeat about achieving a compromise.
Mr. Grassley and Mr. Enzi have good reason to avoid showing their cards. If it becomes clear that they will not vote for the bill Democrats will probably respond by dumping provisions that Mr. Enzi and Mr. Grassley won during negotiations.
Even if the group of six hangs together the broader 23-member Finance Committee will almost certainly end up fighting over a crucial component of the health care bill: a proposed expansion of Medicaid a topic that often divides lawmakers more by geography than by party.
Expanding Medicaid the state-federal insurance program for the poor has been a major issue in recent days as Mr. Baucus moved to finish his plan. Ms. Snowe whose vote is crucial has said it tops her list of concerns.
And for many members of Congress as well as for governors and state legislators around the country Medicaid expansion is even more important than issues like the public option" or illegal immigrants that have tended to get far more publicity.
Easy In Principle
Deciding to expand Medicaid is something of a no-brainer. After all a central problem with the current system is that insurance is expensive and the people who lack insurance are predominantly poor. Medicaid already covers about 60 million Americans.
But while expanding Medicaid would be a relatively cost-effective way to reduce the number of uninsured it would still be expensive. The Congressional Budget Office has estimated that Medicaid provisions in the House legislation would cost $438 billion over 10 years.
Although Mr. Baucus is proposing to spend less than that he has said that a part of the cost must be borne by the states. So while President Obama is intent on a national approach to revamping health care members of Congress must also consider their local interests.
That is what makes the Medicaid dispute so tricky especially when so many state budgets have been sapped by the recession.
As Goes Maine…
Ms. Snowe is particularly concerned about how much additional federal aid will go to states like hers that already offer relatively broad eligibility because such states will most likely get less new federal money than states with tighter Medicaid restrictions.
The House legislation as well as a Senate framework released by Mr. Baucus calls for raising the income eligibility threshold for Medicaid to 133 percent of the federal poverty level a figure that for 2009 translates to about $14400 for an individual.
A big change is that childless adults under age 65 who are now typically excluded from Medicaid will be eligible. So will many parents who now often face tighter restrictions.
Currently states must offer Medicaid to pregnant women and to children under age 6 from families with income under 133 percent of the poverty level. States must also offer coverage to children age 6 to 18 from families with income below the poverty line.
And though many states have set higher thresholds for children typically at more than 200 percent of poverty many parents of these children do not have coverage. Only 11 states cover parents earning more than 133 percent of poverty.
Experts estimate that roughly one-third of Americans who currently lack insurance earn less than 133 percent of the poverty limit a group of 10 million people who might join Medicaid under the proposed new rules.
Questions of Fairness
The House legislation initially called on the federal government to pick up the entire cost of the Medicaid expansion. But under recent revisions the states would have to pay 10 percent of the cost beginning in 2015.
Senator Dianne Feinstein Democrat of California has warned that her state could face $2 billion a year in additional costs. Senator Charles E. Schumer Democrat of New York has said states should not be punished for having spent more Medicaid in the past.
Ms. Snowe appearing Sunday on Face the Nation" on CBS pointed out that Maine is one of just a few states that already offer Medicaid to some childless adults. It would be unfair" she said to penalize states that are doing the right thing already."
