House and Senate look to final health care talks

How to pay for overhaul joins abortion and public option as key concerns

   WASHINGTON - How many Americans will get subsidized medical coverage — plus who will pay for it — will be front-burner issues when Congress returns next month to complete President Barack Obama's health care remake.
   Pocketbook concerns join abortion and whether Uncle Sam should peddle insurance as the top bones of contention for negotiators who must resolve difference between the House and Senate bills.

   The negotiations are the last chance for Democrats to shape the legislation to deliver concrete benefits to Americans skeptical that it will help control skyrocketing premiums as it expands coverage to millions more.
   "People will really begin to focus on some of the core issues that have received less attention," said Rep. Chris Van Hollen, D-Md., a member of the House leadership. "These are the bread-and-butter issues that will have the most significant impact on people's pocketbooks."
   Broadly speaking, both bills would gradually expand coverage, while banning objectionable insurance industry practices such as turning down people with health problems. Eventually, all Americans would be required to carry health insurance, with government subsidies to make premiums more affordable for many of them.

Employer-insured workers won't see big changes
   Those covered by big employers wouldn't see major changes, but individuals buying their own policies and small businesses would be able to shop for competitively priced plans in an insurance supermarket called an exchange. Medicare cuts and an assortment of taxes and fees would pay for the bills.
   Democrats are under pressure to reconcile the House and Senate versions before Obama's first State of the Union speech. Not yet scheduled, it's usually delivered in late January or early February. Republicans will wage legislative guerrilla warfare to delay an agreement.
   There's not much time, and apparently not much give either.
   Senate moderates say they won't vote for a bill that changes the basic terms they agreed to with Majority Leader Harry Reid.
   Independent Sen. Joe Lieberman of Connecticut and conservative Sen. Ben Nelson, D-Neb., have drawn a line against reintroducing a government-run insurance plan to compete with the likes of Aetna and Wellpoint. The House bill includes it, but Reid, D-Nev., needs every member of his 60-vote coalition to hold off GOP opponents.
   More difficult to solve is the issue of how to restrict taxpayer funding for abortions. Abortion opponents disagree among themselves over the Senate's approach. Abortion rights supporters are completely against the more restrictive House language and are divided on how the Senate has handled it.
   Obama will probably have to step in to settle disputes and keep things moving.
   Democrats have options on how to handle the negotiations. They could agree to a limited set of changes, allowing each chamber to pass identically amended bills. Or they could set up a formal conference committee to resolve differences. Leaders have made no decision yet. Naming a conference committee would signal that the issues have proven difficult.
   Yet the longer Democrats argue, the more suspicious the public becomes about remaking the health care system. "The making of salami and legislation is not pretty for people to watch," said Harvard professor Robert Blendon, who tracks public opinion on health care. "It has left them nervous that the interests of middle-income people are not being served."
   That's one reason leading Democrats are arguing for a focus on pocketbook issues in the homestretch.
   "There will be a certain amount of replaying issues that have been hot-button issues, but I think there will also be a refocusing, especially on cost," said Senate Budget Committee Chairman Kent Conrad, D-N.D. "At the end of the day, when all of us go home, what we hear about is the ever-increasing, ever-escalating costs."


Scrutiny will center now on costs
   There are some signs of that already.
   Last week, Reid pledged on the Senate floor to close the coverage gap in Medicare prescription benefit — as the House bill already does. The message was aimed at seniors worried that Medicare cuts to hospitals and other providers will jeopardize their care.
   And Conrad said senators may go along with the House timetable for expanding coverage, which calls for starting subsidies in 2013, a year earlier than the Senate bill.
   The House bill provides coverage to 36 million, while the Senate covers 31 million. Lawmakers in the House want the Senate to move toward their number.
   Another priority will be to make sure the final bill promotes competition in the health insurance market, which in many states is dominated by one or two large carriers.
   Though it sounds arcane, a major problem for negotiators is whether the new insurance supermarket should be state-based, as in the Senate bill, or national, as the House calls for.
   Some advocates say a national approach provides stronger consumer protection.
   Finally, the issue of who to tax won't be easy.
   Unions are adamantly opposed to the Senate plan, which would impose a 40 percent tax on high-cost health insurance above $8,500 for an individual plan, $23,000 for families. Organized labor sees the tax on so-called Cadillac plans as a hit on its members, who have fought for years for better-than-average coverage. Unions are a core Democratic constituency and many House Democrats want to knock out the insurance tax.
   The Obama administration, however, supports such a tax. In a recent session with reporters, White House economic adviser Christina Romer called the tax "a very effective cost-growth containment mechanism," arguing that it will force people into more efficient plans.
   Rep. Joe Courtney, D-Conn., wasn't buying it. "The most troublesome component of the Senate bill remains the 40 percent excise tax on high-cost health care premiums," he said. More than 190 House Democrats agree. Instead, they want to tax upper-income earners.

Copyright 2009 The Associated Press. 

Health Bill to result in few changes for millions

By REED ABELSON

Updated 5:05 a.m. ET, Fri., Dec. 25, 2009

Now that the Senate has caught up with the House by passing a sweeping health care bill, lawmakers are on the verge of extending coverage to the tens of millions of Americans who have no health insurance.
But what about the roughly 160 million workers and their dependents who already have health insurance through an employer? For many people, the result of the long, angry health care debate in Washington may be little more than more of the same.

As President Obama once promised, "If you like your health plan, you can keep your health plan."

That may be true even if you don't like your health plan. And no one seems to agree on whether the legislation will do much to reduce workers' continually rising out-of-pocket costs.

True, there is an important advantage for the working insured: more peace of mind for people who are worried about being laid off or would like to change jobs.

There are still many gaps to bridge between the House and Senate bills. But even before the House-Senate negotiations begin in January, both bills offer this assurance: If you lose your job or move to one that does not provide benefits, there should be better alternatives when shopping for your own coverage.

And both the House and Senate bills share the same basic goal of placing new rules on insurers so that even someone with a pre-existing medical condition, or a few years to go before qualifying for Medicare, should have a much easier time finding a relatively affordable policy.

The legislation should give most working people "the guarantee of security if their circumstances change," said Karen Davis, the president of the Commonwealth Fund, an independent research group that has studied the House and Senate bills.

Proposed changes
Of course, with more security will come more obligation. Congress seems likely to impose an individual mandate that will require people to be insured or face a financial penalty.

The other proposed changes for employer-provided coverage seem aimed mainly at workers whose benefits are either very generous or exceedingly skimpy.

On the generous end, about a fifth of employers now offer health plans that could be affected by a new 40 percent excise tax in the Senate bill on so-called Cadillac policies, according to an estimate by Mercer, a benefits consulting firm. That tax, to be imposed on annual premiums that exceeded $23,000 for family coverage, would go into effect in 2013. For example, if an insurer, or a self-insured employer, offers a plan costing $25,000, it must pay a 40 percent tax on the $2,000 that is above the threshold, or $800.

If the excise tax survives the House-Senate negotiations, it is hard to predict how employers will respond. But almost two-thirds of the employers Mercer recently surveyed said they were likely to reduce employee benefits rather than pay the tax.

"They're going to work hard to find a way to keep the cost of their plans below the threshold," said Beth Umland, Mercer's director of health and benefits research.

She predicts that many of those companies will rely on what she described as "the tried-and-true method" — passing along more of the costs to employees, in the form of higher deductibles and co-payments, in order to reduce overall premiums.

The public policy goal of the tax, in theory, is to have everyone spend less on medical care, even if it means using it less.

"We know people will use less care under such plans," said Paul Ginsburg, president of the Center for Studying Health System Change, a nonpartisan group.

What is not so clear, Mr. Ginsburg said, is whether people will make — or be able to make — rational choices between treatments that are not particularly effective and treatments that may help them from becoming sicker later.

'Minimal' impact
Congress also seems intent on establishing some minimum insurance standards so people with coverage could not end up with large piles of unpaid medical bills anyway. Both the House and Senate bills contain measures meant to eliminate lifetime maximum limits on coverage, for example.

But that might end up affecting relatively few people. Many plans limit how much they will pay out over a lifetime, but the ceilings are generally so high that the vast majority of people never hit them, according to a new study that used existing coverage for workers in California to compare the House and Senate proposals.

The "impact of this change will be minimal on most employers, but would be quite meaningful for the small number of employees who meet the limits," according to the study, conducted by policy analysts from the University of California, Berkeley, the benefits consultant Watson Wyatt Worldwide and the National Opinion Research Center at the University of Chicago.

Congress is also considering annual limits on out-of-pocket medical costs. The House seems to think $5,000 is as much as somebody should pay in medical bills, while the Senate has picked a figure closer to $6,000.

Under the Senate proposal, the new limits would not apply to self-insured employers — big companies that provide their own insurance and have enough employees to effectively spread the risk of paying any large claims.

Congress is also considering other minimum standards for insurance, like setting a baseline level of coverage for plans.

Still unclear is whether any of the new standards — the lifetime caps, the out-of-pocket maximums, the minimum coverage standards — would apply to employer-based policies.

Because most big companies already offer plans that would meet the minimum standards being set, their workers would probably be unaffected by the new rules in any case.

But it is a different story for small businesses. Much of the legislation is aimed at making it easier for them to provide affordable coverage by trying to make changes to the insurance market.

Wider choice of plans
People working for small businesses — an estimated 40 percent of the private labor force — could see their coverage affected. And if their employer decided to use one of the new insurance exchanges, workers might have a much broader choice of plans than they do now.

The premiums a small-business employee are charged could also change, especially if that company's work force is particularly young and healthy. Those people could wind up paying more, Mr. Ginsburg said, because the legislation tries to spread the risk of covering employees with expensive medical conditions by setting new rules over how insurers can determine premiums.

The real unknown, of course, is whether any final legislation will accelerate the rise in premiums or slow it. At least one impartial analysis, by the nonpartisan Congressional Budget Office, concluded that the legislation was not going to have much of an effect on the cost of premiums either way.

There are plenty of doomsayers who argue that the cost of expanding coverage to millions of people, many of whom will need help to pay their premiums, is going to be borne by everyone else. But there are others, including Mr. Obama, who argue that the legislation will make health insurance more affordable than it would be otherwise. "If we don't pass it," he recently said during a television interview, "here's the guarantee — your premiums will go up, your employers are going to load up more costs on you."

This story, "As Health Bill Advances, Few Changes Seen for Millions," first appeared in The New York Times.

Copyright © 2009 The New York Times

Health Care Reform attempts from the past

Here's a timeline at the attempts of health care reform in the past.

Senate passes historic health care legislation

Unusual Christmas Eve vote symbolic in ongoing debate

updated 9:14 a.m. ET, Thurs., Dec . 24, 2009

WASHINGTON – Senate Democrats passed a landmark health care bill in a clinic Christmas Eve vote that could define President Barack Obama's legacy and usher in near-universal medical coverage for the first time in the country's history.

The 60-39 vote on a cold winter morning capped months of arduous negotiations and 24 days of floor debate. It also followed a succession of failures by past congresses to get to this point. Vice President Joe Biden presided as 58 Democrats and two independents voted "yes." Republicans unanimously voted "no."

The tally far exceeded the simple majority required for passage. The Senate's bill must still be merged with legislation passed by the House before Obama could sign a final bill in the new year. There are significant differences between the two measures but Democrats say they've come too far now to fail.

Both bills would extend health insurance to more than 30 million Americans.

Speaking not long after the Senate passed the $871 billion bill by a 60-39 vote, Obama welcomed the vote as bringing America "toward the end of a nearly century-long struggle." He said presidents since Theodore Roosevelt in 1912 have been trying unsuccessfully to overhaul medical care.

Standing in the State Room of the White House before leaving on a holiday trip to his home state of Hawaii, Obama said the measure the Senate passed "includes the toughest measures ever taken to hold the insurance industry accountable."

'It's merely the beginning' Vicki Kennedy, the widow of the late Massachusetts Sen. Edward Kennedy, who made health reform his life's work, watched the vote from the gallery. So did Rep. John Dingell, D-Mich., the longest-serving House member and a champion of universal health care his entire career.

"This morning isn't the end of the process, it's merely the beginning. We'll continue to build on this success to improve our health system even more," Majority Leader Harry Reid, D-Nev., said before the vote. "But that process cannot begin unless we start today ... there may not be a next time."

At a news conference a few moments later, Reid said the vote "brings us one step closer to making Ted Kennedy's dream a reality."

The Nevadan said that "every step of this long process has been an enormous undertaking."

Sen. Max Baucus, D-Mont., chairman of the Finance Committee, said he "very happy to see people getting health care they could not get."

It was the Senate's first Christmas Eve vote since 1895, when the matter at hand was a military affairs bill concerning employment of former Confederate officers, according to the Senate Historical Office.

The House passed its own measure in November. The White House and Congress have now come further toward the goal of a comprehensive overhaul of the nation's health care system than any of their predecessors.

The legislation would ban the insurance industry from denying benefits or charging higher premiums on the basis of pre-existing medical conditions. The Congressional Budget Office predicts the bill will reduce deficits by $130 billion over the next 10 years, an estimate that assumes lawmakers carry through on hundreds of billions of dollars in planned cuts to insurance companies and doctors, hospitals and others who treat Medicare patients.

For the first time, the government would require nearly every American to carry insurance, and subsidies would be provided to help low-income people to do so. Employers would be induced to cover their employees through a combination of tax credits and penalties. The legislation costs nearly $1 trillion over 10 years and is paid for by a combination of taxes, fees and cuts to Medicare.

Republicans were withering in their criticism of what they deemed a budget-busting government takeover. If the measure were worthwhile, contended Minority Leader Mitch McConnell, R-Ky., "they wouldn't be rushing it through Congress on Christmas Eve."

House Minority Leader John Boehner assailed the bill moments after passage.

"Not even Ebenezer Scrooge himself could devise a scheme as cruel and greedy as Democrats' government takeover of health care," the Ohio Republican said in a statement.

"Senator Reid's health care bill increases premiums for families and small businesses, raises taxes during a recession, cuts seniors' Medicare benefits, adds to our skyrocketing debt, and puts bureaucrats in charge of decisions that should be made by patients and doctors," he said. "The bill also authorizes taxpayer-funded abortions, violating long-standing federal policy. It's no coincidence that the more the American people learn about this monstrosity, the more they oppose it.

The occasion was moving for many who'd followed Kennedy, who died in August.

"He's having a merry Christmas in Heaven," Sen. Paul Kirk, D-Mass., appointed to fill Kennedy's seat, told reporters after the tally.

Kirk said he was "humbled to be here with the honor of casting essentially his vote."

Said Dingell: "This is for me, this is for my dad, this is for the country."

Reid nailed the last votes down in a rush of dealmaking in the last week that is now coming under attack because of special provisions obtained by a number of senators. In Nebraska, home to conservative Democrat Ben Nelson, the Democrats' crucial 60th vote, the federal government will pay 100 percent of the cost of a planned Medicaid expansion in perpetuity, the only state getting that deal.

Negotiations between the House and Senate to reconcile differences between the two bills are expected to begin as soon as next week. The House bill has stricter limits on abortion than the Senate, and unlike the House, the Senate measure omits a government-run insurance option, which liberals favored to apply pressure on private insurers but Democratic moderates opposed as an unwarranted federal intrusion. Obama has signaled he will sign a bill even if it lacks that provision.

Copyright 2009 The Associated Press. All rights reserved.

Christmas Greetings

I hope this finds my readers having a wonderful Christmas season.

Local 771's Election Results

Local 771 Officers for 2010

Helen Hanson, President

Alpha One

Joseph Berry, Vice President, Delegate

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Ted Rippy, Secretary, Delegate

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Patricia Crowell, Treasurer, Alternate

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Carol Cammack, Delegate

Home Care for Maine

Dave Levasseur, Delegate

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Janet (Dixie) Lewis, Delegate

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Sherrie Rippy, Delegate

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Juanita Burtt, Alternate

Home Care for Maine

Roxann Gargac, Alternate

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Kyle Hofman, Alternate

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Welcome to all 771's officers, delegates and alternates.

Playing Hard to Get: Maine's Senators Suddenly Back in Play on HCR?

Brian Beutler | December 2, 2009, 9:55AM

What a difference a week makes. After casting votes to kill the Senate health care bill, Sens. Olympia Snowe (R-ME) and Susan Collins (R-ME) are meeting with high-level White House officials as Democrats try to reach sixty votes.

When Harry Reid announced that his health care bill would include a public option, but that Washington would allow individual states to opt out, it left him basically no wiggle room. He lost the cautious support of Snowe and suddenly needed to run the table in his caucus.

In the hours and days afterward, it became clear that a clean sweep would be difficult, if not impossible. Days before Thanksgiving recess, leaders began negotiating with conservative Democratic hold outs on a possible compromise, modeled on Snowe's trigger plan. And if you wanted some evidence that, on balance, the discussions are currently favoring the centrists, Tuesday offered a pretty clear picture of that.

Snowe in particular continues to speak of health care reform as a project she's a part of. Yesterday, defying her party's own talking points, she told The Hill that a new CBO report, regarding the impact of the Senate legislation on insurance premiums, is encouraging news for reformers.

The CBO report, she says, indicates that the legislation "makes strides, without question" toward extending affordable coverage. On this score she sees room for improvement: "We have to be sure that we are providing the most affordable plans to Americans, and that's not abundantly clear at this point," she said. "That's what's of concern to me."

But it's not just her. Susan Collins, Snowe's Maine colleague, told reporters yesterday that she's been meeting with Nancy-Ann DeParle, Director of the White House Office of Health Reform, and DeParle's deputy Jeanne Lambrew.

Those negotiations are ongoing, and Collins is a tougher sell than Snowe, but for the first time in weeks Collins suggested she may be in play.

"I made very clear that I could not support the bill as it's currently drafted, and that there would have to be substantial changes, but I certainly hope that that will be possible," Collins told reporters. "I think there is unease on both sides of the aisle about specific provisions in this bill, and that it's possible that we can come up with alternatives that will garner bipartisan support."

Collins says she's "not a fan," of the latest public option compromise being discussed. Still, one Democratic aide said Collins' vote might even be more gettable than some of the recalcitrant conservative Democrats.

As always in Congress, the situation is very fluid. Momentum shifts directions very suddenly. But the very fact that so much focus is being placed on these two women should be writing on the wall to public option supporters.

from talkingpointsmemo.com

Senate Bill Maintains Direct-Care Worker Provisions

Posted on01 December 2009

Matt Ozga - PHInational.org

Following months of intense negotiations and extensive input from stakeholders, Senate Majority Leader Harry Reid (D, NV) and other Democratic leaders presented the blended Senate health insurance reform bill on November 18.

The new legislation, the Patient Protection and Affordable Care Act, would extend coverage to 94 percent of Americans.

PHI’s side-by-side chart (pdf) provides an update of the new Senate bill and compares the House and Senate provisions.

Some of the most significant provisions of the bill include a public insurance option that gives states the choice to opt out, an excise tax on high-cost insurance plans offered by employers, and a Medicare payroll tax on people with high-incomes (individuals with annual incomes above $200,000 and couples above $250,000).

There are also many provisions — some related to health coverage, others to long-term care services — that could have significant impact on direct-care workers. The major changes since the Senate Finance and HELP committees released their proposals this summer include:

• Expansion of mandatory Medicaid coverage to include all non-elderly Americans with income below 133 percent of the federal poverty level (FPL), which is $24,352 for a family of three. (While affordability premium credits for individuals between 150 and 400 percent FPL have been scaled back, out-of-pocket spending has been capped to protect individuals’ level of cost sharing at each income tier.) With median annual wages of $17,000, many direct-care workers would gain affordable comprehensive coverage through Medicaid.
• Inclusion of the CLASS Act — a new, voluntary, public long-term care insurance program to purchase community-living assistance services and support for individuals with functional limitations.
• Advancing the establishment of core training competencies for personal care attendants through three-year demonstrations in six states.

Preliminary Congressional Budget Office (CBO) estimates of the blended bill project a cost of $848 billion, a figure that would reduce the federal deficit by about $130 billion over the next 10 years.

The next step is floor consideration, where the entire Senate will debate and vote on the bill. Debate began earlier this week.

Delays in CBO analyses have led to increasing speculation that work on health reform could continue into the beginning of next year.

Bruising debate awaits health bill in Senate

Legislation moves to floor after Thanksgiving as Dems overcome key hurdle Associated Press updated 7:17 am ET, Sun. Nov. 22, 2009

Senate Majority Leader Harry Reid, D-Nev., speaks Saturday after the U.S. Senate voted to begin debate on health care legislation on Capitol Hill in Washington. Sen. Chris Dodd, D-Conn., right, and Sen. Tom Harkin, D-Iowa, look on. photo by Jose Luis Magana/AP WASHINGTON - A bruising debate on health care awaits the Senate after Thanksgiving now that the historic legislation has cleared a key hurdle over the opposition of Republicans eager to inflict a punishing defeat on President Barack Obama. The bill would extend coverage to roughly 31 million who lack it, crack down on insurance company practices that deny or dilute benefits and curtail the growth of spending on medical care nationally. In the final minutes of a daylong session, Majority Leader Harry Reid, D-Nev., accused Republicans on Saturday of trying to stifle a historic debate the nation needed. GOP warns of ‘unsustainable debt’ The Republican leader, Sen. Mitch McConnell of Kentucky, said the vote was anything but procedural — casting it as a referendum on the bill itself, which he said would raise taxes, cut Medicare and create a "massive and unsustainable debt." Two final Democratic holdouts, Sens. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas, announced they would join in clearing the way for a full debate. "It is clear to me that doing nothing is not an option," said Landrieu, who won $100 million in the legislation to help her state pay the costs of health care for the poor. Landrieu and Lincoln, who faces a tough re-election next year, both stressed they were not committing in advance to vote for the legislation that ultimately emerges from next month's debate. Of particular contentiousness to moderates is a provision for the government to sell insurance in competition with private companies, subject to state approval — a part of Reid's bill expected to come under significant pressure as the debate unfolds. Positive response from White House White House press secretary Robert Gibbs said the president was gratified by the vote, which he says "brings us one step closer to ending insurance company abuses, reining in spiraling health care costs, providing stability and security to those with health insurance, and extending quality health coverage to those who lack it." Vice President Joe Biden told Iowa Democrats that the Senate handed the president a big victory with its decision. "Tonight we have more momentum than we've ever had in the history of health care discussions,'" Biden told about 1,000 Democrats in Des Moines. "I see the special interests raising tens of millions of dollars, hundreds of millions of dollars to defeat our agenda," Biden said. "We've never thought change would be easy. You all knew change would be hard. It's hard to change the direction of a nation that's been adrift for at least eight years." The legislation would require most Americans to carry insurance and provide subsidies to those who couldn't afford it. Large companies could incur costs if they did not provide coverage to their workforce. The insurance industry would come under significant new regulation under the bill, which would first ease and then ban the practice of denying coverage on the basis of pre-existing medical conditions. Congressional budget analysts put the legislation's cost at $979 billion over a decade and said it would reduce deficits over the same period while extending coverage to 94 percent of the eligible population. Kennedy’s legacy figures prominently Memories of the late Sen. Edward M. Kennedy, a long-time proponent of health care, figured prominently Saturday night. Sen. Paul Kirk of Massachusetts, appointed to office this fall after Kennedy's death, said he spoke for those "who for so many years revered and loved and elected and re-elected" him. Sen. Chris Dodd of Conn. referred to Kennedy's "lifelong quest" for national health care and said "we will pay him the highest compliment by fulfilling that" goal. Reid said he had talked with Kennedy's widow, Vicki, about the vote and they both agreed "Ted would be happy." © 2009 The Associated Press. All rights reserved.

Moderate Dems wooed in crucial health vote

Key lawmaker annouces he'll vote Saturday to begin debate on the bill Associated Press updated 9:20 p.m. ET, Nov. 20, 2009 WASHINGTON - Suitably opaque, Section 2006 takes up only a few dozen lines in a sweeping health care bill that runs to 2,074 pages and mentions neither Sen. Mary Landrieu nor her state of Louisiana. But the section's purpose is indisputable: to deliver $100 million or more in federal funds to the state. And in the process it could clear the way for one of three moderate Democratic fence-sitters — Ben Nelson of Nebraska and Blanche Lincoln of Arkansas are the others — to help propel the legislation past its initial hurdle in a crucial Saturday vote. Nelson, Landrieu and Lincoln emerged several days ago as the last public holdouts among 58 Democrats and two independents whose votes Majority Leader Harry Reid and the White House must have to overcome the Republicans' attempt to strangle the bill before serious debate can begin. Each has moved carefully with an eye on home-state voters. And inside the Senate, each has taken advantage of the political leverage newly available. Alone among the three, Nelson issued a statement Friday ending any lingering public suspense about his intentions. "The Senate should start trying to fix a health care system that costs too much and delivers too little for Nebraskans," he said, adding his decision should not be seen as an indication of how he will vote on the legislation itself. Nelson had been publicly signaling his intentions for more than a week, and his words presumably came as no surprise to Reid or the White House, which issued a statement Friday saying the bill "provides the necessary health reforms that the administration seeks." Currying votes This sort of political minuet can be delicate, as shown when the Senate's second-ranking Democrat, Dick Durbin of Illinois, said earlier on Friday that Lincoln had already confided to Reid how she planned to vote. Republicans, eager to scuttle the bill — and defeat Lincoln in 2010 — instantly accused the two-term senator of telling Democratic party leaders before informing her own constituents in Arkansas. "No other senator speaks for Senator Lincoln. She is still reviewing the bill," declared the senator's spokeswoman, Leah Vest DiPietro, adding her boss had not yet made up her mind. For his part, Durbin sought to quickly close the loop with a statement saying he had been unclear and misinterpreted. As for Nelson, several officials, speaking on condition of anonymity, said he had insisted Reid omit from the bill any change in the insurance industry's protection from federal antitrust law. The House version of the legislation would expose the industry to scrutiny by both the Justice Department's antitrust lawyers and the Federal Trade Commission. Reid, who spoke out strongly in favor of the change in antitrust treatment earlier in the fall, left it out of the bill he drafted over several weeks and unveiled on Wednesday. Eyes on Lincoln Lincoln has been the most close-mouthed about her intention. As a committee chairman, she is the most powerful of the group. As the only one of the three seeking re-election next year, she is also the most politically vulnerable. In public, she has asked that the bill be available for 72 hours before the vote occurs. In private, her demands have been more substantive, according to officials who did not describe them. She is virtually certain to be criticized no matter what her vote. After the House cleared its version of the legislation this month, a conservative group began airing commercials criticizing Rep. Vic Snyder, D-Ark., for voting in its favor. At the same time, MoveOn.org, a liberal organization, slammed another one of the state's lawmakers, Rep. Mike Ross, for opposing it. A hint: At home, Lincoln has suggested her vote will be influenced by former President Bill Clinton, who was Arkansas governor for 12 years before winning the White House. Clinton recently met privately with Senate Democrats, telling them that passing an imperfect bill was better than nothing. "We don't ever go to Washington with the idea that we're going to create a work of art," Lincoln said afterward. "It's got to be a work in progress." She and the other moderates face pressure from business groups opposed to the legislation. In a statement Friday the Business Roundtable, which represents big company CEOs, said the Senate bill "will not effect the needed changes to measurably improve the American health care system." Democrats and the White House had seized on a report by the same group last week concluding that some of the provisions under consideration by Congress had the potential to tame runaway medical inflation. Section 2006 for Landrieu? Of the three centrists, Landrieu has been the clearest about her intentions, and her interests ranged beyond health insurance to the oysters for which Louisiana is famous. When the Food and Drug Administration proposed banning sales of raw oysters from the Gulf of Mexico during warm weather months, Landrieu and others objected. A week ago, the agency thought better of the idea and shelved the plan in favor of further study. "I'm really thankful that they listened," said Landrieu, who had met with FDA Commissioner Margaret Hamburg to discuss the issue. Over recent weeks, Landrieu has issued a string of statements outlining the areas she wanted addressed for the benefit of her constituents — issues that could be dealt with only after health legislation made it to the Senate floor. After meeting with Reid almost a month ago, she mentioned the "unique challenges Louisiana is facing in terms of Medicaid." In a Senate speech and statement, she noted that Louisiana has the highest breast cancer death rate in the country and the lowest female life expectancy of any state. And she said, "Unless something is done, annual health care costs for small firms over the next 10 years are expected to more than double to reach $339 billion in 2018." Landrieu can point to provisions in the legislation that are designed to attack all three problems. They include Section 2006. Reading it is of little assistance. "Special adjustment to FMAP Determination for Certain States recovering from a Major Disaster" is the title, and about two pages of similarly indecipherable legalese follows. According to the Congressional Budget Office, it will send an additional $100 million to Louisiana to help it cover costs for Medicaid, the federal-state health care program for the poor. Should Landrieu decide to side with Republicans this weekend, she would also be voting to deny her state those funds. Copyright 2009 The Associated Press. All rights reserved.

Democrats have 60 votes to advance health bill

Two remaining Dem holdouts announce they will vote 'yes' to begin debate Associated Press updated 23 minutes ago WASHINGTON - Democratic leaders secured the last votes needed to move ahead on historic health care reform legislation, clearing the way for a Saturday night showdown on President Barack Obama's top domestic policy initiative. In long-awaited speeches, two centrist Democratic senators said they would stand with their party and vote "yes" on the crucial test procedural vote despite deep reservations with parts of the 2,074-page bill to remake the U.S. health care system. "The truth is this issue is very complex. There is no easy fix and it's imperative that we build on what's already working in health care in America," Sen. Blanche Lincoln of Arkansas told her Senate colleagues. Earlier, Sen. Mary Landrieu of Louisiana said she would vote "yes" on the procedural vote to determine whether debate can go forward on the Senate floor on Majority Leader Harry Reid's health care reform bill. Democratic leaders were optimistic they now have the 60 votes needed in the 100-member Senate to go forward. The Senate's 40 Republicans are unanimously opposed. "I've decided that there are enough significant reforms and safeguards in this bill to move forward, but much more work needs to be done," Landrieu said, with the 8 p.m. EST (0100 GMT) vote looming. But the two moderate Democrats both cautioned that while they have agreed to allow debate to continue, their vote Saturday does not commit them to supporting the final bill. At a 10-year cost approaching $1 trillion, Reid's legislation is designed to extend coverage to roughly 31 million who lack it, crack down on insurance company practices that deny benefits to people with preexisting medical conditions, and curtail the growth of spending on medical care nationally. Almost everyone would be required to purchase insurance, and billions in new taxes would be levied on insurers and high-income Americans to help extend coverage. During Saturday's debate on the bill, Democrats called a revamp of the nation's health care system long overdue. The U.S. is the only major developed country that does not provide comprehensive medical coverage for its people, and Obama campaigned on a promise to change that. "The country suffers when there is a failure to act on serious challenges that millions of ordinary Americans face in their daily lives," Sen. Patrick Leahy, a Vermont Democrat, said during the rare weekend session. United in opposition, Republicans cast the bill as a costly government takeover of the health care system, built on budget gimmicks. "Move over, Bernie Madoff. Tip your hat to a trillion-dollar scam," said Sen. Kit Bond of Missouri, referring to the mastermind of a multibillion-dollar Ponzi scheme. The action in the Senate comes two weeks after the House of Representatives approved a health overhaul bill of its own on a 220-215 vote. Major health care reform legislation has now advanced further through Congress than at any time since the 1960s when the government-run Medicare health insurance program for seniors was enacted. After the vote Saturday night, senators will leave for a Thanksgiving holiday recess. Upon their return, assuming Democrats prevail on Saturday's vote, they will launch into weeks or more of unpredictable debate on the health care bill, with numerous amendments expected from both sides of the aisle and more 60-vote hurdles along the way. Democratic centrists from conservative states are particularly wary of provisions to have a government-run plan compete with private insurers to drive down coverage costs. Efforts to insert stricter language to bar federal funds from being used to cover abortions has also become a divisive issue. Senate leaders hope to pass their bill by the end of the year. If that happens, January would bring work to reconcile the House and Senate versions. If a compromise can be reached, it would then have to be approved by both chambers of Congress before a final package could land on Obama's desk to sign. The House and Senate bills have many similarities, including the new requirements on insurers and the creation of new purchasing marketplaces called exchanges where self-employed individuals and small businesses could go to shop for and compare coverage plans. One option in the exchanges would be a new government-offered plan, something that's opposed by private insurers and business groups. Differences include requirements for employers. The House bill would require medium and large businesses to cover their employees, while the Senate bill would not require them to offer coverage but would make them pay a fee if the government ends up subsidizing employees' coverage. Another difference is in how they're paid for. The Senate bill includes a tax on high-value insurance policies that's not part of the House bill, while the House would levy a new income tax on upper-income Americans that's not in the Senate measure. The Senate measure also raises the Medicare payroll tax on income above $200,000 annually for individuals and $250,000 for couples. Both bills rely on more than $400 billion in cuts to Medicare. Copyright 2009 The Associated Press. All rights reserved.

Uninsured ER patients twice as likely to die

New study highlights disparity of care for those who don't have coverage Associated Press updated 4:00 p.m. ET, Mon., Nov . 16, 2009 CHICAGO - Uninsured patients with traumatic injuries, such as car crashes, falls and gunshot wounds, were almost twice as likely to die in the hospital as similarly injured patients with health insurance, according to a troubling new study. The findings by Harvard University researchers surprised doctors and health experts who have believed emergency room care was equitable. "This is another drop in a sea of evidence that the uninsured fare much worse in their health in the United States," said senior author Dr. Atul Gawande, a Harvard surgeon and medical journalist. The study, appearing in the November issue of Archives of Surgery, comes as Congress is debating the expansion of health insurance coverage to millions more Americans. It could add fodder to that debate. The researchers couldn't pin down the reasons behind the differences they found. The uninsured might experience more delays being transferred from hospital to hospital. Or they might get different care. Or they could have more trouble communicating with doctors. The hospitals that treat them also could have fewer resources. "Those hospitals tend to be financially strapped, not have the same level of staffing, not have the same level of surgeons and testing and equipment," Gawande said. "That also is likely a major contributor." Gawande favors health care reform and has frequently written about the inequities of the current system. The researchers took into account the severity of the injuries and the patients' race, gender and age. After those adjustments, they still found the uninsured were 80 percent more likely to die than those with insurance — even low-income patients insured by the government's Medicaid program. "I'm really surprised," said Dr. Eric Lavonas of the American College of Emergency Physicians and a doctor at Denver Health Medical Center. "It's well known that people without health insurance don't get the same quality of health care in this country, but I would have thought that this group of patients would be the least vulnerable." Private hospitals more likely to transfer uninsured Some private hospitals are more likely to transfer an uninsured patient than an insured patient, said Lavonas, who wasn't involved in the new research. "Sometimes we get patients transferred and we suspect they're being transferred because of payment issues," he said. "The transferring physician says, 'We're not able to handle this."' Federal law requires hospital ERs to treat all patients who are medically unstable. But hospitals can transfer patients, or send them away, once they're stabilized. A transfer could worsen a patient's condition by delaying treatment. The researchers analyzed data on nearly 690,000 U.S. patients from 2002 through 2006. Burn patients were not included, nor were people who were treated and released, or dead on arrival. In the study, the overall death rate was 4.7 percent, so most emergency room patients survived their injuries. The commercially insured patients had a death rate of 3.3 percent. The uninsured patients' death rate was 5.7 percent. Those rates were before the adjustments for other risk factors. The findings are based on an analysis of data from the National Trauma Data Bank, which includes more than 900 U.S. hospitals. "We have to take the findings very seriously," said lead author Dr. Heather Rosen, a surgery resident at Los Angeles County Hospital, who found similar results when she analyzed children's trauma data for an earlier study. "This affects every person, of every age, of every race." © 2009 The Associated Press. All rights reserved.

Milbridge Healthcare Workers In Search Of New Contract

by Rob Poindexter · Nov 16th 2009 WABI-TV 5 Workers at a healthcare facility in Milbridge say their being treated unfairly by ownership and they've decided to let their voices be heard. They've decided to take their frustration to the streets. LaVerne Coopersmith, a CNA at the facility, says their demands are not that unreasonable. "Maybe a 2% raise and a signed contract, that doesn't seem like asking too much, it seems fair," she says. The workers say management got a pay raise and they want what they say is fair. Dr. Stephen Weisberger is the owner of the facility and he told TV5 the following over the phone. "To my knowledge, no raises have been given to any administrator or manager since the wage freeze. These are tough times. My workers are fantastic and we're working towards a solution that is financially viable for them." Workers claim management received their pay increases just a month before their own wages were frozen and they say that isn't right. "We realize the economy is bad," says Marie Leighton a CRMA at the facility, "but I guess if management hadn't gotten theirs, it wouldn't have been so bad, but they got theirs in April and we got a freeze in May and I don't think that's quite fair." Patients and their families say the staff here works hard and deserves fair treatment. Jackie Jellison's mother is being treated in the Narraguagus Healthcare Facility and she says the care there is first rate. "The care that these ladies have for these residents is wonderful. I mean they go out of their way and like Marie said, they stop in on their off time to see how patients are." The protestors say they will continue to picket as long as it takes. The two sides are scheduled to sit down at the negotiating table on December 4th. Video for this story is available through this link.

Local 771 - November 21, 2009 Agenda

MSEA-SEIU Local 1989 Local 771 Chapter Meeting November 21, 2009, 10 am to Noon

MSEA Headquarters, 65 State Street, Augusta, Maine

10:00 Welcome Introductions 10:05 Review Minutes from October meeting 10:10 Treasurer’s Report 10:15 Membership Update 10:20 771 Election of 2010 Officers 10:50 MSEA-SEIU Annual Convention Disaffiliation with SEIU 11:00 771 By-Laws: Elections 11:10 Legislative Update Long-Term Care System LEAN Process Worker Taskforce Group, Monday, 11/30, 1pm DHHS 11:25 Bargaining Alpha One 11:40 KVO Annual Fundraising Campaign 771 wish to make a donation? 11:50 Downeast Federation of Nurses & Health Professionals Local 5073 Narraguagus Bay Health Care Facility Picket 11:55 Next Steps Next Local 771 Meeting _________________________ 12:00 Adjourn Be sure to check out your Local’s blog: http://www.unionmaine771news.blogspot.com/. If you need to contact me, Helen Hanson, helen.hnsn@gmail.com.

Minutes October 24, 2009 Meeting

LOCAL 771 CHAPTER MEETING 10/24/2009 MINUTES Attendance: Members: Helen Hanson, Joe Berry, Ted Rippy, Juanita Burtt, Roxann Gargac, Dixie Lewis, Dee Dee Strout Local 771 Field Rep: CJ Betit Local 771 Organizers: Jay Economy MSEA-SEIU Retiree: Phil Wolley MSEA-SEIU 1989 President: Bruce Hodgdon Review of Minutes of 9/19/09 Chapter Meeting Helen Hanson distributed the minutes of the 9/19/09 Chapter Meeting and they were reviewed and accepted. The one change to the minutes was in the Alpha One Bargaining Update that Dennis Fitzgibbons had not been present at the 9/10/09 meeting. National Direct Care Partnership & Voices Institute Local 771 members Ted Rippy and Dee Dee Strout reported on their attendance at the Voices Institute for leadership training in Wisconsin during the week of September 27th.Ted and Dee Dee both reported that this was an invaluable experience in learning how to lobby for change. The Direct Care Alliance is working hard to professionalize the DCW field, and DCW’s from 16 different states were in attendance. Ted and Dee Dee said they saw a lot of change and growth during the week, and very much appreciated the scholarships from MSEASEIU. Ted and Dee Dee will report back to MSEASEIU’s Board of Directors in November regarding their experiences at the Voices Institute. Treasurer’s Report In Pat Crowell’s absence, Helen Hanson reported Local 771 currently has $896.61 in it’s savings account and $105.57 in it’s checking account. LD 1078 Update Helen Hanson reported that the DHHS Lean Study of the long term care system is well under way. There are 18 members on the core committee ( including Helen) , and that Dee Dee Strout, Ted Rippy, and Helen will also be working on the Worker’s Committee which begins meeting on Oct. 26, 2009. Helen related that the study seems to be showing that the system is too top heavy administratively and that the clearing house agency of Elder Independence of Me ( EIM) is being looked at very closely. MSEA-SEIU 1989 Convention 2009 Local 771’s delegates for convention will be Helen Hanson, Joe Berry, Ted Rippy, Sherri Rippy, Dave Levasseur, Carol Ann Cammack, and Dixie Lewis. Carol Ann was elected as a delegate at an emergency chapter meeting held at the Area One Caucus on October 3, 2009. There was a general discussion of the upcoming convention and President Hodgdon reviewed resolutions that were currently scheduled to be raised at convention, including a resolution to consider disaffiliation from SEIU. Local 771 is strongly opposes this disaffiliation resolution, as SEIU has been a strong advocate for health care workers and many of our members take advantage of the health and dental insurance plans offered by SEIU. Pre-Retirement Planning Retiree Phil Wooley gave a presentation on the importance of pre-retirement planning, and reviewed the pre-retirement committee’s training provided to state employees. He emphasized that everyone’s retirement is different and you can not begin planning too early. Phil distributed a survey for members to complete and return. Alpha One Bargaining Update Field Rep CJ Betit reported that the one remaining issue to be resolved in the new A1 contract is the decision of when the closed shop status will go into effect. This issue should be resolved shortly. Labor Management Committee Dixie Lewis and Carol Ann Cammack will serve on the HC4M Labor Management Committee with CJ Betit. Issues to be discussed include scheduling and fill-ins. HC4M has told CJ that if a DCW calls in for a fill in the worker will not get a call back unless they cannot fill the request. This is something DCW’s had not been aware of and expecting and not getting a call back has been very frustrating. CJ reported that on he had received some good news in that HC4M has been over budget in hours of service delivered in July 1491-1403, August 1543-1403 and September 1554-1403. Next Meeting November 21, 2009 , 10AM – Noon at MSEA Headquarters in Augusta. Coffee and refreshments will be provided. Chapter elections for officers and delegates will be held at this meeting.

Why So Many of Us Don't Have Health Care Insurance

Don Krutsinger, 2009 Voices Institute graduate November 11, 2009 I work as a direct support professional with developmentally disabled adults in residential settings. One thing I have in common with just about all my coworkers is that we need to work more than 40 hours a week to make ends meet – and even so, too many of us can’t afford our employers’ health care coverage. With the recent cutbacks by our state (Minnesota), most of our residential programs have cut out overtime and cut down the number of full-time positions, reducing the number of positions that receive health insurance and paid time off. That means nearly all of us have to work two to three jobs to make ends meet. Chances are, we don’t get enough hours from any one of them to qualify for health insurance. That’s a difficult, demoralizing way to live, especially for those of us who are dedicated to direct support work and have invested years of our lives in our careers. I’ve been a direct support professional for 21 years. From 1988 to 2004, I worked in residential and day services programs in Kansas. I received a social work degree and worked as a targeted case manager in Iowa. In 2006, I moved to Minnesota to become a group home supervisor. My supervisory experience has taught me how difficult it is to train and retain quality staff. I’ve found the best way of supporting our residential programs is to float between homes, filling in where I’m needed because someone couldn’t show up that day. For a while, I worked full-time at another residential program on a day shift while floating part-time at my group homes, but the other program had to eliminate their full-time day shift positions after the cutbacks. I now work full-time in my float position while working part-time during the day as a personal care attendant. As a PCA, I help an elderly man with multiple sclerosis get up in the morning. I also help a professional man with cerebral palsy use the restroom at his workplace twice a day. Although I work for fairly good agencies that would provide some benefits if I were full-time, the distance between jobs and the short hours of support with each client make it difficult to put in 40 hours I’d need to be eligible for health insurance – and to afford the premiums. A few of the people receiving PCA services need assistance during every waking hour or around the clock. You might think the PCAs who work with these individuals would qualify for health insurance, but the cutbacks have changed that too. There are now limits on how many hours a week PCAs can work, so agencies don’t have to pay overtime. Some people’s hours are so limited that they don’t qualify for health insurance either. It wasn’t easy to make it on one PCA job before the cutbacks either, but we had it better than most. The only reason we qualify for overtime is that Minnesota requires it, but less than half of the 50 states say home care workers are entitled to overtime pay. If you live in one of the others you’re out of luck. The federal Fair Labor Standards Act, as interpreted by the U.S. Department of Labor (DOL), does not cover workers who provide “companionship services” to people in their homes. http://www.directcarealliance.org/index.cfm?pageId=538#no_minimum_wage The DOL ruling was challenged in court by Evelyn Coke, a home care worker who had been paid only $7 an hour throughout her 30-year career, receiving no overtime pay even though she worked regularly over 70 hours a week. She made it all the way to the Supreme Court, but the court ruled against her. This is an issue that can and must be decided on the federal level. We need legislation to include all home care workers in the federal Fair Labor Standards Act. We need to pay people fairly for the work they have done, so home care workers can afford health insurance and other basic benefits. Until we do, we won’t be able to find and keep enough quality personal care attendants to meet the needs of the elders and people with disabilities who want to remain in their homes. originally published in the Direct Care Alliance e-newsletter

Local 771 holding Elections

Local 771 is holding its elections on Saturday, November 21st, at MSEA headquarters at 65 State Street in Augusta. The meeting will run from 10 to noon. Anyone interested in being an officer or a delegate for 771 can file a nomination. You can do this in person, at the meeting. You can email your nomination to me, helen.hnsn@gmail.com or to Jay Economy at organizing@mseaseiu.org. Any member of 771 in good standing can run.

Error reported with Local 5073 and Narraguagus Bay Health Care

I reported an error with Local 5073 and the Narraguagus Bay Health Care Facility. Local 5073 is not ending their picket. They will be back out on the picket line on Monday. Please keep these workers in your thoughts and prayers.

Local 5073 decides to End Picket at Narraguagus Bay Health Care Facility

Downeast Federation of Nurses & Health Professionals Local 5073 decide to End Picket The picketing by members of Local 5073 has officially come to an end. After the owner of Narraguagus Bay Health asked the union "what would stop the whole uproar", union leaders gave him a list of issues. He said he would look into them. Union leaders made a good faith decision to stop the picketing. Mediation starts on December 4th.

March for Health Care Justice

March for Health Care Justice, today, noon, Kennebec County Courthouse to Senator Snowe's office. Tell Senator Snowe that Athem's suing the state because they were not granted the 18% rate increase for policy holders they asked for. The state told them they could charge 10% more. Anthem says it cannot live with a 3% increase in profits so it is suing the state. Hope you can be there!

Bill Clinton urges passage of health care bill

Former president calls reform "an economic imperative"

Associated Press

updated 25 minutes ago

Former President Bill Clinton arrives on Capitol Hill in Washington on Tuesday, Nov. 10, 2009.

Charles Dharapak/AP

WASHINGTON - Former President Bill Clinton told anxious Senate Democrats on Tuesday to pass a health care bill soon because the U.S. economy can't resist the toxic combination of exorbitant medical costs and nearly 50 million uninsured for much longer.

"My argument was that this is an economic imperative," Clinton said after the closed-door meeting.

Addressing Democrats' insecurities about the complex legislation, Clinton said he told the senators "there is no perfect bill — you'll always have unintended consequences. There will be amendments to this next year. But the worst thing to do is nothing."

Clinton was the last Democratic president to attempt to revamp the health care system to cover all Americans and try to control costs. The spectacular collapse of his plan probably cost Democrats control of Congress in 1994, but Clinton is still admired for having tackled the issue. He went on to win a second term in office.

"People trust him," said Sen. Max Baucus, D-Mont., one of the architects of the current Senate health care bill.

"His argument was that getting the best bill is not only good for the people, it's the best politics," said Sen. Ben Nelson, D-Neb., one of a clutch of moderates who hold the fate of the legislation in their hands.

Clinton said he hoped all the senators understood his bottom line: "It's not important to be perfect here," he said. "It's important to act, to move, to start the ball rolling."

The House passed its health care bill last Saturday by a narrow 220-215 vote. In Senate, Majority Leader Harry Reid, D-Nev., is working on a final Democratic draft. But the combination of divided Democrats, and Republicans determined to force delays under the Senate's arcane rules, is making it less likely that President Barack Obama will get a bill this year.

"Our goal is to make sure it's out of the Senate this year," said Sen. Dick Durbin, D-Ill., the No. 2 Senate Democrat. The Senate bill would then have to be combined with legislation passed Saturday by the House, and the final version passed by both chambers before it could go to Obama's desk. Finishing that whole process before year's end would be tough.

"They want us to finish quickly. We do too. But some of these things are beyond our control," Durbin said of the White House's desire for fast action.

Complicating the effort, abortion opponents in the Senate are seeking tough restrictions in the health care overhaul bill, a move that could roil the shaky Democratic effort.

Nelson, the Nebraska moderate, said he could not support a bill unless it clearly prohibits federal money from going to pay for abortions. He is weighing options, including offering an amendment similar to the one passed by the House this weekend, which had more stringent language than that approved by Senate committees.

"While there may be different views about abortion, I think there's a strong majority against using federal dollars to fund abortions," Nelson said Tuesday on NBC's "Today."

Senate Majority Leader Harry Reid, who is personally opposed to abortion, said the issue was being negotiated.

"I expect the bill that will be brought to the floor will ensure that no federal funds are used for abortions and that the conscience rights for providers and health care facilities like Catholic hospitals are protected," Reid said Tuesday. "I think we can work that out."

The House-passed restrictions were the price Speaker Nancy Pelosi, D-Calif., had to pay to get a health care bill passed. But it's prompted an angry backlash from liberals at the core of her party, and some are now threatening to vote against a final bill if the curbs stay in.

Obama said the legislation needs to find a balance.

"I want to make sure that the provision that emerges meets that test — that we are not in some way sneaking in funding for abortions, but, on the other hand, that we're not restricting women's insurance choices," Obama said in an interview with ABC News.

The House bill would bar a new government insurance plan from covering abortions, except in cases or rape, incest or the life of the mother being in danger. That's the basic rule currently in federal law, under a provision called the Hyde amendment, which Reid said Tuesday had worked well.

"The one thing we're certain to do is to maintain what we've had in the past," said Reid, D-Nev. "The Hyde amendment has been a pretty good way to go."

The House bill would also prohibit health plans that receive federal subsidies in a new insurance marketplace from offering abortion coverage. Insurers, however, could sell separate coverage for abortion, which individuals would have to purchase entirely with their own money. The committee-passed Senate versions differ on abortion, but none would go as far as the restrictive amendment passed by the House.

Copyright 2009 The Associated Press. All rights reserved.