Here are my quick notes, pretty much in the order they were raised, from a "background only" (no names) media conference call tonight with senior Democratic Senate staff, including Finance Committee and HELP Committee staffers, about Harry Reid's just-released version of the Senate healthcare reform bill. Feel free to ask for clarification etc. either in the comments or by Twitter (@msbellows):
-- Reported CBO numbers are "feedback," not the final score, but look good. Bill is under $900 billion, achieves $100 billion deficit reduction over 10 years, covers 98% of "all legal residents of all ages" (ie, including people already covered by Medicare -- really 94% of those not Medicare-eligible). Insures 31 million people currently uninsured.
-- I asked whether staff analyzed the cost of marginal increases in the coverage rate: what would it cost to increase the rate from 94% to 96%? From 31 million to 33 million? Answer was that they didn't crunch the numbers that way, but that Reid's bill covers 2 million more people than the Finance Committee bill did. Staffer seemed proud of that.
-- Phases in over time. In 2010: ban on rescission, lifetime/annual expense limits, young adults can remain on parents' policies until age 26. State-based insurance exchanges will be operational in 2014. (Finance committee bill Reid was working from had some provisions start 2013; those moved to 2014.) The preexisting condition ban doesn't become effective until exchanges are operational in 2014; until then, bill enables risk pools to help people having difficulty finding coverage.
-- How's it paid for? Much like the Finance Committee bill. Continue that committee's excise (ie, luxury) tax on high-cost "Cadillac" plans, but definition of Cadillac increases from $8,000 to $8,500 for individuals, $21,000 to $23,000 for families.
-- Side deals: tax on medical device makers reduced to $2 billion/year. Insurance and PhRMA deals unchanged from Finance bill.
-- 5% elective cosmetic surgery tax, previously removed, has been put back in. Yields $5 billion in revenue.
-- Bill increases the Medicare payroll tax by 1/2 of 1% for individuals earning over $200,000 per year, couples earning over $500,000/year; that generates $54 billion in new revenue over 10 years.
-- Blue Cross/Blue Shield get incentive to boost loss ration to over 85%.
-- Medicare Part D "donut hole" shrinks by $500 in 2010.
-- Illegal immigrants can't buy insurance through the new exchanges.
-- Abortion/Stupak: sounds complex. Each state's exchange must provide at least one plan that doesn't cover abortion and one plan that does. No public money can be used to fund abortions. The Secretary of HHS will determine, using GAAP and longstanding federal accounting rules, whether or not the public plan's abortion coverage is paid for with premium dollars or taxpayer dollars, and if premium-funded (as that plan is supposed to be in the first place, I'll note), then it may cover abortion, unlike the House bill.
-- The "individual mandate" (referred to in the call as "individual responsibility") is enforced by a penalty that phases in over time. By 2016, the penalty maxes out at $750 for adults and triple that for children not provided insurance by their parents (who can otherwise afford it). Not exactly "go to jail if you don't buy insurance."
-- CHIP: Sen. Rockefeller's Children's Health Insurance amendment survives in Reid's bill.
Plus, to be honest, deeply wonkish stuff that I didn't follow but some very knowledgeable-seeming reporters did. I'm looking forward to reading the really deep analysis tomorrow morning.