Getting to 60 Votes in the Senate

According to news reports, last night the 58 Democrats in the Senate held a closed door meeting with the two independent members of their caucus, Bernie Sanders and Joe Lieberman, in an attempt to reach a consensus on the healthcare reform bill. To secure Joe Lieberman’s support and apparently reach the 60 votes required to avoid a filibuster, the Democrats had to scrap a compromise deal reached last week on a limited expansion of Medicare to some individuals in the 55-65 age group and a private-sector approach to the public option.

From the start, some conservative Democrats had been opposed to the so-called “public option,” in which a government-run health plan would compete in the new-created insurance exchanges with private insurance companies in offering health insurance plans to individuals and small businesses. Last week, a group of Senate Democrats worked out a compromise in which, in lieu of a government-run plan, the White House Office of Personnel Management would oversee national health plans offered by private insurance companies, much like the current health insurance benefits for federal employees. In addition, certain beneficiaries in the 55-65 age group would be able to enroll in Medicare, although their premiums would not necessarily be subsidized.

Over the weekend, however, Joe Lieberman indicated that he would not be willing to support such an expansion of Medicare, leaving the Democrats without enough votes to avoid a filibuster. To win Senator Lieberman’s support, Senate Democrats apparently were willing to drop the public plan completely, including the previous compromise reached over the limited Medicare expansion. While there are still some hurdles to overcome, it appears that the Democrats now have the 60 votes they need to pass a bill in the Senate before Christmas. It would then be up to a Conference Committee to reconcile the House and Senate bills into a final bill for next month.

In the Senate Healthcare Bill, Do Premiums Increase or Decrease?

On Monday, November 30, the Congressional Budget Office released its analysis on the effect of the proposed healthcare reforms in the Senate’s version of the bill on health insurance premiums. Both Democrats and Republicans have seized on this report’s conclusions to support their positions on healthcare reform legislation. Democrats have emphasized that beneficiaries in the non-group market (beneficiaries who purchased individual or family policies on their own, not through their employer) would pay lower premiums, on average, under the Senate’s reform bill, once the impact of government subsidies is taken into account. Republicans, on the other hand, have emphasized the increase in premiums in the non-group market, excluding the impact of government subsidies.

While both of these positions are accurate, it should be emphasized that the non-group market, while expanding under healthcare reform, will still account for a relatively small share of the overall insurance market. The vast majority of the non-elderly will still receive insurance from their employers, with 70% in the large group market and 13% in the small group market (in the CBO’s analysis, “small group” is defined as employers with 50 employees or less). Only 17% of non-elderly beneficiaries would be covered in the non-group market, and these non-group policies would be purchased through the new insurance exchanges. Average premiums for both the small group and large group policies would essentially be unchanged, or may even decrease under the Senate bill, according to the CBO’s analysis.

For the non-group market, however, average annual premiums would increase from $5,500 to $5,800 for singles under the Senate bill, while average annual premiums for families would increase from $13,100 to $15,200 under the Senate bill. For 57% of beneficiaries, however, the actual cost would be substantially lower because their premiums would be subsidized by the federal government. Moreover, the biggest reason for the increase in premiums in the non-group market under the Senate reforms is because the insurance coverage provisions of the new policies would be much better, on average, than current policies in the non-group market. Under the reforms, the insurance coverage for policies in the non-group market would be essentially the same as current group market policies, in contrast to current policies in the non-group market, which often offer poor coverage. Other effects of reform, such as slightly lower administrative costs and a slightly healthier pool of beneficiaries, serve to slightly offset the increase in premiums associated with the more comprehensive coverage provisions.
Therefore, according to the CBO’s analysis, average health insurance premiums for most beneficiaries would remain essentially unchanged under the Senate’s version of healthcare reform. In the non-group market, however, premiums would increase, primarily because of better insurance coverage, although 57% of beneficiaries in the non-group market would receive significant subsidies, so their costs would be much lower than the average premiums.