Americans would be able to buy long-term care insurance from the government for $65 a month under a provision tucked into sweeping health care legislation that senators will begin considering next week.
The 651-page bill, released Tuesday by Sen. Edward M. Kennedy, D-Mass., would revamp the way health insurance works. Insurance companies would face a slew of new government rules, dealing with everything from guaranteed coverage for people with health problems to possible limitations on profits. Taxpayers, employers and individuals would share in the cost of expanding coverage to nearly 50 million uninsured Americans.
Release of the bill by Health, Education, Labor and Pensions Committee Democrats came as lawmakers at both ends of the Capitol accelerated their drive to enact health care legislation. House Democratic leaders also outlined a proposal, but offered only limited details.
Both plans omitted specifics on how to cover the costs, which could exceed $1 trillion over 10 years. Given the uncertainty as well as the political sensitivity over raising taxes or cutting Medicare, Senate Republicans prodded Democrats to fill in the blanks before the scheduled beginning of committee work next week.
A first-ever tax on employer-provided health benefits figures prominently among financing options under consideration in Congress, but President Barack Obama campaigned against that last year and its inclusion would require him to reverse course. Obama has proposed $634 billion in tax increases and spending cuts as a down payment on the plan and is soon expected to outline an additional $300 billion in Medicare and Medicaid cuts.
Kennedy’s long-term care plan is designed to help disabled people pay for support services that would allow them to remain in their own homes and avoid moving into nursing homes. People would enroll in the program during their working years and begin paying premiums. To collect benefits, a person would have had to pay premiums for at least five years.
The benefit would be modest — not less than $50 a day — but it could be used to cover a wide range of services.
Prospects for the long-term care provision are uncertain, but Kennedy’s advocacy may sway other lawmakers. For Kennedy, who is being treated for brain cancer, health care legislation would be the crowning achievement of a long and productive career.
At their core, the partial draft bill released by Senate Democrats and an outline circulated by senior House Democrats were largely identical.
Individuals would be able to purchase insurance through a new federally regulated national exchange, and private companies would be barred from denying coverage or charging higher premiums because of pre-existing conditions. Those who are satisfied with their current coverage could keep it.
Both bills would require individuals to purchase insurance if they could afford it. Waivers would be available in hardship cases. The Senate measure provides for an unspecified penalty for anyone refusing to obey the so-called mandate, and House Democrats are considering a similar approach.
In both the House and Senate, Democrats want to provide subsidies to families with incomes well into the middle class. One option under the Senate plan would phase out subsidies at about $110,000 for a family of four.
House Democrats also are said to be considering a wide-ranging change for Medicaid that would provide a uniform benefit across all 50 states and increase payments to providers. Medicaid is a joint state-federal program of health coverage for the poor.
The Senate plan would allow children to stay on the parents’ insurance until age 26.
On a particularly contentious point, the emerging House plan would give people the option of buying insurance provided by the federal government.
Democrats on the Senate committee embraced a similar provision last week but omitted it from Tuesday’s draft in what Sen. Chris Dodd, D-Conn., said was a gesture to Republicans who oppose it.
Sen. Mike Enzi, R-Wyo., the top Republican on the committee, responded derisively. He said Democrats did so "because they know we’re not going to like what they’ve written and they don’t want us to have any time to comment."
Senate Republicans on two committees most involved with health care urged Democrats not to move ahead without detailed cost information. "Paying for health reform in a responsible and sustainable way may be the most single difficult element of our efforts," they wrote.
But after months of preliminary effort, Democrats made clear they intend to move ahead on their own timetable, one that calls for passage of legislation in the House and Senate by early August. A final compromise would wait for September or later in the fall, according to a schedule the party’s leadership established weeks ago.
"This is the year we have to do it," said Rep. Henry Waxman, the California Democrat who chairs the House Energy and Commerce Committee. Waxman was one of several senior Democrats who outlined proposed legislation to the party’s rank and file during the day.
Numerous senior Democrats now aging and ailing have worked their entire careers on health care, but no one is more identified with the issue than Kennedy, first elected to the Senate in 1964. In a poignant announcement Tuesday, Dodd said Kennedy, diagnosed a year ago with a brain tumor, will be unable to attend the working sessions of the health committee he chairs beginning next week.
Associated Press writers Erica Werner and David Espo contributed to this report.