This latter element is something Sanders and several other Senators have been fighting to keep in the bill. It is seen as a way to potentially enact a single-payer health care system at the state level. In Vermont, lawmakers have said they will take testimony on various bills aimed at expanding the availability of publicly funded and managed health care insurance to Vermonters.
Sanders this week disappointed many single-payer advocates by yanking a proposed amendment that, though not expected to pass the Senate, would have forced a debate on creating a Medicare-for-All health care system in the United States. For months, Sanders touted his amendment as a "historic" moment, where for the first time in history the Senate would debate the merits of a single-payer system.
However, after Sen. Tom Coburn (R-OK) called on Sanders' amendment to be read word for word, the Vermont independent immediately withdrew his nearly 800-page amendment. Sanders agreed to withdraw the amendment per Majority Leader Sen. Harry Reid's request, as Reid was worried reading the amendment aloud would have taken up nearly 12 hours of Senate time — potentially derailing the entire health care reform debate.
Sanders called the Republicans' tactic "an outrage."
Since then, however, he has intimated that his vote is not iron clad on the final bill. That said, he noted today that he will vote for cloture — a move to end debate and move toward an up or down vote on the full legislation.
Leahy said he, too, will vote for cloture, as he believes it's time for senators to either vote yes or no on the legislation.
Many progressives who claim the reform effort has been so watered down without a so-called public option of any kind are urging Sanders and other liberal members of the Senate to vote against the bill.
Neither Sanders nor Leahy would say how they will vote on the final bill, however. A final vote on the Senate version of health care reform is expected before Christmas.
Among the key provisions included in the bill that will benefit Vermont is a Leahy-crafted measure that will bring an additional $250 million in Medicaid funding to Vermont between 2014 and 2019.
The Senate’s reform bill requires all states to expand their Medicaid programs to cover more low-income individuals, and increases Medicaid payments to cover the expansion. But, because Vermont has already expanded its coverage using the Medicaid program, Leahy, Sanders and Gov. Jim Douglas warned that the state would have been penalized for the state’s early efforts. This would make Vermont ineligible for extra Medicaid funding.
Under the Vermont-specific formula fix engineered by Leahy to the bill’s Federal Medical Assistance Percentage (FMAP), Vermont will be in a position to net an additional $250 million between the years 2014 and 2019, according to the Congressional Budget Office (CBO), whose scoring of the Leahy-led provision was also released Saturday.
“Vermont has always been a national leader in expanding access to health insurance, and that is something that any health reform plan should reward and not punish. This formula adjustment will ensure that Vermont is not disproportionately burdened by a further expansion of the Medicaid program," said Leahy. "This is a major improvement in the bill for Vermont. Majority Leader Reid has kept his word in working with us to fix this unintended loophole.”
Sanders also praised the additional spending, and Leahy for his leadership.
“It would have been unfair for states like Vermont, which did the right thing by providing broad coverage for more low-income people, to be penalized," said Sanders. "I am pleased that this issue has been addressed in a way that recognizes and rewards Vermont’s forward-thinking policies instead. The Vermont delegation worked well together on this, and I appreciate Senator Leahy’s leadership.”
Sanders, too, scored a victory with the inclusion of what is likely to be a $14 billion expansion of free community health centers, and provide loan repayments and scholarships through the National Health Services Corps.
The provision is expected to provide primary care for 25 million more citizens.
Sanders said the additional resources will create new, or expanded, health centers in an additional 10,000 communities. The provision would also provide loan repayments and scholarships through the National Health Service Corps to create an additional 20,000 primary care doctors, dentists, nurse practitioners, physician assistants and mental health professionals.
Another Leahy-authored amendment will make clear that the same level of medical malpractice coverage under the Federal Torts Claims Act (FTCA) received by community health centers will be extended to free clinics. Current law, Leahy says, makes it unclear whether nonmedical staff such as board members and administrative staff serving the community in free clinics are covered by malpractice insurance. This lack of clarity results in free clinics purchasing medical malpractice insurance on the private market for all of their nonmedical staff.
The Senate bill will also put more effort into investigating and prosecuting fraud, waste and abuse.
The amendment – which includes key provisions from the Health Care Fraud Enforcement Act introduced in October – will further strengthen the government’s capacity to investigate and prosecute waste, fraud and abuse in both government and private health insurance that drains between $72 billion and $220 billion from the system annually.
The amendment makes straightforward but critical improvements to the federal sentencing guidelines, to health care fraud statutes, and to forfeiture, money laundering and obstruction statutes, all of which would strengthen prosecutors’ ability to combat this particularly destructive form of fraud, Leahy noted.
One Leahy-backed element that didn't make it into the compromise bill is his amendment repealing the antitrust protection granted to health insurance companies.
In September, Leahy introduced the Health Insurance Industry Antitrust Enforcement Act. It aimed to repeal the exemption for flagrant antitrust violations, including price fixing, bid rigging and market allocations, and subject health insurers and medical malpractice insurers to the same good-competition laws that apply to virtually every other company doing business in the United States.
“I am disappointed the [amendment] will not be part of the Senate’s debate on health reform legislation," said Leahy. "I look forward to working to include a repeal of the industry’s antitrust exemption when the Senate and House convene to reconcile this health care legislation.”