To win bill’s passage, deals had to be made

Special interests, senators line up for concessions

Associated Press / December 22, 2009

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Some of the concessions that lawmakers and interest groups won in the latest version of the Senate’s health care overhaul bill:

■Ben Nelson, a Nebraska Democrat who provided the critical 60th vote, won tighter restrictions on abortion coverage, plus numerous benefits for Nebraska. Among them: the federal government will pay the full cost of a proposed expansion of Medicaid, at an estimated cost of $100 million over 10 years; Blue Cross Blue Shield of Nebraska will be exempted from an annual fee on insurers; supplemental Medigap policies such as those sold by Mutual of Omaha are exempted from the annual fee on insurers; and a physician-owned hospital being built in Bellevue, Neb., could avoid a new ban on referrals from doctors who own such hospitals.

■ Max Baucus, a Montana Democrat and chairman of the Senate Finance Committee, put in a provision to help the 2,900 residents of Libby, Mont., many of whom have asbestos-related illnesses from a now-defunct mineral mine, sign up for Medicare benefits.

■ Christopher Dodd, a Connecticut Democrat and chairman of the Senate Banking Committee who is facing a difficult reelection next year, added an item making $100 million available for construction of a hospital at a public university that he hopes will be the University of Connecticut.

■ Patrick Leahy, a Vermont Democrat, negotiated $600 million in additional Medicaid benefits for his state over 10 years, a benefit he said Vermont is due because it has already expanded Medicaid eligibility to the levels outlined in the bill. Massachusetts is getting $500 million in Medicaid help for similar reasons.

■ Bernie Sanders, a Vermont independent who was angered after a new government-run plan was dropped from the bill, won a $10 billion increase for community health centers.

■ Mary Landrieu, a Louisiana Democrat and key moderate, withheld her support from the legislation until she was able to procure Medicaid help from the federal government worth at least $100 million in 2011.

■ Bill Nelson, a Florida Democrat, pushed a provision he said will let about 800,000 Florida seniors enrolled in private Medicare Advantage plans keep their extra benefits.

■ The American Medical Association announced its coveted endorsement yesterday after a series of changes. Among them: eliminating a 5 percent tax on elective cosmetic surgery procedures, replacing it with a 10 percent tax on indoor tanning services; eliminating payment cuts to specialty and other physicians that were to be used to pay for bonuses to primary-care physicians and general surgeons in underserved areas; and dropping a proposed $300 fee on physicians who participate in Medicare that was to be used to fight fraud in the program.

■ Doctors and hospitals in Montana, North Dakota, South Dakota, Utah, and Wyoming will get paid more than providers in other states.

■ Longshoremen were added to the list of high-risk professions shielded from the full impact of a new tax on high-value health insurance plans, joining electrical linemen, police officers, firefighters, emergency first responders, and workers in construction, mining, forestry, fishing, and certain agriculture jobs.

■ Makers of brand-name biotech drugs won 12 years of protection against would-be generic competitors.

■ Drugmakers fended off proposals to allow importation of cheaper drugs from Canada and other countries, and to let the government negotiate drug prices for Medicare recipients.