WASHINGTON  – Sen. Max Baucus on Wednesday brought out the much-awaited Finance Committee version of an American health-system remake – a landmark $856 billion, 10-year measure that starts a rough ride through Congress without visible Republican backing.

The bill by Baucus, chairman of the Finance Committee, would make major changes to the nation’s $2.5 trillion health care system, including requiring all individuals to purchase health care or pay a fine, and language prohibiting insurance company practices like charging more to people with more serious health problems.

“This is a unique moment in history where we can finally reach an objective so many of us have sought for so long,” Baucus said.

“The Finance Committee has carefully worked through the details of health care reform to ensure this package works for patients, for health care providers and for our economy.”

Consumers would be able to shop for and compare insurance plans in a new purchasing exchange. Medicaid would be expanded, and caps would be placed on patients’ yearly health care costs. The plan would be paid for with $507 billion in cuts to government health programs and $349 billion in new taxes and fees, including a tax on high-end insurance plans and fees on insurance companies and medical device manufacturers.

The bill fails to fulfill President Barack Obama’s aim of creating a new government-run insurance plan – or option – to compete with the private market. It proposes instead a system of nonprofit member-owned cooperatives, somewhat akin to electric co-ops that exist in many places around the country. That was one of many concessions meant to win over Republicans.

In other ways though, including its overall cost and payment mechanisms, the bill tracks closely with the priorities Obama laid out in his speech to Congress last week. Baucus is still holding out hope for GOP support when his committee actually votes on the bill, probably as early as next week.

The measure represents the most moderate health care proposal in Congress so far, compared to legislation approved by three committees in the House and the Senate’s health panel. Obama’s top domestic priority is to revamp the health care system to provide coverage to nearly 50 million Americans who lack it and to rein in rising costs.

The bill includes provisions to keep illegal immigrants from obtaining health coverage through the new insurance exchanges – reflecting the White House’s newly stringent stance on the issue after a Republican House member interrupted Obama’s speech last week to accuse him of lying about it.

The bill also would prevent federal funds from being used to pay for abortions except in cases of rape, incest, or if the life of the mother would be endangered. It’s all but certain that the Baucus provisions will not be the last word on either of those volatile issues.

The bill would set up a verification system to make sure people buying insurance in the exchanges are U.S. citizens or legal immigrants, using Social Security data and Homeland Security Department files. The bill would impose penalties for fraud and identity theft.

While only legal residents would be able to buy coverage through the exchanges, illegal immigrant parents would be able to get insurance for their U.S. born children.

The bill would prohibit abortion from being included in any minimum benefits package. However, plans in the exchange could offer unrestricted coverage for abortions, provided that no funds from government subsidies are used to pay for them. Women who want coverage for abortions would have to pay for it with their own money.

Wednesday’s bill release follows months of negotiations among Baucus and five other Finance Committee senators dubbed the “Gang of Six” – Republicans Chuck Grassley of Iowa, Mike Enzi of Wyoming and Olympia Snowe of Maine, and Democrats Kent Conrad of North Dakota and Jeff Bingaman of New Mexico.

Enzi said he couldn’t support the Baucus bill and preferred an incremental approach. “Let’s start by focusing on the issues where we already have broad, bipartisan agreement,” he said.

In the end, Democrats believe Snowe may be the only Republican to support the bill, though she wasn’t ready to commit her support Tuesday night. “Hopefully at some point through the committee process we can reach an agreement,” she said.

The bill drew quick criticism from Republican leaders.

“This partisan proposal cuts Medicare by nearly a half-trillion dollars, and puts massive new tax burdens on families and small businesses, to create yet another thousand-page, trillion-dollar government program,” said Senate Minority Leader Mitch McConnell, R-Ky. “Only in Washington would anyone think that makes sense, especially in this economy.”

Many liberals also have concerns. Some wanted Baucus to include a public option, while others fear that, in his effort to hold down the price of his bill, Baucus didn’t do enough to make health coverage affordable to working-class Americans. Sen. Jay Rockefeller, D-W.Va., a member of the Finance Committee, said Tuesday that he couldn’t support the bill in its current form.

Baucus’ plan, released as a detailed 223-page summary, aims to make health insurance more affordable for self-employed people and those working for small companies, who now have the biggest problems in getting and keeping coverage.

People insured through large employers would not see major changes, but some of their health care benefits would be nicked to help pay for the cost of the plan. The Baucus proposal would limit to $2,000 a year the amount people can contribute to flexible spending accounts, which are used to cover copayments and deductibles not paid by their employers. That provision would raise $16.5 billion over 10 years.

Everyone covered through an employer would learn the full costs of their health benefits, which starting next year would be reported on employees’ W-2 tax forms. Although family coverage averages about $13,000 a year most workers don’t know how much their employer is paying.

Not carrying insurance could result in a steep fine, as much as $3,800 per family, or $950 for an individual. People who can’t afford their premiums would be exempted from the fine.

The plan proposes a $6 billion annual fee on health insurance providers, which would recoup some of the profits the companies expect to make from millions of new taxpayer-subsidized customers.

Unlike the health care bill written by majority Democrats in the House, which permanently rolls back scheduled cuts in Medicare payments to doctors, the Baucus plan only suspends the reductions for one year. That trims more than $100 billion from the cost of the bill, but has already led to criticism from the American Medical Association.

The legislation makes no changes in medical malpractice laws. It does incorporate Obama’s call for federal funds for state experiments on alternatives to malpractice lawsuits. Democratic leaders are aiming for votes in the full House and Senate this fall.

RALEIGH, N.C.  – North Carolina ministers are holding a religious service outside the office of Sen. Kay Hagan to promote health care reform.

Congregants participating in the interdenominational service will bring petitions for the Democrat. Rev. Tom Rhodes of the Unitarian Universalist Fellowship said the “religious community must do its part to make sure that Sen. Hagan and other elected officials understand that health reform is an urgent moral imperative.”

Rhodes said people of faith must speak out whenever people are suffering or dying due to problems with insurance.

By Richard Craver.
JOURNAL REPORTER

The governor’s office said yesterday that North Carolina has received a $17 million federal grant to pay for a pilot health-coverage program for uninsured, low-income residents.

The grant, which covers five years, is from the U.S. Health and Human Services Department.
North Carolina is one of 13 states participating in the State Health Access Program. The program will be administered by the N.C. Office of Rural Health and Community Care, and the N.C. Division of Medical Assistance.

The goal is to provide coverage to at least 1,500 families. David Kochman, a spokesman for the governor’s office, said that it has not been determined which areas will receive the initial money in early 2010.

To qualify, a family’s household income must be at or below 125 percent of federal poverty level, or $27,563 for a family of four.

Parents must demonstrate their children are enrolled in, or have applied for, Medicaid or the state Children’s Health Insurance Program, or otherwise have private-insurance coverage.

Enrollees will be expected to pay “a modest premium and small copayments,” according to the governor’s office.

The state will receive more than $1.26 million to develop a low-cost, limited benefit plan. The annual amount increases to $4 million in years two through five.

“As an unstable economic climate has caused increasing numbers of families to face limited access to vital services to maintain good health and well being, we are pleased to be a part of this program that’s designed to close the gap,” said Lanier Cansler, the secretary of the state’s Health and Human Services Department.

According to the N.C. Institute of Medicine, almost half of the uninsured in North Carolina are low-income adults. A U.S. Census Bureau report released Thursday found that about 1.4 million North Carolinians under 65 – or one in six – were without health coverage in 2007 and 2008.

Given that the state’s unemployment rate has nearly doubled in the past 12 months to 11 percent in July, health-care analysts say that this year it is highly likely that even more residents don’t have coverage.

The federal program also outlines plans to work with private insurers in North Carolina to develop a limited benefit plan, which can be offered to small businesses by year four of the grant.

By The Associated Press
A look at key issues in the health care debate:

THE ISSUE: Will there be enough doctors to provide care to millions of previously uninsured patients if health reform is passed?

THE POLITICS: With primary-care doctors in limited supply, Republicans opposed to sweeping reform say the health care system would be overwhelmed if nearly 50 million uninsured Americans are given coverage. As is, the American Academy of Family Physicians is predicting a shortage of 40,000 primary-care doctors by 2020, with medical schools graduating only half the number needed to meet demand. Democrats and the Obama administration do not dispute looming shortages, now seen in many poor and rural areas, that could lead to longer waits and more emergency-room visits. But they argue that health care legislation would address those problems.

WHAT IT MEANS: Due to increasing medical demands from aging baby boomers, the U.S. faces a dangerous shortage of primary-care doctors whether sweeping overhaul is passed or not. Several doctors’ groups are backing the legislation, citing in part provisions to expand the work force. For example, the proposed House legislation would add funds, loan repayment and training grant programs designed to promote use of specialized nurses, encourage doctors to work in underserved areas and entice new students into primary care. Existing medical schools also have begun to increase enrollment, while new schools are under development from El Paso in West Texas to Kalamazoo in western Michigan. Still, it remains to be seen whether the efforts will be far and fast enough, given the long-standing attraction of medical specialties which offer students higher salaries and more prestige.

RALEIGH, N.C.  – North Carolina ministers are holding a religious service outside the office of Sen. Kay Hagan to promote health care reform.

Congregants participating in the interdenominational service will bring petitions for the Democrat. Rev. Tom Rhodes of the Unitarian Universalist Fellowship said the “religious community must do its part to make sure that Sen. Hagan and other elected officials understand that health reform is an urgent moral imperative.”

Rhodes said people of faith must speak out whenever people are suffering or dying due to problems with insurance.

RALEIGH, N.C.  – Response in North Carolina to President Obama’s speech Wednesday night to a joint session of Congress didn’t appear to eliminate the sharp divisions on the most vocal sides of the health care issue.

While Democrats who watched the president speak on television or in person praised Obama for laying out principles for his health insurance changes, many of the more than 1,000 people at a conservative rally said Obama still lacks credibility.

Obama spoke in favor of but didn’t insist upon a government program to sell insurance in competition with private industry. But people at the Americans for Prosperity event remain convinced the president and Democratic leaders in Congress want to phase out private insurance by pushing employers to put them on the public plan.

“He is still speaking without details,” Ralph Dean, 54, of Raleigh, a hardware store salesman, said at the Americans for Prosperity event at the State Fairgrounds. “There are sensible solutions to the problem and most of them don’t involve government.”

Many of the rally participants held signs saying “Hands Off My Health Care,” sometimes booing when Obama made a comment of which they disagreed.

Americans for Prosperity President Tim Phillips said the American public can’t believe Obama when he said he wouldn’t sign a plan into law that would raise the deficit now or in the future because other government programs have put the country more in debt.

“He’s lying. I think he’s lying,” said Tim Genest, 47, of Garner, who works for a phone company. “How do we trust him?”

Democrats and Obama supporters who heard his speech, many of them meeting at scores of homes and restaurants in smaller “watch parties” across the state, said his comments on the moral imperative to reduce the rolls of the uninsured were effective.

“This is a defining moment in the character of our nation,” said Charles Coble, 67, of Chapel Hill, who held a watch party that attracted nearly 20 visitors to his home. Coble said he was glad to hear Obama speak squarely against some accusations made by opponents this summer, calling one a “lie, plain and simple.”

“This thing has become so politicized,” Coble said. “It was important that (he) calls it like he sees it.”

State Democratic Party Chairman David Young said Obama made a compelling case about the need to pass health insurance reform this year, adding that Republicans in North Carolina have opposed reform to hurt the president politically.

“Opponents of reform have a choice,” Young said in a statement. “They can either stop playing partisan games and come up with their own reform proposal, or they can start explaining to the American people why it’s better to stand by and do nothing at all as thousands more North Carolinians face skyrocketing costs and lose their coverage every day.”

U.S. Sen. Richard Burr, R-N.C., who has introduced his own health care bill that would provide tax credits to help consumers pay for their own insurance, said he agreed with the president that the Congress needed to do something to improve health care but warned against rushing through legislation.

“I am hopeful that my colleagues will realize the need to pass responsible health care reform on a bipartisan basis, not just push legislation through without proper debate and consideration of the
consequences for all Americans.” Bill Pully, executive director of the North Carolina Hospital Association, sat in the House gallery Wednesday night, just as he did 16 years ago this month when President Clinton gave a similar speech. In 1993, he was a guest of then-U.S. Rep. Tim Valentine.

This time, it was Rep. Bob Etheridge.

While there remains division on the health care issue, Pully said he felt an energy in the House chamber that he couldn’t remember back in the Clinton administration to fix health care.

“The country is eager for something,” Pully said.

WASHINGTON — While some were moved to tears by the president’s soaring rhetoric, others were moved not at all. Where some saw a new clarity, others saw more vagueness. And while some praised him for reaching out to Republicans, there were those who felt he was overreaching in some ways and not reaching far enough in others.

Americans listened intently to President Barack Obama’s much-anticipated speech on health care reform Wednesday night, and not surprisingly, their reviews varied. Few said they had changed their minds.

Matt Petrovick set his treadmill at a leisurely 2.8 mph pace so he could pay full attention to the television on the wall in front of him. He’s not sure the president’s words boosted his heart rate, but the speech certainly got him going.

“There were definitely certain times where I got tingles down my arms and just felt like we might actually accomplish something with this generation and this presidency that’s never been done before, and hopefully will be for the better and won’t blow up in our faces,” the 24-year-old insurance agent said as he worked out at a Planet Fitness gym in Raleigh, N.C. “Only time will tell.”

At the Winter Park Towers, a residential assisted living community in the Orlando, Fla., suburb of that name, 25 senior citizens skipped the facility’s Wednesday night movie – “The Soloist” – to watch Obama’s speech on a large, flat-screen TV in a multipurpose room that resembled a small auditorium.

There was applause at several points during the speech, and several people dabbed at moist eyes when Obama mentioned the late U.S. Sen. Ted Kennedy, who died last month of brain cancer.

“I thought the speech had strengths, and some very severe soft spots,” said Don Meckstroth, an 89-year-old retired executive.

“The strengths are that, I believe Mr. Obama spoke tonight as an elected president rather than a person campaigning for the presidency. He had some specific proposals, and I thought the highlight of his speech was when he said, ‘I intend to be the last president that will be attempting to reform health care that fails.”‘

The weaknesses? “It’s a terribly complex structure that he proposed. … the assumptions were less than convincing, at least they were to me on the lower costs we were going to achieve, and how we were going to achieve them, how we are going to pay for it without any additional expense. `Not one dime more?”‘

Meckstroth rolled his eyes when his wife Wanda said cost “is something that can always be worked out.” But she insisted that the “most important thing here was security. He really made me feel this thing was going to be workable.”

Across the country at San Francisco’s Women’s Community Clinic, doctors, nurses and volunteers crowded together with cookies and popcorn to watch Obama’s speech streaming live through an office computer. Many of the clinic’s clients hold part-time jobs that don’t offer insurance, and the staff are increasingly seeing the recently unemployed.

The president’s call for a health care system that wouldn’t leave patients without lifesaving care was met with calls of “amen.” And when Obama mentioned a provision that would bar insurance companies from denying coverage because of pre-existing conditions, the women clapped and cheered.

“That’s everyone in that room – every single person in that room,” said Tara Medve, 31, the clinic’s development director. Katie McCall, 35, who volunteers as a policy director at the clinic, said the speech was reassuring and should inspire confidence in doubters.

“If he says this isn’t going to increase the deficit, I believe him,” she said. “If he says we’re not going to cover people who are undocumented, I believe him.”

But some skeptics remained skeptics.

Earlier in the day, Mark Hutchinson drove from his home in Mays Landing, N.J., to participate in a rally near Philadelphia’s Independence Hall against the health care bill. A member of the group Liberty and Prosperity, which takes its name from the New Jersey state motto, Hutchinson carried a sign that said, “A Trillion Times No.”

He said Obama’s speech did nothing to convince him that the so-called “public option” – a government-run health program that would compete with private insurers – would be truly voluntary.

“I thought there was a lot of inaccuracies in there and falsehoods,” he said. “If we’re taxpayers, we’re paying for it. Can I opt out of paying for it?”

In the Minneapolis suburb of Plymouth, Steve McCulloch, owner of Linsk Flowers, took notes as he watched the speech. McCulloch provides high-deductible health insurance and health care savings accounts to his nine employees, and he was happy to hear the president talk more specifically about the plan he wants.

He just wishes Obama had backed down on the notion of a public option.

“If he’s going to get something done, you don’t make those kinds of statements,” he said. Michael Berglund, a 41-year-old high school English teacher, watched the speech at his Tulsa, Okla., home. Berglund said his domestic partner, Kevin, a 43-year-old hair stylist, has to buy his own health insurance, which comes with high costs and deductibles.

“There are times he has not gone to the doctor because he knows he’ll need an X-ray or an MRI,” Berglund said. Berglund said before Obama’s speech he was “skeptical” of health care reform, but “It seemed a lot clearer to me now.”

Not so for Phillip Friesen, a 23-year-old medical student from Enid, Okla. While he was pleased that Obama hit on a few specifics like preventive medicine and how the massive overhaul would be paid for, he still would like more information on how the new system would affect physicians in their practices and how Medicare would be handled.

“I’m a Type-A medical student at heart,” he said. “I still need to see the details of it.”

Back at the gym in Raleigh, patrons working out before the row of 15 big-screen televisions could have watched U.S. Open tennis, MTV’s “Pranked,” the game pitting the Tampa Bay Rays against the New York Yankees, or “So You Think You Can Dance?” But many chose to tune the headphones to Obama.

From what he heard of Obama’s plan, Petrovick said the insurance industry for which he works is likely to lose a “lot of business” in coming years. Still, he couldn’t help wishing the president well.

“Everything that comes out of his mouth sounds like gold,” he said. “He always has done a very good job at getting his points across. Whether they’re right or wrong, he makes you feel good about it usually.”

WASHINGTON -  President Barack Obama will tell the nation in a prime-time address precisely how he wants to expand health care, including what his spokesman says will be a fresh argument for the much-debated government-run insurance option.

“What we’re going to hear tonight is, the president’s going to speak clearly and directly to the American people about what’s in this bill for them,” press secretary Robert Gibbs said Wednesday.

Making the rounds of morning news shows, Gibbs said Obama will highlight his vision of a health care overhaul that secures the insurance people now have, makes affordable care accessible to those without it and cuts insurance costs for familie and small businesses.

Discussing Obama’s thinking, a senior administration official said the president will make a case for why he believes a government-run option is the best way to introduce greater competition into the system. The official, who discussed the speech on grounds of anonymity because preparations remain under way, also said Obama would offer to hear new ideas and he would not suggest any veto scenario at this time.

Even as Obama prepared to speak to a joint session of Congress and a live television audience, the leader of the influential Senate Finance Committee raced to broker a bipartisan agreement on
the president’s top domestic priority.

The White House set a high bar for the rare presidential address, acknowledging the huge stakes and creating big expectations about the level of specificity Obama would provide.

The president has stressed repeatedly the broad goals for the sweeping health care overhaul he seeks, but has left the details to lawmakers. Through a hot summer of angry debate, he lost his grip on the process.

Aiming to reclaim it at a pivotal moment and open a final push for a bill, Obama said, “We do intend to get something done this year.”

“I’m open to new ideas,” the president said in an interview Wednesday on ABC’s “Good Morning America” in which he previewed the themes of his speech. “We’re not being rigid and ideological about this thing.”

Gibbs said the country needs “additional choice and competition so that those that are on the private insurance market aren’t just dealing with one competitor to try to get quality, affordable
insurance.”

“The public option is a way of putting a check on insurance companies,” he said.

Asked pointblank if Obama was preparing to demand a public option, Gibbs said only that he “will outline what he thinks the value of the public option is.”

Republican Party Chairman Michael Steele dismissed the proposal in a separate interview, saying “the idea that the federal government can come in and be the same as Allstate in providing insurance, that’s ridiculous.”

Gibbs argued that a government-run option is “supported by a majority of people in this country” and said that currently “there’s nobody to compete” in a situation where a private health care insurance company dominates the market.

With Obama’s approximately 35-minute speech still being written, much by the president himself, White House officials said the president will “answer all the major questions” – including the sticky issue of how to pay for getting coverage for the 50 million Americans who lack it.

Obama will appear before lawmakers a day after their return from an August recess marked by contentious town halls and much misinformation and confusion about what a health care overhaul may look like.

A senior administration official said Obama has ceased worrying about whether he gets any Republican participation. “If they don’t want to, we can’t worry about that,” said the official, who spoke on condition of anonymity to more freely discuss behind-the-scenes thinking.

But that is no longer Obama’s biggest difficulty, a fact underscored by the conflicting advice he was getting from within his own party.

Rep. Zack Space, D-Ohio, a member of the fiscally conservative Blue Dog coalition, said Obama should “appeal to both sides of the aisle, and to everyone involved in this situation, to embrace a sense of compromise and moderation.”

But Rep. Raul Grijalva, D-Ariz., co-chairman of the House Progressive Caucus, said he wanted Obama to state his unequivocal support for a government-run health insurance option to compete with private companies, and to clearly distance himself from the two alternatives now circulating.

One of those would structure a public plan so that it would be triggered only if private insurance companies weren’t providing enough affordable choices in certain areas; the other would set up nonprofit co-ops. Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee, circulated a proposal that would cost $900 billion over 10 years and guarantee coverage for nearly all Americans, regardless of medical problems. Fees on insurers, drug companies and others in the health care industry would finance tax credits to help expand coverage. Baucus’ panel is the only one of the five involved in health care not to complete a bill yet, and the only one still searching for a bipartisan compromise.

One provision would fine families up to $3,800 for failing to buy health insurance, essentially requiring that everyone have medical coverage, much like the case with car insurance. Obama rejected a mandate, and fines, during his presidential campaign.

Baucus asked his “Gang of Six” bipartisan negotiators to report back with suggestions by Wednesday morning. “I made that clear, that the bipartisan effort will have more effect if there’s
agreement prior to the president’s address,” he said.

But few appeared ready to do as Baucus wants and move before hearing from the president. “That’s the cart before the horse, as they say in Maine,” said Sen. Olympia Snowe, a moderate Republican being courted by the White House.

Like bipartisanship, prospects for a public insurance plan also dimmed. It is not in Baucus’ plan, and two prominent House Democrats backed away from it Tuesday.

It is this issue that has become Obama’s main quandary: Liberal lawmakers say they won’t vote for legislation that doesn’t include a public plan. But Republicans and many moderate Democrats won’t vote for one with it.

House Speaker Nancy Pelosi said Obama told her and Senate Majority Leader Harry Reid during a White House meeting Tuesday that his message would essentially be: “If you have a better idea, put it on the table.”

Gibbs appeared on NBC’s “Today” show and CBS’s “The Early Show,” and Steele was interviewed on the “Today” show.

BY CIVITAS
RALEIGH, N.C. – With President Barack Obama set to address Congress Wednesday evening to plead his case for overhauling the health insurance and health care industry, a new Civitas Flash Poll released today finds voters deeply divided on their support for the plan.

According to the poll of 662 registered voters, nearly an identical number support the proposal as oppose it.  Of those surveyed, 47.6 percent said they somewhat or strongly supported the health care reform plan presented by President Obama and Congressional Democrats, 47 percent of voters said they were opposed to the plan and 5.4 percent said they were unsure.

“The health care proposal by the President and Congress has deeply divided the nation,” said Francis De Luca, executive director of the Civitas Institute.  “Feelings on the plan are quite intense, with very few people in the middle.  Basically, you either support the plan or you abhor it.”

A reflection of the deep divisions is that roughly three-fourths of voters said they either strongly supported (35.4%) or strongly opposed (40.6%) the plan.

“Candidate Obama pledged to be a uniting force for our country.  However, the actions and proposals by President Obama and the Democratic majority in Congress are driving the nation apart,” added De Luca.

Additionally, only 20.5 percent of voters think the cost of health care will go down and 27.3 percent of voters think the quality of their health care will get better if the President’s plan passes.

“Regardless of their support of the President’s proposals, very few think it will actually make things better.  It’s apparent much of the President’s support on the plan is not from people who think it will improve health care, but from their personal support of him,” concluded De Luca.

The Civitas Flash Poll study of 665 registered voters was conducted September 2-3 by Insider Advantage of Atlanta, Georgia.  It has a margin of error of +/- 3.9 percent.  Other factors such as weighting may introduce additional error.