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July 21, 2017

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Dems’ reservations show how tough health care reform struggle is

Rep. Dean Heller

Rep. Dean Heller

Dina Titus

Dina Titus

Shelley Berkley

Shelley Berkley

To understand the complexities in crafting a health care bill that could gain enough support to pass Congress, consider the concerns raised by Nevada’s House delegates.

Democratic Rep. Shelley Berkley wants to rearrange what she calls the “bass-akward” approach to health care by putting more emphasis on prevention and less on end-of-life care.

Republican Rep. Dean Heller says if the so-called government-run public option is so great (he doesn’t believe it is), the bill should require all members of Congress to sign up.

And Democratic Rep. Dina Titus wants to cover the uninsured, but she doesn’t want to tax her wealthy suburban households that earn more than $350,000 a year to pay for it.

“We’re not there yet,” said Berkley, who serves on the Ways and Means Committee, one of three committees handling the bill. “We’re trying very hard.”

President Barack Obama’s ambitious plan to revamp the nation’s health care delivery system and provide coverage for the 47 million uninsured is grinding its way through Congress, tangled in the varying agendas of the 535 members.

Senate Majority Leader Harry Reid announced the inevitable last week when it became clear his chamber would not have a bill ready for a vote before adjourning Aug. 7 for a month.

The Senate will not vote before the break. Whether the House, which adjourns this week, will vote before Friday remains unclear.

Nevada has among the highest proportions of uninsured residents in the nation — nearly one in five, or about 500,000 people.

The House bill would create a new method for the uninsured to buy health care by establishing a national health care exchange, a marketplace where those ineligible for employer-sponsored plans could buy their own insurance.

One of the plans offered on the exchange would be the public option — government care, which supporters say will provide needed competition to bring down the price of plans offered by private companies. Detractors denounce this as socialized medicine.

To help people buy insurance through the exchange, the bill offers subsidies. People making less than $44,000, or $88,000 for a family of four, would be offered credits to buy their own health plan.

In fact, $770 billion of the $1 trillion health care bill over 10 years comes from the credits that will be offered to help Americans buy insurance.

So how do we pay for all of this?

About half is to come by cutting costs, the rest from raising taxes.

The House bill would put a new tax on individuals making more than $280,000 and joint filers making more than $350,000. The tax would be staggered as incomes rise, topping out at 5.4 percent for joint filers making more than $1 million, or $800,000 for single filers.

All of the new taxes would apply only to income exceeding the limits — for example, the 1 percent tax would kick in on the first dollar earned over $280,000 for single filers and $350,000 for those filing jointly. The 5.4 percent tax would be charged on the first dollar earned over $1 million.

Republicans mostly dismiss the bill as government-run health care. They say it will lead to higher costs overall.

Heller is among those Republicans who argue that 114 million Americans will lose their existing coverage through their employers if the reform legislation is approved. The figure comes from a widely circulated report by the Lewin Group, a consulting firm owned by a health insurance company.

Heller, who also sits on the Ways and Means Committee, offered an amendment that would require citizenship verification before individuals or families could receive the subsidy to buy insurance.

Democrats say illegal immigrants are explicitly banned from coverage in the bill, much the way they are prohibited from accessing Medicare and Medicaid. But Republicans argue that immigrants can use fake documents to access the system.

But mostly, the hang-up on advancing the health care bill — even among Democrats who support the overall goal — is the new tax.

Titus voted against the bill in the House Education and Labor Committee because she opposes the tax on high-income households. She said many families making more than $350,000 in her Southern Nevada district are small-business owners — including those who run the mini-mall shops and restaurants that make up a large part of the suburban economy.

“This was a difficult vote,” Titus said in remarks submitted to the committee.

She had campaigned in part on health care reform. She held a telephone town hall in her district, hosted several round-table meetings and received 1,000 mail-back postcards from constituents whose views she sought on the issue.

Titus’ committee pulled an all-nighter to pass the bill — working until 6 a.m.. The committee approved an amendment Titus offered to increase the size of small businesses that could buy insurance on the exchange — enabling more small-business employees to participate.

But she voted against the bill. She said she thinks the taxes on high-wage earners would snare too many constituents, many of whom are struggling with underwater mortgages in the Las Vegas area’s disastrous market.

“Increasing taxes that can affect small businesses in my district will make it harder for them to be the engines of growth that pull us out of this recession and put people back to work,” Titus said.

Berkley said she, too, had reservations about the tax. But she voted for the bill in committee because she thought it was the “least intrusive way” to provide the revenue needed.

“We are talking about a surtax that only applies to 1.4 percent of Nevada taxpayers — and I’m in that income bracket,” Berkley said.

Both Berkley and Titus strongly opposed earlier suggestions to raise the money by taxing workers for the employer-backed benefits they receive. Workers now enjoy those benefits tax-free.

Facing pushback on the tax-plan from her rank and file, House Speaker Nancy Pelosi has floated a proposal to tax only those with incomes in excess of $1 million — the millionaires’ tax.

Titus said she would be more willing to support a millionaires’ tax, because fewer of her constituents earn incomes that high.

But if the tax remains at the current level of $280,000 for individuals and $350,000 for joint filers, Titus would have a difficult time supporting the final bill and may have to vote against it on the floor.

“She doesn’t like it,” Titus spokesman Andrew Stoddard said. “It’s not something she intends to or would support if it comes to the floor in the same manner it came to committee.”

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