Webb, Warner quiet on health care bill, for now

As the U.S. Senate completes its first week of debate on a massive health care overhaul bill, Virginia's two senators have been silent.

Sens. Mark Warner and Jim Webb, both Democrats, have said they want comprehensive health care reform that would cut costs and ensure quality care for more people. But they have yet to say what changes are needed in the 2,000-plus-page bill, called the Patient Protection and Affordable Care Act, to win their support.

In rejecting requests for interviews with Webb and Warner this week, their spokespersons said the senators aren't ready to join in the floor debate just yet.

But that could change soon.

Warner has been working with 11 other freshman senators on a package of amendments that might be introduced next week. The proposals include improved collection of information about health care treatments, outcomes and pricing so that they can be studied and compared, said Kevin Hall, Warner's communications director.

The goal would be a transparent system in which costs, treatments and outcomes for patients could be compared across the nation in real time, he said.

It would be a step toward "a health care system that is based more on outcomes than on fees for service," Hall said.

The Senate bill, HR3590, already has provisions that call for supporting research into the outcome of medical treatments, but the 12 senators' proposal would push that goal harder, including a provision to empower the secretary of Health and Human Services to take action, Hall said.

"You can't do it overnight," he said. "The amendments get us focused more quickly on the efforts to change the current model where the health providers are paid by volume rather than outcome."

Meanwhile, Webb is considering proposing amendments that would shift more of the cost of health care from consumers to highly profitable health care insurers, said Jessica Smith, the senator's communications director.

The details are still being discussed, Smith said. "There's so much that goes into this. It's fiscally a very populist view."

Both lawmakers voted Nov. 21 with their fellow Democrats to bring the bill to the floor for debate and an eventual vote, but neither endorsed it as a final product. Senate Majority Leader Harry Reid, D-Nev., who crafted the legislation by merging two other Senate bills, has said the debate will take weeks, including weekends.

The bill, which is similar to a health care measure passed by the House last month, would require most Americans to have health insurance and require all but smaller employers to offer coverage.

Low- and some middle-income Americans would be eligible for federal assistance to pay for all or part of their health insurance. The legislation would establish state-level insurance exchanges or marketplaces where consumers without insurance could choose from an array of plans.

Among those choices would be a government or public insurance plan. However, each state could choose not to offer the public option if it provides health insurance as complete as what the legislation requires.

As in the House-approved bill, the Senate proposal would prohibit insurance companies from denying coverage because of a pre-existing condition or dropping a customer who becomes ill.

The Senate plan would cost about $984 billion over 10 years and would be financed with a new tax on high-cost insurance policies and new fees on certain industries, and through cost savings in Medicare and Medicaid. It would reduce the federal deficit by $130 billion over 10 years, according to the Congressional Budget Office.

Webb and Warner favor requiring most Americans to have health insurance by mandating it for those who can afford it and providing it for those who cannot.

They also aren't opposed to requiring larger businesses to offer health care coverage. But they are concerned about the possible economic hardships on smaller businesses, Hall and Smith said.

Under the Senate bill, businesses with more than 50 employees would be required to offer health insurance or pay a $750 penalty for each worker who gets a tax credit for using a health insurance exchange. Smaller employers would not have to pay the penalty.

In the past, Warner has said he doesn't like the public insurance option and would favor a private, nonprofit cooperative.

Webb has said he supports a government insurance plan as a way to provide competition and lower health care costs. Smith said the senator isn't necessarily wedded to the government plan if another acceptable method for lowering costs can be found.

The two legislators are reluctant to take rigid positions on specific aspects of the bill because the legislation is likely to change as it is debated, their spokespersons said.

"I can't point to three items in the bill that are deal-breakers," Hall said. "There are trade-offs."

Both senators say that their final votes on the bill, which the Democratic leadership will need to pass the legislation, will be driven by basic principles.

"As Sen. Webb has said all along," Smith said, "the bottom line is to achieve a more cost-effective health care system that increases accessibility, affordability and quality of care."

Warner has said controlling the fast-rising cost of medical care is critical to reviving the national economy.

"I will only support a final bill," he said last month, "if I am convinced it will lower the deficit, drive down health care costs over the long term, and improve the value and quality of the health care Virginians receive."

Bill Bartel, (757) 446-2398, bill.bartel@pilotonline.com