A look at concessions lawmakers and interest groups won in the Senate’s health care bill

Concessions lawmakers won in the health bill

Here’s a look at some of the concessions lawmakers and interest groups won in the latest version of the Senate’s health care overhaul bill:

LAWMAKERS:

SEN. BEN NELSON, D-NEB., who provided the critical 60th vote that Senate Majority Leader Harry Reid needed, received numerous benefits for Nebraska, along with tighter curbs on abortion. Among the Nebraska-specific provisions:

—The federal government will pick up 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; the exemption could also apply to nonprofit insurers in other states, possibly including Blue Cross Blue Shield of Michigan.

—Supplemental “Medigap” policies such as those sold by Mutual of Omaha are exempted from the annual fee on insurers, something that would help other companies selling such policies.

—A physician-owned hospital being built in Bellevue, Neb., could get referrals from doctors who own it, avoiding a new ban in the Senate bill that will apply to hospitals built in the future. Without mentioning Nebraska or other states by name, the Senate bill pushes back some legal deadlines by several months, in effect making a few hospitals near completion eligible to continue receiving referrals from the doctors who own them.

SEN. MAX BAUCUS, D-MONT., chairman of the Finance Committee and a key architect of the legislation, 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. Under Baucus’ provision, which never mentions Libby by name, sickened residents could sign up for Medicare benefits.

SEN. CHRISTOPHER DODD, D-CONN., who is facing a difficult re-election next year, added an item making $100 million available for construction of a hospital at a public university. The measure leaves it up to the Health and Human Services Department to decide where to spend the money. Dodd says more than a dozen sites could be eligible, but he hopes the University of Connecticut will be the beneficiary.

SEN. PATRICK LEAHY, D-VT., negotiated $600 million in additional Medicaid benefits for his state over 10 years. He said Vermont is due the additional benefits because the state already has acted to expand Medicaid eligibility to the levels now contemplated by the federal government. Vermont would be unfairly penalized if other states are now being helped with that expansion, he said. Massachusetts is getting $500 million in Medicaid help for similar reasons.

SEN. MARY LANDRIEU, D-LA., a key moderate, withheld her support from the legislation until she was able to procure Medicaid help worth at least $100 million in 2011 from the federal government.

SEN. BERNIE SANDERS, I-VT., who was angered after a new government-run health plan was dropped from the legislation to win over moderates like Nelson and Landrieu, held out on backing the bill until Reid, D-Nev., agreed to a $10 billion increase in support for community health centers.

SEN. BILL NELSON, D-FLA., pushed a provision he said will let about 800,000 Florida seniors enrolled in private Medicare Advantage plans keep their extra benefits. It also helps seniors in a handful of other states. Elsewhere, Medicare Advantage patients risk losing benefits because the private plans are a major target of planned cuts to Medicare.

STATES:

—Doctors and hospitals in Montana, North Dakota, South Dakota, Utah and Wyoming will get paid more than providers in other states under formulas in the bill designed to help the so-called Frontier States.

INTEREST GROUPS:

—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. Electrical linemen were already shielded, along with policemen, firefighters, emergency first responders and workers in construction, mining, forestry, fishing and certain agriculture jobs. Sen. Jeff Merkley, D-Ore., took the lead in pushing for the longshoremen carve-out.

—Merkley also pushed for language that will exclude all but the very smallest construction industry companies from the bill’s small business exemption. In general, the exemption says that companies with fewer than 50 workers aren’t subject to penalties if they don’t ensure their employees. In the construction business, under Merkley’s change, only firms with fewer than five workers and a payroll under $250,000 would be exempt. Merkley’s spokeswoman said the change was needed to ensure that construction contractors, which are overwhelmingly small businesses, provide insurance for their workers.

—Gun rights lobbyists pushed for language to ban collection of data on gun ownership in the bill.

—The American Medical Association announced its coveted endorsement Monday after Reid made a series of change to please doctors, including 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 (the bonuses remain); and dropping a proposed $300 fee (to be used to fight fraud) on physicians who participate in Medicare.

—Makers of brand-name biotech drugs — expensive pharmaceuticals made from living cells — 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.