The Senate Finance Committee voted this afternoon 14-9 to pass the America’s Healthy Future Act of 2009 out of Committee. Republican Olympia Snowe was the only Committee member to break party lines and vote for the bill. Majority leader Harry Reid is expected to begin full Senate debate on a version of the bill which reconciles the Finance and HELP bills in the last week of October. Meanwhile, House Democratic leaders are still working on details of their health overhaul legislation, which will also likely go to the floor for debate in late October.

CRFB has two charts outlining costs and spending in the Senate Finance Committee bill. One chart compares it with the first version of the bill, before it was amended in Committee. The other chart compares it with the House Tri-Committee bill, the Senate HELP bill, and the President’s Reserve Fund. Through the US Budget Watch project, we've also written a comprehensive guide of all three proposals, although it is based on an older version of the Finance bill.

The Committee for a Responsible Federal Budget put out a release today commenting on the passage of the legislation. In response to the vote by the Finance Committee, CRFB president Maya MacGuineas said:

“We’re glad the Finance Committee is taking their fiscal obligations seriously. In the face of trillion dollar deficits and with Medicare headed off a cliff, we need to reduce – not increase – our budgetary obligations. This bill is a minimum standard for what health reform must do…We do have a number of serious concerns about this bill. For one, we do not think it is appropriate to rely on timing gimmicks to meet certain fiscal goals, as this bill does. Additionally, we worry that failing to update Medicare physician payments beyond 2010 will leave over $200 billion of updates for future Congresses to deficit-finance. And finally, the bill needs to do a lot more to rein in Medicare’s and Medicaid’s unsustainable long-term costs.”

While CRFB appreciates that the America’s Healthy Future Act takes a stab at fiscal responsibility, there are a number of provisions the Committee could have included in the bill which would have helped to slow long-term health care costs. In the release we recommended the following measures which could both help pay for physician payment updates and slow long-term costs:

• Replacing the excise tax with a cap on employer-sponsored insurance tax exclusion at the 75th percentile of premium costs - $160 billion
• Increasing cost-consciousness in Medicare through a unified deductible, uniform coinsurance, and catastrophic limit - $26 billion 
• Restricting Medigap coverage of Medicare’s cost-sharing - $41 billion 
• Reducing Medicare payment rates in high-spending areas - $51 billion 
• Enacting medical malpractice liability reform - $54 billion
  

There are other efforts, many of them outlined in an Engelberg Center for Health Care Reform at the Brookings Institution paper seen here, which if taken together could work to extensively slow long term health care spending growth. These include: 

• Greater efforts to effectively invest in health information technology by creating interoperatibiliy and provider communications standards and defining meaningful use health IT bonuses
• Establishing a regulatory pathway for follow-on biologics
• Strengthening the Medicare Commission so it has power over Medicaid and health care tax policies
• Reforming Medicare benefit design by restructuring Medicare parts A and B with a catastrophic out-of-pocket maximum, and a global deductible
• Promoting prevention and wellness through targeting obesity reduction through price incentives such as taxing sugar-sweetened beverages
• Promoting prevention and wellness by enforcing outcome-based accountability through bonuses and penalties in Medicare and Medicaid payment rates