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zoom RSS 上院財務委員会で医療制度改革法案が可決/米国医療事情 オバマ政権

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 上院財務委員会で数百万人に対して補助金により保険購入する医療制度改革法案が、メーン州共和党のOlympia J.Snowe上院議員の支持と民主党13人全員により可決された。他の共和党議員は反対したため、14:9の票結果だった。
 スノウ議員は、自らの理想には遠い法案であると認めたが、行動に移さないでいるより自らの時代の喫緊の課題への解決能力を示すあらゆる機会を利用するという議会の使命を感じていると述べた。今日の投票は今日の自分であり、明日はどういう投票行動をとるかはわからない。
 オバマ大統領はすぐさま、彼女の決定について賞賛した。
 上院財務委員会ではバウカス委員長の下、白熱した議論が交わされた。共和党は、医療への政府統制へと進むことの危険を指摘している。
 議会で制度改革の議論がはじまりすでに数十年が経過している。法案は全ての未婚の米国人に影響があり、年間2兆5,000億ドル、米国経済の1/6を占める医療産業の変革となる。委員会は13:10で民主党優位なために結果は不明というわけではなかった。
 リード上院院内総務が今月に法案を採択することを発表し、バウカス議員と、保健委員会での法案通過時の委員長ドッド議員にたいして、法案の取りまとめをホワイトハウスとも協議する予定とした。スノウ議員にも今後の議論に加わってもらうつもりだという。
 連邦-州共同運営のメディケイドの貧困層への拡張と、連邦貧困レベルの200%未満(4人家族では年収44,100ドル)の人に対して州が運営する保険プログラムの新設により、未保険者への医療給付を提供する。中所得層へは、政府により調節された市場から保険を購入するための補助金を提供する。保険業者に対しては、持病による保険加入拒否の禁止など、厳密な新たな規則を課す。
 議会予算局の分析では、財務委員会法案により10年間で2900万人の無保険者を減らすだろうという。
(書きかけ)
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Senate Panel Clears Health Bill With One G.O.P. Vote
Stephen Crowley/The New York Times
By DAVID M. HERSZENHORN and ROBERT PEAR
Published: October 13, 2009
http://www.nytimes.com/2009/10/14/health/policy/14health.html
画像

Senator Max Baucus at the Senate Finance Committee hearing with Senator Olympia J. Snowe, who provided the lone Republican vote in favor of the health care bill.

WASHINGTON ― The Senate Finance Committee voted on Tuesday to approve legislation that would reshape the American health care system and provide subsidies to help millions of people buy insurance, as Senator Olympia J. Snowe, Republican of Maine, joined all 13 Democrats on the panel in support of the landmark bill.

The vote was 14 to 9, with all of the other Republicans opposed.

Democrats, including President Obama, had courted Ms. Snowe’s vote, hoping that she would break with the Republican Party leadership and provide at least a veneer of bipartisanship to the bill, which Mr. Obama has declared his top domestic priority. Ms. Snowe was a main author of the bill but she had never committed to voting for it.

But shortly after 1 p.m., she announced that she was on board, in a speech that silenced the packed committee room and riveted colleagues on both sides of the dais.

“Is this bill all that I would want?” Ms. Snowe asked. “Far from it. Is it all that it can be? No. But when history calls, history calls. And I happen to think that the consequences of inaction dictate the urgency of Congress to take every opportunity to demonstrate its capacity to solve the monumental issues of our time.”

In her speech, she said she still shared many of her Republican colleagues’ reservations about the legislation, and she pointedly warned Democrats that they could easily lose her support at any of the many legislative steps that still lie ahead.

“My vote today is my vote today,” she said. “It doesn’t forecast what my vote will be tomorrow.”

President Obama was quick to praise Ms. Snowe for her decision to support the measure. “I think not only Chairman Baucus and others,” he said, “but in particular Senator Snowe has been extraordinarily diligent in working together so that we can reduce cost of health care, make sure that people who don’t have it are covered, make sure that people who do have insurance have more security and stability, and that over the long run we’re saving families, businesses, and our government money.”

Before and after Ms. Snowe’s speech, senators on the panel engaged in heated debate, with Democrats asserting that the bill would set the nation on more sound fiscal footing, and Republicans countering that it would dangerously expand the federal government.

“All Americans should have access to affordable quality health care coverage,” the Finance Committee chairman, Senator Max Baucus, Democrat of Montana, said in opening remarks. “Now is the time to get this done.”

The committee’s top Republican, Senator Charles E. Grassley of Iowa, said that he would oppose the legislation. “This bill is already moving on a slippery slope toward more government control of health care,” he said.

The Finance Committee’s deliberations offered a small preview of what is certain to be a rollicking, impassioned and highly politicized debate on the far grander stage of the Senate floor, where Democrats hold a 60-to-40 majority.

It has been many decades since such far-reaching legislation got this far in Congress. The health care bill would affect every single American and would reshape the $2.5 trillion-a-year health care industry, representing one-sixth of the nation’s economy.

Because Democrats hold a 13-to-10 majority on the committee, the outcome of the vote was never in doubt. The majority leader, Harry Reid of Nevada, had already announced that the full Senate would take up the health care legislation later this month.

On Wednesday, Mr. Reid plans to meet with Senator Baucus, Senator Christopher J. Dodd, the Connecticut Democrat who was acting chairman of the health committee when it passed its version of the bill and representatives from the White House to begin to meld the Finance Committee bill with the alternate version approved in July.

A spokesman for Mr. Reid, said that Ms. Snowe would also be invited to future sessions, adding that the Democratic leader “is prepared to do what he can to keep her on board while putting together a bill that can get the 60 votes necessary to overcome a Republican filibuster.”

With its vote a little before 3 p.m., the Finance Committee became the fifth Congressional panel to report out a sweeping health care bill. In the House, the speaker, Nancy Pelosi, is working to combine three measures into one. The bill endorsed on Tuesday seeks to provide health benefits to a majority of uninsured by expanding Medicaid, the federal-state insurance program for the poor, and creating new state-run insurance options for individuals and families earning less than 200 percent of the federal poverty level or $44,100 for a family of four.

For many other moderate-income Americans, the bill would provide government subsidies to help them buy insurance through new government-regulated marketplaces.

The legislation also seeks to impose strict new regulations on the insurance industry, including banning insurers from denying coverage based on pre-existing conditions, and it would require nearly all Americans to obtain coverage.

According to an analysis by the nonpartisan Congressional Budget Office, the Finance Committee bill over 10 years would reduce the number of uninsured Americans by 29 million.

It would still leave 25 million people uninsured, about one-third of them illegal immigrants.

The bill is projected to cost $829 billion over the 10 years, which would be fully offset by new tax and fees, including a tax on high-cost insurance policies, as well as by savings from slowing the growth in Medicare spending by the government.

Democrats and Republicans argued loudly over the fiscal implications of the bill, which the budget office has predicted will reduce federal deficits by $81 billion over 10 years.

Republicans said the bill would cost more than anyone expects, and eventually drive the nation further into debt.

WASHINGTON ― After months of relentless courting and suspense, Senator Olympia J. Snowe, Republican of Maine, cast her vote with Democrats on Tuesday as the Senate Finance Committee approved legislation to remake the health care system and provide coverage to millions of the uninsured.

With Ms. Snowe’s support, the committee backed the $829 billion measure on a vote of 14 to 9, with all the other Republicans opposed.

“Is this bill all that I would want?” Ms. Snowe said. “Far from it. Is it all that it can be? No. But when history calls, history calls. And I happen to think that the consequences of inaction dictate the urgency of Congress to take every opportunity to demonstrate its capacity to solve the monumental issues of our time.”

Ms. Snowe’s remarks silenced the packed committee room, riveted colleagues and thrilled the White House. President Obama had sought her vote, hoping that she would break with Republican leaders and provide at least a veneer of bipartisanship to the bill, which he has declared his top domestic priority.

Mr. Obama, speaking in the Rose Garden, described the committee’s action as “a critical milestone” and declared, “We are now closer than ever before to passing health reform.” But he added: “Now is not the time to pat ourselves on the back. Now is not the time to offer ourselves congratulations. Now is the time to dig in and work even harder to get this done.”

With its vote Tuesday, the Finance Committee became the fifth ― and final ― Congressional panel to approve a sweeping health care bill. The action will now move to the floors of the House and the Senate, where the health care measures still face significant hurdles.

Aside from Ms. Snowe, no Republicans in Congress have publicly endorsed the bills in their current form. And Republican leaders are strongly opposed, saying the bills cost too much, raise taxes, cut Medicare and dangerously expand federal power.

Pressure from lobbyists is sure to grow in the coming weeks. And many more lawmakers will get involved in what promise to be impassioned and highly politicized debates in the Senate and the House.

After the Finance Committee vote, the chief architect of the bill, Senator Max Baucus, Democrat of Montana and chairman of the committee, declared: “It’s clear that health care reform will pass this year. Our action today provides terrific momentum.”

Senator Charles E. Grassley of Iowa, the senior Republican on the Finance Committee, said the bill put the nation on “a slippery slope toward more and more government control of health care.”

Ms. Snowe helped write the Finance Committee bill, in months of bipartisan negotiations, but had not committed to vote for it. She said Tuesday that she shared many of her Republican colleagues’ reservations about the legislation, and pointedly warned Democrats that they could lose her support later in the legislative process.

“My vote today is my vote today,” she said. “It doesn’t forecast what my vote will be tomorrow.” And she observed, “There are many, many miles to go in this legislative journey.”

Ms. Snowe gave no clue how she would vote in the first few hours of committee deliberations Tuesday and she did not alert the White House to her plans.

While colleagues spoke, she kept her head buried in papers, fidgeted and spoke occasionally with aides. When Mr. Baucus stepped over to speak to her, a small army of photographers snapped pictures, with cameras clicking like a chorus of chirping crickets.

The Congressional Budget Office said the bill would cost $829 billion over 10 years. The costs include $345 billion for the expansion of Medicaid and $461 billion for subsidies to help lower-income people buy insurance.

The budget office said the costs would be completely offset by new fees and taxes and by cutbacks in Medicare, so federal budget deficits in the next 10 years would be $81 billion lower than now projected.

But Douglas W. Elmendorf, director of the Congressional Budget Office, said his agency had not estimated the impact of the bill on overall national health spending, public and private, and could not say whether it would “bend the cost curve,” as Mr. Obama and lawmakers want.

Likewise, Mr. Elmendorf said he did not know for sure how the bill would affect premiums.

Several senators said they would fight for changes on the Senate floor.

Liberal Democrats, like Senator John D. Rockefeller IV of West Virginia, said they would push for a public insurance plan. Senators Ron Wyden of Oregon and Robert Menendez of New Jersey, both Democrats, said they would seek changes to make insurance more affordable to middle-income families. And Senator John Kerry of Massachusetts said he wanted to require employers to provide insurance to their employees.

The bill does not include such an employer mandate. But employers with more than 50 workers would have to reimburse the government for some or all of the cost of federal subsidies provided to employees who buy insurance on their own.

Ms. Snowe said she liked the Finance Committee bill because it would prohibit insurance companies from discriminating against people on account of health status or sex and would create a network of insurance exchanges where individuals, families and small businesses could shop for coverage, with subsidies from the federal government.

At the same time, Ms. Snowe said she shared Republican “concerns about vast governmental bureaucracies and governmental intrusions.” That, she said, is why she had opposed amendments to create a government insurance plan and would continue to do so.

Ms. Snowe said she was open to a compromise under which a public plan could be “triggered” in states where people could not otherwise find affordable insurance. She said her “paramount concern” was that insurance might be too expensive for some people, even with government subsidies.

The Congressional Budget Office said the Finance Committee bill would provide coverage to 29 million people, but still leave 25 million uninsured in 2019. Of those left uncovered, about a third would be illegal immigrants.

David Stout contributed reporting.

--------------------------------------------------------
Page last updated at 03:50 GMT, Wednesday, 14 October 2009 04:50 UK
Senate panel passes health bill
http://news.bbc.co.uk/2/hi/americas/8304375.stm

A member of the Health Access protest group holds a placard as part of their campaign against what they say is the poor state of US Healthcare in Los Angeles
Healthcare and reform: Strong opinions in US

A Senate committee has approved a bill to reform US healthcare, a key step in President Barack Obama's attempt to overhaul the system.

Senators voted by 14 votes to nine to pass the bill, with one Republican joining Democrats on the Senate Finance Committee in voting in favour.

Senator Olympia Snowe became the first Republican to back the proposals.

The reforms, intended to cut costs and make insurance more affordable, are Mr Obama's top domestic priority.

The president welcomed the committee's decision, calling it a "critical milestone".

"We are closer than ever before to passing healthcare reform but we are not there yet," he said. "Now is not the time to pat ourselves on the back... It is time to dig in further and get this done."

The president knows the process still has some way to run, says the BBC's Paul Adams in Washington.

But the Senate committee approval was a significant boost for the central plank of his domestic agenda.

'Miles to go'

Obama welcomed the progress made so far on the bill

Announcing her decision to break with her party on Tuesday, Senator Snowe said: "When history calls, history calls."

However, the moderate Republican said it did not necessarily mean she would support later versions of a bill.

"There are many, many miles to go in this legislative journey," she said. "My vote today is my vote today. It doesn't forecast what it will be tomorrow."

The panel's bill, which was drafted after weeks of at times bitterly bipartisan debate, sets out a 10-year $829bn (£525bn) plan to cut health costs and provide affordable health insurance to most Americans.


US HEALTHCARE
No universal coverage
Private health insurance available through employer, government or private schemes
US spends some 16.2% of GDP on healthcare, nearly twice average of other OECD countries
US Census Bureau estimates some 46m people do not have health insurance - includes 9.2 million non-citizens and 18 million people who earn over $50,000 a year
Medicaid: federal-state programme for low income groups
Medicare: for people 65 years old and above and some younger disabled people

Q&A: Healthcare reform
Healthcare around world

Senator Charles Grassley, the senior Republican on the panel, criticised the legislation and predicted that the bill would move "leftward" as it progressed through Congress.

"This bill is already moving on a slippery slope to more government control of healthcare," he said.

The finance committee's bill must now be combined with a bill drafted by the Senate Health Committee before going to the full Senate for a vote.

It is not guaranteed to pass, as it needs all the Democrats, two independents and one Republican to vote in favour.

'Public option'

Mr Obama argues that all Americans are entitled to insurance coverage, that rising costs must be tackled and that private insurers must not be able to deny coverage or end it when someone becomes seriously ill.

ANALYSIS
Paul Adams
Paul Adams, BBC News, Washington
On the long, tortuous road towards reform of America's healthcare system, this was a decisive moment. Several members of the Senate Finance Committee called the vote historic. The Washington Post this morning reported that not since Theodore Roosevelt proposed universal healthcare in 1912 has any such bill come this far. After months of debate, the committee's chairman, Max Baucus, looked delighted and relieved.

In the end, those in favour of the bill won comfortably. This was due in part to a Democratic majority, but also to the support of Senator Olympia Snowe, who became the first Republican to back any of the bills proposed this year.

But this is not the end of the process. There are many more legislative hurdles to overcome before it becomes law. In the meantime, debate will continue to rage.

A long congressional slog still lies ahead, correspondents say, but Mr Obama's push for healthcare reform has gone further than attempts in the 1990s by President Bill Clinton, which never got beyond all the committees.

All the different versions of the bill produced by House of Representatives and Senate committees are broadly similar in the scope of their reforms:

* toughen regulations on health insurers
* mandate all Americans to get insurance
* offer subsidies to the less well-off and set up health insurance exchanges for people without employer-sponsored coverage, to help them choose between different options.

Lawmakers are divided, however, over whether there should be a new government-run insurance scheme - the so-called "public option".

The finance committee's bill is the only one not to include a public option, an element advocated by Mr Obama and some Democrats as the means of creating competition between insurers.

Last week, the nonpartisan Congressional Budget Office concluded that the finance committee's bill would result in reducing the federal deficit by $81bn and mean some 94% of eligible Americans would have insurance coverage.

However, Republicans say the final draft which will be voted on is likely to be very different and more expensive than this version. They say the proposed reforms are too costly and represent too much government intrusion into healthcare.

At the weekend, the private insurance industry issued a study that said the plans could mean policies end up costing people hundreds, if not thousands, more dollars.

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医療制度改革法案が上院通過/米国医療事情・・医師の一分さん
医療制度改革法案が上院通過/米国医療事情 http://kurie.at.webry.info/200912/article_33.html ...続きを見る
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2009/12/27 01:50

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上院財務委員会で医療制度改革法案が可決/米国医療事情 オバマ政権 医師の一分/BIGLOBEウェブリブログ
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