After seven days of debate and a final marathon session that saw votes on dozens of amendments, on October 2 the Senate Finance Committee, chaired by Max Baucus (D-MT), finalized a health reform bill that would establish health coverage for 94 percent of the American population.

The public insurance option was hotly debated, and its exclusion was a major blow for direct-care workers and others who struggle to afford insurance premiums. The debate’s final hours focused largely on making health reform affordable for the middle class.

Some of the most significant provisions included in the bill would:

• Establish an individual mandate for obtaining health insurance, but no employer mandate. Families that cannot find insurance coverage for less than 8 percent of their income would be exempted.
• Create an insurance exchange, where individuals and some small employers could compare plans and prices when buying insurance.
• Cut hundreds of billions of dollars from Medicare’s projected growth.
• Require the federal government to cover 90 percent of Medicaid expansion, and require states to maintain current coverage levels for children under Medicaid and CHIP.
• Increase federal matching funds for home and community-based services and create additional training for Alzheimer’s care.
• Fund two competitive demonstration grant programs (at a cost of $425 million over five years). One program will provide eligible low-income people with financial and supportive assistance when receiving education and training for health care jobs affected by labor shortages. The other will work to develop a set of core training competencies and certification programs for personal and home care aides.

The Congressional Budget Office (CBO) announced on October 8 that the bill’s price tag would come in at $829 billion over next 10 years — well under the proposed amount. This amount came with several caveats, however. For example, the final sum omitted proposed payment increases for Medicare physicians (“Health care bill would cost $829B, help cover 94 pct,” AP, Oct. 8).

The CBO’s announcement sets the stage for the Finance Committee’s final vote. Senate Majority Leader Harry Reid (D-NV) will then combine the bills from the Senate’s Finance Committee and HELP Committee into a single piece of legislation that will be able to secure 60 votes when it goes to the Senate floor.

Several key centrist Democrats are reportedly still holding out for what they regard as a stronger bill, including Sen. Ron Wyden (OR) and Sen. John D. Rockefeller IV (WV).

Reid announced that the Senate vote would take place on October 13.