Donna Smith

The Senate's healthcare reform legislation published by Democratic leaders last night included a big surprise for anyone saving up to enhance or undo what God gave them -- a new 5 percent tax on elective cosmetic procedures.

The tax would take effect beginning in January and is being proposed as part of the sweeping healthcare overhaul to partly pay the cost of helping millions of uninsured people obtain medical coverage.

It would raise nearly $6 billion over 10 years, and who knows, perhaps even a few lawmakers might be enhancing the Federal Treasury if the tax ends up in a final bill signed by President Barack Obama.

The tax proposal came as a bit of a surprise to investors, and shares of Allergan, which markets popular wrinkle fighting Botox and Natrelle breast implants, fell in early trading along with the share prices of other makers of products for cosmetic procedures.

It is possible that the proposed new tax will be cut from the bill during the upcoming Senate debate.

And if it survives the Senate, there is still the question of whether House Democrats, led by Speaker Nancy Pelosi, will nip and tuck the proposal right out of the bill.

Do you think elective cosmetic surgery should be taxed?

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Photo credits: Reuters/Jim Young (Senator Reid looks at Senator Max Baucus as he speaks about meeting with president in August), Reuters/Luke MacGregor (woman holds breast implant at plastic surgeons conference)

Sarah Palin says on her Facebook page that the healthcare overhaul passed by the U.S. House of Representatives last week should be "Dead on Arrival" in the U.S. Senate. 

The House-passed bill, which includes a new government health insurance plan, may not be what the Senate passes. But the far-reaching healthcare reform backed by President Barack Obama is far from dead. At least one influential Republican senator believes Congress will enact sweeping legislation.

"I think a bill is going to pass," said New Hampshire Republican Senator Judd Gregg. In an interview with C-Span's "Newsmakers" that will air on Sunday, Gregg said Obama has invested too much political capital in his top domestic priority to allow it to fail. Gregg once considered joining the Obama administration, but now has become a major critic of Obama's proposed healthcare reform and its impact on the country's mounting debt.

"We're on an unsustainable path, it is that simple," Gregg said.

Gregg said he does not see Democrats scaling back the legislation in the face of eye-popping, record deficits.  On the contrary, with Senate Majority Leader Harry Reid struggling to muster the 60 votes needed to pass the bill in the 100-member Senate, Gregg sees "more baggage" being added to it in an effort to win votes.

The bill that initially passes the Senate is not likely to include a new government-run health insurance program, Gregg said. But he said the legislation will likely "move to the left" once Senate and the House negotiators meet to work out their differences and develop a single bill. He said he expects the final bill to include some version of a new public insurance option.

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Photo credit: Reuters/Kevin Lamarque (Senator Judd Gregg in his office)

Former President Bill Clinton is clearly hoping that Congress succeeds this time around where his administration failed 15 years ago.

And perfection is not required -- just get healthcare reform done. That was Clinton's message to Senate Democrats who are now behind the steering wheel in trying to move legislation forward.

Clinton's own effort to overhaul the healthcare system in 1994 fizzled long before reaching this far -- the House of Representatives approved its version of a bill last weekend.

Clinton told Democratic senators at their weekly lunch that healthcare reform was an economic imperative and they should not let this latest opportunity slip away.

"It is not important to be perfect here, it is important to get it passed," Clinton told reporters after the meeting.  "The worst thing to do is nothing -- that was my message today."

President Barack Obama wants healthcare legislation passed by the end of this year. Senate Majority Leader Harry Reid is hoping the Senate can do that, but time is running short as he awaits an official cost estimate from the Congressional Budget Office.

Reid faces a tough task of stitching together one bill from separate bills passed by two Senate committees that will garner the 60 votes needed to move it in the 100-member chamber.

Senators said the pep talk by Clinton helped.

"People trust him," said Senate Finance Committee Chairman Max Baucus, who is playing a major role in writing the Senate bill. "He has excellent political and policy judgments and he believes it is far better to pass healthcare legislation than not."

"He's the former president of the United States he's got a lot of sway, he's a big man." Baucus said.

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Photo credit: Reuters/Las Vegas Sun/Steve Marcus (Former President Clinton and Senate Majority Leader Harry Reid in August 2009)

Like it or not, the healthcare debate has turned into a fracas over abortion rights.

U.S. House Democratic leaders had hoped to avoid just that in their push to expand healthcare coverage and reform the health insurance market.

But getting the votes to pass the historic legislation on Saturday boiled down to settling a dispute between pro-choice and pro-life forces over abortion.

Abortion foes won. The House passed an amendment restricting the availability of insurance policies that include elective abortion services even though many medical plans currently offer such coverage.

The debate over abortion highlights broader questions surrounding the government's reach in healthcare.  Once the government starts subsidizing insurance premiums, it will dictate what can and cannot be included in that coverage.

Democrat Congressman Louis Capps underscored that in arguing the amendment "will mean more women will have their reproductive health choices made by politicians and anti-choice zealots in Washington, DC, instead of by themselves and their doctors."

With abortion-rights supporters vowing to strip the amendment out of the bill as it moves through the legislative process, the debate now shifts over to the Senate.

Senate Democratic leaders are struggling to build enough support for the healthcare overhaul to overcome procedural hurdles that stand in the way of major legislation.

The biggest point of contention has been whether the government should offer a new health plan option.  But the abortion debate will likely prove impossible to avoid.

Jim Manley, spokesman for Senate Majority Leader Harry Reid, acknowledged the issue will come up when the Senate takes up healthcare reform possibly as early as next week.

"It is an issue that we are going to have to deal with over here," he said. "Senator Reid will need to talk to his caucus about how to proceed."

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Photo credit: Reuters/Yuri Gripas ( U.S. House Speaker Nancy Pelosi following House vote on healthcare reform legislation)

The Congressional Budget Office, Congress' non-partisan score keeper on the cost of legislation, has some good news for Republicans and the alternative healthcare proposal they plan to offer in the House of Representatives. Their plan would save the federal budget deficit $68 billion over 10 years and on average reduce insurance premiums compared to what they would be under current law.

"Under Republican health care reforms, premiums will go down, making coverage more affordable for families and employers, which is the first step to reducing the number of uninsured Americans," said Republican Representative Dave Camp.

The proposal is far more limited in scope than the sweeping healthcare overhaul written by Democrats that the House is expected to debate on Saturday. The Republican proposal would provide for the sale of insurance coverage across state lines and calls for medical malpractice lawsuit reforms.

The proposal would also provide incentives to states to encourage them to review their insurance rules and mandates to find ways to reduce costs and expand medical coverage.

Now the bad news. The proposal would reduce the rolls of the uninsured by about 3 million in 2019, leaving about 52 million people without medical coverage, the CBO said. Also, the CBO said that premiums for some people, mostly the less healthy, would go up, feeding into Democratic criticisms that the Republican plan would allow insurers to "cherry pick" and enroll healthier, less costly people.

"The Republican approach is certainly not healthcare reform," said House Democratic Leader Steny Hoyer. "It's a large amount of talk, with very little walk."

CBO stressed that its estimates were preliminary.

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Photo credit: Reuters/Joshua Roberts ( U.S. Capitol police watch protesters opposed to Democratic healthcare refrom

Republican victories in the Virginia and New Jersey governors' races may send shivers through Democratic circles, but what does it mean for President Barack Obama's ambitious proposal to overhaul the $2.5 trillion healthcare system?

Not much, say Democrats. They are looking beyond the state issues that dominated the governor's races and instead are focusing on two congressional races won by Democrats where national issues like healthcare reform were in play. 

"From my perspective we won last night," House Speaker Nancy Pelosi told reporters when asked about Tuesday's elections. "This was a victory for healthcare reform. From my standpoint we picked up votes last night -- one in California and one in New York."

The two victories--one in New York district 23 where Bill Owens became the first Democrat to win the seat in over a century and in California district 10 where John Garamendi kept the seat vacated by Ellen Tauscher in Democratic hands -- brings the number of Democrats in the House to 258.

 That gives Pelosi a little more breathing room as she tries to muster the votes needed to pass the sweeping health reform legislation.  She could lose as many as 40 Democrats when the House votes, possibly later this week, and still pass the measure.

The two new members are expected to be sworn into office on Thursday.

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Photo credit: Reuters/Joshua Roberts (House Speaker Nancy Pelosi unveils Democratic healthcare legislation)

Democrats, who have been on the defensive in a partisan battle over their sweeping healthcare overhaul, are firing back now that Republicans are preparing an alternative in the U.S. House of Representatives.

House Majority Leader Steny Hoyer told reporters that Republicans will get a vote on their proposal when the House considers the Democratic-written legislation possibly later this week.

Hoyer, a Democrat, did not shy away from offering his own opinion about the Republican bill, saying it would allow insurance companies to sell policies across state lines and would "gut consumer protections and encourage a race to the bottom."

Republicans argue the provision would inject more competition into the market and help lower premiums. But Hoyer said insurers would flock to states with the fewest consumer protections, sell their policies at low prices and that many consumers would discover in the middle of a health crisis that their policies don't offer adequate protection.

Other provisions in the bill, as outlined by House Republican Leader John Boehner, would encourage insurers to "cherry pick" and enroll the healthiest people, Hoyer said.

The Republican proposal also leaves out major market reforms contained in the Democratic bill that would bar insurers from denying coverage to people with pre-existing conditions or charging more based on medical history.

A summary of the House Republican proposal is to be made available here.

Boehner argued that the Republican plan aims to rein in soaring insurance premiums, but Hoyer and other Democrats say it would do little to expand coverage or make healthcare more affordable.

"It doesn't provide for insurance availability for all Americans," Hoyer said. "It does little to expand access to coverage or address the $1,000 to $1,100 extra that every American is paying for people who do not have coverage and therefore add to the uncompensated care in hospitals."

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Photo credit:  Reuters/Joshua Roberts (House Majority Leader Steny Hoyer is greeted by Speaker Nancy Pelosi at healthcare event)

Republicans in the U.S. House of Representatives are gearing up for an epic battle against the sweeping healthcare reform that Democratic leaders hope to bring to the House floor for debate later this week.

"Our goal is to make this as difficult as possible to vote for it," said House Republican Leader John Boehner. "We think this bill is the wrong prescription for what ails our healthcare system in America."

Representative Mike Pence, who heads the House Republican Conference, said the campaign against the bill unveiled last week by House Speaker Nancy Pelosi began over the weekend with Republican members delivering copies of the huge 1,990-page bill to public libraries. Also, Republican women are speaking against the bill this week on the House floor.

"It is a fact that 85 percent of healthcare decisions in this country are made by American women," Pence said.

On Thursday, House Republicans plan a special Internet town hall meeting. Pence said the discussion with participants will last at least 12 hours.

"Our members are going to stand on principle against Speaker Pelosi's trillion dollar government takeover of our healthcare system," Boehner said.

Republicans plan to offer a far less sweeping alternative to the Democratic bill. Boehner said it will focus on reducing the cost of health insurance.

The proposal will allow individuals and businesses to purchase insurance across state lines and to form pools to buy insurance. It will also seek to limit malpractice lawsuits, which Republicans say lead to higher healthcare costs.

The Republican bill will also encourage states to look over their own insurance laws and mandates to find ways to lower costs.

"Many states don't realize that mandates in their own laws actually drive up the cost of health insurance," Boehner said.

The Republican bill will not include the sweeping insurance market reforms contained in the Democratic bill, which would bar insurers from excluding people from coverage or charging more because of medical history.

Instead, the Republican bill would provide some federal money to help states create high risk insurance pools where those people could obtain coverage, Boehner said.

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Photo credit: Reuters/Jonathan Ernst (House Republican Leader John Boehner plays golf with Tiger Woods.)

It's really big.

How big is it?

So big that Republican Congressman David Camp was going to take it with him to read on a flight to his Michigan home but it wouldn't fit in the overhead compartment, an aide quipped.

What is it? The healthcare reform legislation made public on Thursday by Democratic leaders in the U.S. House of Representatives.

The 1,990-page document comes in at more pages than an English translation of Leo Tolstoy's "War and Peace" which is just shy of 1,500 pages.

The health legislation may or may not be more interesting than the epic story about 19th century Russian society, but it is the center of attention on Capitol Hill at the moment.

Republican Senator Lamar Alexander says he will read it and recommends that everyone else does too. The legislative text of the "Affordable Health Care for America Act" is available on the House Rules Committee website.

"I have an important announcement to make on a subject which I believe will be of interest to the American people: the era of the 1,000-page bill is over," Alexander said. "We have 2,000-page bill."

Democrats argue that the weighty legislation will help millions of uninsured Americans, reduce costs and end insurance industry practices that result in loss of coverage and discriminate against people because of medical history, sex and profession.

Republicans argue that a more modest, step-by-step approach to changing the healthcare system is needed and that the cost of the proposed Democratic bill is high.

"A 2,000-page healthcare bill that costs a trillion dollars means that every page costs the American people a half-billion dollars," says Don Steward, spokesman for Senate Republican Leader Mitch McConnell.

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Photo credit: Reuters/Joshua Roberts (House Speaker Nancy Pelosi unveils House Democrats' healthcare bill)

All the government subsidies in the world will not be enough to make health insurance premiums affordable for Americans without more cost control and competition in the proposed sweeping reform backed by President Barack Obama, one Senator says.

No that's not a Republican talking, it's a Democrat.

As congressional Democrats work to narrow their differences over healthcare reform some are worried that people will be unable to afford the premiums on the medical coverage they will be required to buy.

Legislation being considered in the Senate and House of Representatives include substantial subsidies, but will that be enough to make insurance affordable? Democratic Senator Ron Wyden does not think so.

"My own theory is there will not be enough subsidy money on the planet to get the kind of affordability if that is the only approach you use," Wyden said.

"The approach that is going to get more cost containment more quickly for more people is competition and choice," he said.

Democrats are focusing on creating a new government health plan to compete with private insurers as one way to provide more competition. Republicans are opposed to what the Democrats are proposing.

Democratic Senator Thomas Carper said lawmakers are discussing ways to give states "plenty of options" to provide "competition and choice that works to the advantage of consumers, not insurance companies."

Beyond a government run insurance plan and nonprofit cooperatives, some ideas being considered include states standing up their own public plans, and allowing states to create compacts to allow plans to be sold across state lines.

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Photo credit: Reuters/Natalie Behring (Protesters at an HMO in New York in October)