Health care reform, LGBT provisions in question

U.S. Rep. Tammy Baldwin (D-Wis.) (DC Agenda photo by Michael Key)

Complications on Capitol Hill over health care reform are raising questions about whether the final measure will include the LGBT-specific and HIV/AIDS provisions advocates are seeking — or even if lawmakers will manage to pass any kind of reform.

Lesbian Rep. Tammy Baldwin (D-Wis.), a proponent of LGBT language in health care legislation, told reporters Thursday the election of Massachusetts Republican Scott Brown to the U.S. Senate last week is “an enormous obstacle” to passing reform and puts the future of such legislation in doubt.

“I think talking right now, a little over 24 hours after the conclusion of the election in Massachusetts, that there are still abundant question marks on how health care reform will proceed — or even if health care reform will proceed in its current iteration,” she said.

Carl Schmid, deputy executive director for the AIDS Institute, said lawmakers are rethinking plans for the legislation.

“Some are saying it’s a timing thing and they should take a month break from health care reform,” he said. “Other senators are saying we should start again with a new bill and work with Sen. Brown to try to get the 60 votes.”

The House legislation has several LGBT and HIV/AIDS provisions the Senate plan lacks. The House bill bars discrimination in health care; allows the federal government to collect health data on the LGBT population; eliminates the tax penalty on health benefits received for same-sex partners under an employer plan; and allows states to cover under Medicaid low-income people living with HIV before they develop AIDS.

Both the House and Senate versions of health care legislation have a provision allowing the cost of drugs received through AIDS Drug Assistance Programs to count toward out-of-pocket expenses so that people who receive this medication can more quickly qualify for catastrophic benefits under Medicare Part D.

But Brown’s win in Massachusetts means Democrats no longer have the 60 votes in the Senate to overcome an expected Republican filibuster and pass legislation previously approved by that chamber. And U.S. House Speaker Nancy Pelosi told reporters Thursday that her chamber doesn’t have the votes to pass the Senate plan, which lacks a government-run health care option and taxes high-end health care plans to pay for reform.

Still, Democratic leaders have said they’re committed to passing some kind of health care bill. Those efforts could involve passing compromise legislation in the Senate through reconciliation — a process that requires 51 votes.

Ed Shelleby, spokesperson for Rep. Jim McDermott (D-Wash.), said going back to the drawing board presents a new opportunity to get the domestic partner tax penalty elimination provision in the final version of the bill. McDermott is the sponsor of standalone legislation similar to that provision in the House legislation.

“It turns out that it was questionable whether the defined beneficiary provision — which would benefit domestic partners, among others — was going to end up in the final bill that was negotiated before the Massachusetts election,” Shelleby said. “So we actually get another bite at the apple since Congress will now be reevaluating and renegotiating.”

Schmid noted that advocates are still pushing for the inclusion of HIV/AIDS provisions in the final bill. He said he didn’t know whether the expansion of Medicaid for people living with HIV would make it into the final measure, but the provision for the cost of AIDS drugs has a better chance because it’s in both the House and Senate versions of the legislation.

Schmid said advocates of these provisions are ultimately focused on the passage of health care legislation in its entirety to extend coverage to the estimated 30 million Americans without insurance.

“The biggest issue is getting health insurance coverage for people who don’t have it, and that’s what we hope any bill they come up with that passes will have,” he said.