On October 13, 2009, the Senate Finance Committee approved the “America’s Healthy Future Act,” representing the last step in the committee process before health reform legislation can move to the full Senate for a vote. The Committee approved the bill by a 14-9 margin, with one Republican (Sen. Olympia Snowe) joining all panel Democrats in supporting the bill. According to the Congressional Budget Office (CBO), the package would cost $829 billion gross over 10 years, but result in a net savings of $81 billion over 10 years. The proposal seeks to expand access to affordable health insurance through insurance market reforms, the creation of insurance exchanges to facilitate comparing and purchasing insurance policies, expanded Medicaid eligibility, and various subsidies (the bill does not include a public health insurance option). All individuals would be required to purchase health insurance, subject to limited exceptions. While employers would not be required to offer health insurance, firms with more than 50 workers that do not offer coverage would be subject to a financial penalty for full-time workers who obtain subsidized coverage through the insurance exchanges. The Congressional Budget Office estimates that the bill would reduce the number of uninsured nonelderly individuals by about 29 million, leaving about 25 million nonelderly residents uninsured. The bill also includes a series of provisions impacting Medicare and Medicaid payment policies, including reductions in annual updates to certain Medicare fee-for-service rates (except physicians would receive a 0.5% increase instead of a scheduled 21.5% cut in 2010), new “productivity” adjustments and other payment policies that have the effect of reducing payments for certain health providers, cuts in payments to Medicare Advantage plans, and health care delivery reforms (e.g., expanded Medicare value-based purchasing, reduced payments for avoidable hospital readmissions, and a pilot program on post-acute bundling). Other reforms include expanded federal comparative effectiveness research, disclosure of certain physician-industry financial relationships, greater investment in the health care workforce, and strengthened efforts to combat health care fraud. Financing mechanisms include an excise tax on high-cost insurance policies and annual fees on the pharmaceutical manufacturing sector ($2.3 billion annually), the medical device manufacturing sector ($4 billion) and the health insurance sector ($6.7 billion). The CBO estimates that the bill would reduce direct spending on Medicare, Medicaid, and CHIP by over $400 billion over ten years. Senate leaders now must merge the Finance package with the health reform bill approved by the Senate Health, Education, Labor, and Pensions (HELP) Committee this summer, and the unified bill could move to the full Senate for a vote this month. In the meantime, the House leadership has been working to meld the health reform bills approved by the Energy and Commerce, Ways and Means, and Education and Labor Committees to enable a unified measure to be brought to the House floor for a vote.