Who wins, who loses in Senate health bill

WASHINGTON — The little town of Libby, Mont., isn't mentioned by name in the Senate's mammoth health care bill, but its 2,900 citizens are big winners in the legislation, thanks to the influence of Finance Committee Chairman Max Baucus, D-Mont.

After pushing for years for help for residents, many of whom suffer from asbestos-related illnesses from a now-closed mineral mining operation, Baucus inserted language in a package of last-minute amendments that grants them access to Medicare benefits.

It's just one example of how the sweeping legislation designed to remake the U.S. health care system and extend coverage to 30 million uninsured Americans also helps and hurts more narrow interests.

Here's a look at some other winners and losers in the latest version of the legislation.

WINNERS

 Doctors and hospitals in Montana, North Dakota, South Dakota, Utah and Wyoming, who will get paid more than providers elsewhere under formulas in the bill.

 Cosmetic surgeons, who fended off a 5 percent tax on their procedures.

 Nebraska, Louisiana, Vermont and Massachusetts. These states are getting more federal help with Medicaid than other states. In the case of Nebraska — represented by Sen. Ben Nelson, who's providing the critical 60th vote for the legislation to pass — the federal government is picking up 100 percent of the tab of a planned expansion of the program, in perpetuity. Vermont and Massachusetts get temporary increases in the federal share of their Medicaid tabs. In Louisiana, moderate Democratic Sen. Mary Landrieu negotiated $100 million for 2011 before announcing her support for the legislation.

 Beneficiaries of Medicare Advantage plans — the private managed-care plans within Medicare — in Florida. Hundreds of thousands of them will have their benefits grandfathered in thanks to a provision tailored by Sen. Bill Nelson, D-Fla., that also affects a much smaller number of seniors in a few other states.

 Longshoremen. They were added to the list of workers in high-risk professions who are shielded from the full impact of a proposed new tax on high-value insurance plans. (Electrical linemen were already included, along with policemen, firefighters, emergency first responders and workers in construction, mining, forestry, fishing and certain agriculture jobs.)

 Community health centers. They got $10 billion more in the revised bill, thanks to advocacy by Sen. Bernie Sanders, I-Vt.