If GOP wins crucial race, reform could be blocked
Congressional Democrats made progress last week in the effort to produce a single healthcare overhaul bill, but were faced with a new challenge over the potential loss of a Senate seat in Massachusetts. Older points of contention such as abortion funding and the structure of a health insurance exchange also dogged the process.
After coming to agreement with union leaders on how to structure a tax on certain more-generous, or socalled “Cadillac,” health plans, Democratic leaders turned their attention to other matters as they work to produce a bill before President Barack Obama’s annual State of the Union address, slated for early next month. House leaders were still shaping a final package as the week came to a close, preparing a bill to send to the Congressional Budget Office—one of the final procedural steps in the legislative process.
“Everything we’ve been doing now is trying to get ready for CBO, and we have to continue to finish that work,” House Speaker Nancy Pelosi (D-Calif.) told reporters. Once those matters are out of the way, she said, “then we can deal with other issues. In the interest of time, it has to be sequenced that way.” Some of those targets are more political in nature than financial, Rep. Jan Schakowsky (D-Ill.) said. “There’s still a number of outstanding issues that aren’t connected to the cost of the bill,” she added, ticking off trouble areas like immigration, abortion services and a measure that would strip insurance companies of their antitrust exemptions. “There are going to be follow-up meetings.”
The comments capped a frenzied week that saw House members huddle in closed-door meetings among themselves, Senate leaders, Obama and former President Bill Clinton. News that a prominent proponent of health reform had gotten HHS grants and that the reform bill may drive some providers out of Medicare and Medicaid had seemingly little effect on the effort.
Obama took on a bigger role in the process, meeting for hours with House leaders. The president on Capitol Hill last week rallied Democrats, telling them that they should hold their heads high when discussing the reforms that are part of the bill. “Now believe me, I know how big a lift this has been,” Obama told the Democratic caucus, acknowledging the legislative challenge. “I see the polls.”
House members pressed Obama during a question-and-answer period over the bill’s lack of a public health plan, over pharmaceutical deals and more, according to a senior congressional aide who attended the meeting and who asked not to be identified. House Democrats remained prickly over the contents of what will be a negotiated effort between both chambers of Congress.
According to the aide and other congressional sources, the president said that a measure to reduce the time it takes for a generic drug to make it to market to 10 years rather than 12 years is in the works.
Obama also hinted that he would back a measure that would create a hybrid of a national and
state health insurance exchange, a move that would help corral House Democrats who included plans for the federal government to administer the overall program in their version of a bill. The Senate wants states to have that power.
Rep. Chris Van Hollen (D-Md.) said that “there will be a national component and a uniformity to the exchange,” a measure that was won after a late-night meeting between House members and the president.
The last-minute jockeying was further complicated as a late surge by the Republican candidate for the late Sen. Edward Kennedy’s vacant Senate seat in Massachusetts worried some lawmakers in Washington. A win this week by Scott Brown, a Republican state senator, over state Attorney General Martha Coakley, a Democrat, could wreak havoc on the process. Brown has already said that he would vote against the bill. A loss would take Democrats from their current 60-member majority—the number needed to break a filibuster—down to 59.
The negotiated deal on a tax on the “Cadillac” plans changed the cost threshold and added an eight-year exemption for collectively bargained plans. Under terms of the deal, the cost on the value of benefits would increase to $8,900 from $8,500 for individuals, and to $24,000 from $23,000 for families. Union plans would be exempt from the proposed 40% tax through 2017.
Richard Trumka, president of the AFLCIO, said the tough-won concessions move the unions closer to officially endorsing a merged health reform bill. The Senate’s original proposal would have raised nearly $150 billion over 10 years. With the negotiated changes, however, the measure would raise $90 billion, meaning lawmakers will have to find another revenue-raiser to make up for that loss.
Reports that Jonathan Gruber, a professor at the Massachusetts Institute of Technology, had been paid consulting fees by HHS while acting as a seemingly objective proponent of health reform drew fire from Sen. Chuck Grassley (R-Iowa) and other Republicans, but had little effect on Congress’ effort. Neither did a Jan. 8 CMS report that concluded the Senate health bill could force more providers to end participation in Medicare and Medicaid.
Trumka: Unions closer to endorsing healthcare bill.
House Speaker Nancy Pelosi (D-Calif.) has been working with fellow Democrats to produce a bill. “Everything we’ve been doing now is trying to get ready for CBO,” she says.