Mas­sachusetts con­cern

If GOP wins cru­cial race, re­form could be blocked

Modern Healthcare - - The Week In Healthcare - Matthew DoBias

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.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.