Time for Plan B

Sum­mit stale­mate has Dems looking at al­ter­na­tives

Modern Healthcare - - The Week In Healthcare - Matthew DoBias

The highly pub­li­cized bi­par­ti­san health­care sum­mit did lit­tle to soothe a widen­ing par­ti­san rift on Capi­tol Hill last week, leav­ing Demo­cratic law­mak­ers seek­ing al­ter­na­tive plans for health re­form leg­is­la­tion and Repub­li­cans play­ing de­fense.

Pres­i­dent Barack Obama is ex­pected to an­nounce mid­week a re­vised plan on how to pro­ceed. Spokesman Robert Gibbs said dur­ing a news brief­ing the pres­i­dent would take the “is­sues they agreed on (at the sum­mit) and add them into a pro­posal go­ing for­ward.” While some dif­fer­ences might be im­pos­si­ble to bridge, oth­ers, such as pro­vi­sions on de­fen­sive medicine, sell­ing in­sur­ance across state lines, and tighter con­trol over fraud and abuse in fed­eral pro­grams, could gain trac­tion.

As it stands, the House and Se­nate have passed bills that are sim­i­lar in sub­stance, but fur­ther apart on ide­ol­ogy. Con­gres­sional leaders have been in a hold­ing pat­tern on how to meld the two since the loss of a cru­cial Se­nate seat in Mas­sachusetts long held by Democrats.

At the same time, Repub­li­can leaders again said the process needs to start anew. Se­nate Mi­nor­ity Leader Mitch McCon­nell (R-Ky.), who from day one has op­posed the Demo­cratic-writ­ten bill, said the gen­eral pub­lic has aligned against the size and scope of the pack­age.

“I don’t think pub­lic opin­ion of this mag­ni­tude, where peo­ple have re­ally paid at­ten­tion—have been di­aled into this is­sue— they’re against it,” McCon­nell said just min­utes af­ter the sum­mit ended.

There are a num­ber of ways Demo­cratic leaders can un­stick the process. One would have the House out-and-out pass the bill the Se­nate passed back in De­cem­ber with the prom­ise that a pack­age of “fix-its” would ride shot­gun in a sep­a­rate bill. That sec­ond bill would then go back to the Se­nate for a vote un­der rec­on­cil­i­a­tion, a leg­isla­tive ma­neu­ver that ef­fec­tively al­lows it to pass on a sim­ple ma­jor­ity vote.

House Speaker Nancy Pelosi (D-Calif.) sketched out how that sce­nario might work. Pelosi said House Democrats first need to see the ac­tual sub­stance of a bill and then get as­sur­ances that the Se­nate could pass it on a ma­jor­ity vote. Pelosi added that much of the House’s con­cerns were al­layed by the pro­posal that Obama laid out be­fore the re­form sum­mit. “That’s a big step for­ward,” she said, adding that the meet­ing “took us far­ther down the path.”

But it’s still un­clear if House Democrats can pass such a mea­sure. Rep. Raul Gri­jalva

Gri­jalva: “There has to be a pub­lic pres­ence.”

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