March 3, 2010
Compiled by Brian Betner*
Obama Says He's Exploring Ideas Raised by GOP During Health Summit
March 2, 2010
ABC News Political Punch : In a letter to Congressional leaders President Obama signaled Tuesday afternoon he is "open to several provisions raised by GOP lawmakers during last week's bipartisan health care reform summit, including medical malpractice reform, combating fraud," and the removal of a provisions that would have allowed the federal government to pay for Nebraska's Medicaid expansion and another that would have protected Florida seniors from cuts to the Medicare Advantage program (Tapper, 3/2).
The White House released the letter in the afternoon.
USA Today's The Oval : The GOP ideas "include expanding the use of fraud investigators disguised as patients to uncover waste and abuse in federal programs such as Medicaid, a proposal made by Sen. Tom Coburn, R-Okla. Obama also says he's open to bigger pilot programs on possible changes to the rules governing medical malpractice lawsuits, a longtime GOP issue. Obama also wrote that he is willing to explore higher Medicaid reimbursements for doctors, as proposed by Sen. Chuck Grassley,
R-Iowa." The president also promised to look at expanded use of health savings accounts (Jackson, 3/2).
The Associated Press: "Obama's announcement is not likely to win him any votes from Republicans, who want Obama to tear up the existing bills and start over, but it could give wavering Democrats political cover by showing the party has been willing to compromise in the wake of last week's televised bipartisan health care summit" (Werner, 3/2).
New York Times' Prescriptions : The president "is likely to make a statement at the White House on Wednesday about moving forward with health care legislation, rather than give a speech elsewhere in Washington, DC, as had been announced on Monday, his spokesman, Robert Gibbs, said." His statement is "expected to offer some perspective on his health care summit meeting with Republicans and to discuss why, in his view, Congress should not simply 'start over,' as Republicans have insisted" (Herszenhorn, 3/2).
Bloomberg/BusinessWeek: Meanwhile, in a speech to the Federation of American Hospitals in Washington Tuesday, Secretary of Health and Human Services Secretary Kathleen Sebelius indicated President Obama would reject Republicans' appeals for what she called "a piecemeal approach" to a health care overhaul when he announces his plans for the moving the legislation forward this week (Gaouette, 3/2).
Daschle: Incremental Health Reforms Won't Work
March 2, 2010
By Peggy Girshman
Former Senate Majority Leader Tom Daschle was nominated by President Barack Obama to be secretary of Health and Human Services and the White House's point person on health reform. Although Daschle withdrew his name after reports that he had not paid some taxes, the South Dakota Democrat remains a close adviser to the president and continues to work for a health care overhaul.
He is a co-author of the 2008 book, "Critical: What We Can Do About the Health-Care Crisis," and is a policy adviser to DLA Piper, a law and lobbying firm in Washington.
KHN editors and reporters interviewed Daschle yesterday. Here are edited excerpts:
Q: Where do the Democrats go from here? Is reconciliation the strategy they should use?
A. I think it is. If I had the magic wand, I would complete the work that is now underway to find what would be the most suitable corrections or alterations to the Senate bill that would accommodate a successful vote in the House. I think that process is underway and I am encouraged by the reports I hear to the degree to which that could be done.
Q. Do you think there are political risks to the Democrats with that approach?
A. I think there's even more risk in doing nothing after all of this. I'm very concerned that after the tremendous effort to get to this point, we'd have nothing to show for it. I really believe that once this legislation is passed and people can see what it could mean for them, the impact it could have, the opportunities it presents to lay the foundation for significant change in our health care marketplace that it would be a net positive by November.
Q: How does Speaker Nancy Pelosi get the votes to pass a bill for reconciliation?
A. Speaker Pelosi has proven herself over and over again as a leader capable of organizing a strategy to get to the requisite votes, and I'm confident she can do it again in this case. I think there's just too much at stake. I'm one of those who believe that far more important than any short-term political consideration is the historic opportunity this represents.
Q: If things don't go the way she is hoping, at what point do you think Democrats go into fallback mode and start considering a pared-down bill?
A. I really don't think it's going to be necessary. I think it's so important that they focus on one strategy at a time. I think it would be very hard to put a fallback together in the remaining months of this year. It's just the consensus challenge is very, very hard. Just take one example, insurance reform and the tremendous difficulties that exist with regard to just putting together an insurance reform package that the insurance companies themselves wouldn't fight and wouldn't have huge premium implications if that's all they did. I think there are complicated policy questions and repercussions to these issues and it's somewhat misguided to think that somehow it's going to be easier to pass something smaller.
Q: You mentioned affordability as one of the issues that still has to be resolved, do you think something needs to be done to the Senate bill to make insurance more affordable?
A. Well I believe in [an individual] mandate and I believe that if you are going to have a mandate you also have to have adequate levels of support for those who otherwise may have difficulty meeting their obligations under the mandate. And I think that the Senate bill probably fell short on affordability. Bumping it up, making it a little more supportive of families struggling to pay their premium is something we should do.
Q: Are you satisfied that the Senate bill does enough to control costs?
A. I don't think that either version of the bill does enough. I look at this whole effort as having three components: insurance reform, payment reform and delivery reform. And all three components have cost containment elements in them. Not nearly as much as I'd like, but I think a lot of the building blocks are going to be in place. But you can't expect one bill to comprehensively deal with each one of these components to everyone's satisfaction. I tell audiences all over the country, that if this passes I think we're on the 30-yard line, that we've got 70 yards to go to accommodate really significant change in the system, adequate enough to be able to say we've addressed cost, access and quality in a meaningful way.
Q: How do you think they can resolve the abortion issue?
A. I don't think it will ever be resolved to the extent that there will be unanimity. I mean there are going to be people on either side that will not be happy with the ultimate approach that is decided.
Q: Did you feel as though the summit accomplished anything?
A. I think it accomplished three things. I think the American people benefited from a very honest discussion about many of these issues. I mean there was a pretty clear indication that there are significant philosophical and ideological differences between the parties with regard to this issue. But the discussion, I think, was a healthy one overall. The second thing, I think, that came out of that was an elevation of the issue once again. I think this probably energized the debate a little bit more. The third thing it did, is to a certain extent it was clear from that discussion that it is unlikely we can count on very much Republican support for any effort to do something this year. I think by and large that the message out of that seven-and-a-half-hour discussion is that this issue is probably not going to enjoy the broad bipartisan support that I wish it had, and Democrats might have to move more unilaterally to get this done.
Q: In terms of the polls, it looks like people are either split or leaning toward being opposed on health reform. How does that play in with whether something happens in Congress?
A. It's human nature to be concerned about the unknown, and there's been a lot of fear generated, I'm not saying that the Republicans necessarily did it intentionally, but one of the consequences of this debate is to generate a tremendous amount of uncertainty and fear for the implications this could have for people.
But then you break it down, as many organizations have, to individual issues: do you think there ought to be insurance reform? Of course. Should we close the donut hole? Of course. You know, you go through the list and as soon as you talk about specifics and more directly the components of the reform, you find there's pretty broad support. I think we put way too much emphasis on polling as a factor as how we make our decisions. Should it be a factor? Of course. Should it be the sole factor? Of course not.
This is also an issue of governance. I think that we've got to demonstrate as a country that we're able to tackle the big issues of the day.
Q: What are the parallels or contrasts between the Clinton administration's efforts to get a health care overhaul in 1993-94 and now?
A. I think the biggest non-parallel factor is that you've got stakeholders who are much more supportive of reform now than ever before. You look at the AMA position, that's probably the best example of any. They've been fairly persistent in their support. I know that there are internal divisions, but as an organization they've done it. And so have the pharmaceutical manufacturers, they've hung in there. And even the insurance industry has indicated support for reform, just as there are aspects to this that they would not support.
You've got a lot more recognition that we don't have a luxury this time to fail. Per capita costs were $3,400 in 94, they're $8,000 now. The level of uninsured was 37 million, and now I think it's over 50 million.
Whether it's quality, access or costs you can look at all the numbers, they've dropped precipitously, and we've been able to demonstrate, if anything, out of these last 15 years that incremental reform doesn't work. We've tried incremental reform with SCHIP and with the passage of Part D and maybe portability, a couple things here and there. We've seen everything go south, and it's going to continue to do that until we put in place the corrective policy building blocks to address this more comprehensively.
Sen. Nelson Signals Support for Health Overhaul Bill; Hoyer Offers Alternative Way to Move Legislation Forward
March 2, 2010
Speaking at a conference hosted by the Federation of American Hospitals Tuesday, Sen. Ben Nelson, D-Neb., who withheld his support for a healthcare overhaul bill until just before the Senate passed it in December, "strongly hinted that he is prepared to back the final push to finish the job this spring," The Hill reports. "'Doing nothing on healthcare reform might seem like a reasonable option to some, but in my opinion it's not. Our nation's healthcare crisis will only get worse the longer we delay,' Nelson said. . . . Nelson had been a skeptic of the Democratic healthcare reform proposals since the legislative process began a year ago and voted for the Senate bill only after securing new language designed to prevent federal money from paying for abortion services as well as additional funding for his home state's Medicaid program. But with his vote for the bill on the record, and his name indelibly linked to healthcare reform because of the so-called 'Cornhusker kickback' deal for the Medicaid money . . . Nelson appears poised to join his fellow Democrats in advancing the legislation via budget reconciliation rules that would allow a House-Senate compromise package to pass the upper chamber on a simple majority vote."
"Sen. Evan Bayh (D-Ind.), speaking at the same event, predicted that the Senate Democratic leadership would easily be able to lock down the 50 votes it needs to pass the reconciliation process (with Vice President Joe Biden available to cast a tie-breaking vote if needed). . . . Observing that it will be more difficult for House Speaker Nancy Pelosi (D-Calif.) to get 216 members of her caucus to vote for healthcare reform, . . . Bayh was less optimistic about final passage" (Young, 3/2).
Roll Call : House Majority Leader Steny Hoyer, D-Md., on Tuesday "laid out a path forward for passing health care legislation that wouldn't require House Democrats to first swallow a Senate plan that they largely oppose. . . . Hoyer said that while the House is constitutionally required to initiate reconciliation bills, that doesn't mean the House would have to pass the Senate bill first before passing a reconciliation bill to amend it." Instead, the House "'could pass the reconciliation first, have the reconciliation passed by the Senate and then pass the Senate bill,' Hoyer said. From there, he said, the president would have to sign the Senate bill first and then the reconciliation package," a process Hoyer admitted would be "'more complicated'" (Bendery, 3/2).
Meanwhile, Senate Minority Leader Mitch McConnell, R-Ky., Tuesday warned Democrats "that Republicans will use the issue of health care to bludgeon them in the November mid-term elections if Democrats succeed in passing a comprehensive overhaul," New York Times' Prescriptions reports. "His comments reflected growing Republican concern over President Obama's resolve to secure passage of a comprehensive health care measure, which would be viewed as big Democratic achievement" (Herszenhorn, 3/2).
GOP, Dems Continue Battle Over Using "Reconciliation" to Move Health Reform Forward
March 2, 2010
Democrats are defending the use of the budget reconciliation in a health care overhaul as "nothing extraordinary" while Republicans are accusing them of "trying to ram through legislation using a parliamentary trick that Republicans say was never designed for such a big bill," The Wall Street Journal reports. "At issue is a procedure called reconciliation that allows the Senate to pass a bill with a simple majority, without needing 60 votes to override a filibuster."
Tomorrow, President Barack Obama is expected to call on Congress to use reconciliation to pass an overhaul, The Journal reports. "White House officials are painting the Senate as a place dominated by obstructionists thwarting the will of the majority." Democrats are also saying that "[t]he Children's Health Insurance Program was created using reconciliation, as was the COBRA law that allows workers to keep employee health benefits after they leave a job" (Meckler, 3/1).
The Hill: During the health care summit last week "the president deflected questions from Republicans about the use of reconciliation to pass aspects of healthcare reform, but he did make clear that he wants to see 'an up-or-down vote'" (Youngman, 3/1).
CNN : "Reconciliation, established in 1974, makes it easier for the Senate to pass bills to reduce the nation's debt. The procedure has been used 22 times, and every president beginning with Jimmy Carter has signed bills that used reconciliation. . . . Even before reconciliation could be considered, Democrats must come together to iron out key sticking points--including abortion and the government-sponsored public health care option. The abortion issue has been vexing for Democrats in the House. Rep. Bart Stupak, an anti-abortion Democrat from Michigan, pushed for measures in the House bill to which pro-choice Democrats were opposed" (Hornick, 3/1).
NPR : Using reconciliation could be a tough road for Democrats, according to former Senate parliamentarian Robert Dove: "Total [Senate] debate on a reconciliation bill is limited to 20 hours. Amendments, that's much harder. There is no limit to how many you can send. And you can send amendments of whatever length and have them read." He added that there are several rules for considering if an amendment can be heard on the floor: "Some are very simple. For example, any provision that has no effect on the budget--doesn't increase it, doesn't decrease it--is not in order. But some of them are very difficult. One test requires that if something actually does (affect the budget), it becomes the duty of the parliamentarian to go into the motives of why the provision is there" (Halloran, 3/1).
Roll Call : The GOP is preparing to wage "war to block this 51-vote strategy--and lay the groundwork for what they hope will be big electoral gains in November. Senate Republicans have already set the messaging component in motion, saying reconciliation would subvert the will of the American people. Still under development is the legislative strategy, which Republicans hope will tie the majority party in knots and force vulnerable Democrats to take politically damaging votes--if it doesn't derail reconciliation altogether."
Roll Call notes that "the most likely reconciliation strategy for Congressional Democrats is to have the House pass the $871 billion health care reform bill approved by the Senate on Christmas Eve and then pass a companion bill with the changes desired by House Democrats" (Drucker, 3/2).
Warren Buffett Supports Senate Bill, Franken and Ryan Pushing Their Health Reform Ideas
March 2, 2010
Various personalities are weighing in on health legislation.
CNBC interviewed billionaire investor Warren Buffett, who "called the nation's health care spending 'untenable,' comparing 'out of control' costs to a 'tapeworm eating at our economic body.' While he would support the current Senate health care reform bill if pressed, Buffett says he would prefer a 'Plan C' that would control costs by changing the financial incentives of the system" (Crippen, 3/1).
Reuters: "The world's second-richest person called on Washington policymakers to adopt fundamental reforms on such costs to address what he called a 'national emergency.' He said health care eats up
17 percent of U.S. gross domestic product, at a time when many other countries pay only nine or 10 percent of GDP but have more doctors, nurses and hospital beds per capita" (Stempel, 3/1).
Roll Call : Sen. Al Franken is "breaking out of his shell and positioning himself as an aggressive liberal presence in the Senate--particularly when it comes to one of the most controversial topics in Washington, DC: health care reform." He has "become an outspoken voice pushing for a public insurance option. . . . Sen. Sherrod Brown (D-Ohio) said Franken 'educated the whole caucus well' on how Minnesota successfully limited how much money health insurers could spend on administrative costs, advertising and profits" (Toeplitz and Pierce, 3/2).
Rep. Paul Ryan, R-Wisc., is getting attention from conservatives for his health care proposal, the Milwaukee Journal Sentinel reports. "Ryan's proposal, part of what he calls 'A Roadmap for America's Future,' would replace the existing Medicare benefit for people under 55 with a voucher that could be used to buy private insurance. The payment, which Ryan has said would initially average $11,000 a year, would be adjusted for inflation and tied to income." Ryan says the plan would lessen the "fiscal challenges facing the Medicare program" and would lower costs by pressuring doctors to be more efficient (Boulton, 3/2).
This information was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery . © Henry J. Kaiser Family Foundation. All rights reserved.
*We would like to thank Brian C. Betner, Esquire (Hall Render Killian Heath & Lyman, Indianapolis, IN), for selecting the articles for this week's update.