Health Care Reform: A Long Road Ahead But Highly Possible This Year...It Can't Wait!

Politico----




Moments before unveiling the House Democrats’ health care reform bill Tuesday, Speaker Nancy Pelosi shared a moment with Rep. John Dingell, the 83-year-old dean of the House whose father first pushed for universal coverage in 1943.

“Are you happy?” the speaker asked her onetime rival.

“I’m happy,” the Michigan Democrat replied, “and my father would be happy.”

Democrats invoked 60 years of legislative futility and plenty of old ghosts Tuesday as they insisted that this is the year they’ll make health care available to all Americans. But party leaders have a long way to go — in a very short time — before Pelosi, Dingell and the rest can say they’ve achieved this long-sought legislative landmark.

House Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) vowed Tuesday that the House and Senate would pass bills before members leave for their August recess. But key senators were skeptical, with Senate Finance Committee Chairman Max Baucus (D-Mont.) saying that he was “not going to guarantee” passage of the legislation by the August deadline.

The Congressional Budget Office threw up a barrier almost as soon as the bill was introduced Tuesday, estimating its cost at more than $1 trillion. Although CBO didn’t account for the Democrats’ plan for a $540 billion surtax on wealthy Americans or hundreds of billions more in savings they’re hoping to squeeze out of the current system, the estimate was still a blow; Democrats were desperately hoping to avoid the T-word.

There are other difficult issues ahead.

For instance, Waxman incorporated into the bill the drug industry’s $30 billion deal with the White House and the Senate Finance Committee to help close a gap in prescription drug coverage for seniors. But he refused to strip a provision that reinstates price controls on drugs purchased by seniors who qualify for both Medicare and Medicaid, despite the pleas of more than 60 fellow Democrats.

Those rebates will cost drug companies more than $50 billion, and they’ll lobby fiercely against them.

Meanwhile, Wisconsin Rep. Ron Kind, vice chairman of the moderate New Democrat Coalition, said the bill doesn’t do enough to reward the “value of care given” rather than the “volume of care given” in the medical system.

“There’s too much foot dragging on the House side compared to what the Senate’s proposing,” Kind said.

Another big question concerns Medicare’s reimbursement formula for doctors, hospitals and other health care providers.

In the House, Democrats from all parts of the country have raised major complaints with the existing formula, arguing that it rewards medical providers who charge the most while penalizing communities with the fewest doctors.

The legislation unveiled Tuesday would require the Government Accountability Office to issue recommendations for changing the current formula, but members of the Energy and Commerce and Ways and Means committees said both could make additional changes during the amendment process.

Many Democrats also want to ensure that Medicare’s reimbursement formula isn’t the model for the so-called public plan of government-sponsored coverage. But the bill introduced Tuesday requires the secretary of Health and Human Services to use Medicare pricing as a baseline, while it grants the department some flexibility.

After jamming through a vote on climate change, Democratic leaders want to make sure their rank-and-file members are comfortable with the bill before they bring it to the House floor for a vote — which will make for a rocky three-week road toward the August recess, if not a postponement of it.

“It’s very important for the members to talk through it and see what we’re trying to do,” said California Rep. Xavier Becerra, the vice chairman of the Democratic Caucus.

“We are going to have to work through these issues,” Waxman told reporters Tuesday.

Authors have made some concessions to the rank and file, such as allowing doctors and other medical providers enrolled in Medicare to opt out of the public plan. And Democratic leaders assured reporters Tuesday that other changes will be made in the drafting process.

The Democrats’ bill would require most individuals to secure health insurance, through their employers, the government or private insurance plans. It expands eligibility for Medicaid and establishes insurance “exchanges” to provide individuals and families with federal subsidies to reduce the costs of purchasing insurance.

To help pay for it all, lawmakers are trying to squeeze hundreds of billions in savings from the current health care system. In the House, Ways and Means Democrats also introduced a surtax on the wealthiest Americans. Under that plan, a married couple making more than $350,000 and less than $500,000 would be hit with a 1 percent tax, and higher earners would pay more.

That tax proposal should face plenty of resistance in the Senate, where the process is moving much more slowly than in the House. A day after President Barack Obama pressed key lawmakers to speed up their pace, Senate Budget Committee Chairman Kent Conrad (D-N.D.) told reporters that it’s “hard to see” how the Senate can move on Judge Sonia Sotomayor’s Supreme Court nomination and health care reform before the recess.

Baucus was supposed to meet with the bipartisan group of Senate negotiators Tuesday afternoon but canceled the meeting because of scheduling conflicts with the Sotomayor hearing. He instead met individually with three Republicans, trying to find agreement on financing for the bill.

House Democrats’ plan for a surtax on the wealthy continued to get a cool reception in the Senate.

“I don’t think it is going to go anywhere in the Senate,” said Sen. Jeff Bingaman (D-N.M.), a Finance Committee member. Sen. Ron Wyden (D-Ore.), another member of the committee, likewise said he hadn’t “heard a lot of support in the Senate for the surtax.”

Aides said the Senate Finance Committee is likely to offer several sources of revenue rather than one large funding stream, as the House panel does. Senators were examining fees on insurance and pharmaceutical companies, bonds to pay for the Medicaid expansion, and increased corporate reporting measures that could allow the IRS to collect more taxes, according to sources. They are also looking to find more savings in the health care system, as well as adjusting some of the spending, including dialing down the minimum benefit packages available in the insurance exchange.

Democrats aren’t expecting much Republican support. In the House, GOP lawmakers are expected to seize on the Democrats’ plan to force small businesses to provide health care for their employees or pay a penalty to help foot the cost of government-sponsored coverage.

But Pelosi said Tuesday that “inaction is not an option.”

The importance of the issue — and of the August deadline — isn’t lost on rank-and-file Democrats, who uncharacteristically turned out in large numbers for the news conference unveiling the bill.

Rhode Island Rep. Patrick Kennedy, whose ailing father, Sen. Ted Kennedy (D-Mass.), has pushed to expand health coverage since entering Congress 46 years ago, stood behind a bank of television cameras to watch the announcement.

“It’s an historic day,” he said afterward. “This has been a constant battle for my father, obviously, for his entire career.”

But the history of health care reform has not always been a happy one for Democrats.

“This time is different,” said Dingell, whose name graces the new legislation. “This time we will be successful. This time we must be successful.”

Sources: Politico, Whitehouse.gov