No Snowe for the holidays?
Sen. Olympia Snowe (R-Maine), who is still being wooed by Democrats on health care, was highly skeptical of a proposal to expand Medicare and Medicaid — signaling Tuesday that her support for an emerging public option compromise will be difficult to secure.
Democrats have been hopeful they could attract Snowe’s vote for a final health reform deal and gain a little breathing room in trying to reach 60 votes. But Snowe said the latest proposals on the table would take the legislation in the wrong direction, adding more government involvement at a time when voters want less.
“My deep concern is about the breadth and scale of this legislation, taking it in a more expansionistic approach for government’s role rather than reverse,” Snowe told reporters. “You can design incentives in this legislation to maximize the power of the marketplace in making sure the industry performs."
Already, one of the areas of Snowe’s concern — an expansion of Medicaid to cover more of the uninsured — is fading as a realistic option in the bill, senators said, amid concerns among moderates and many governors that it would put too much of a burden on state governments, which pick up a portion of the coverage costs.
West Virginia Sen. John Rockefeller, one of the leading Democrats calling for a public option, said there is "not a lot" of discussion anymore on expanding Medicaid to people at 150 percent of the poverty level. Rockefeller said he is seeking other concessions, including boosting the State Children's Health Insurance Program.
"Some senators are a little less enamored about that," Senate Finance Committee Chairman Max Baucus (D-Mont.) said of Medicaid expansion.
The Medicaid expansion was viewed as trade-off for liberals who were disappointed that the public option is falling out of the bill. An expansion for Medicare is still under serious consideration because it’s easier to control the costs by controlling who can “buy in” to the program.
Snowe spoke with reporters after she left a private meeting with Senate Majority Leader Harry Reid (D-Nev.), steps away from the room where five moderate and five liberal Democratic senators were in negotiations to break a deadlock over the public option.
The group met for almost three hours Tuesday in hopes of reaching an agreement by the end of the day and plans to meet again Tuesday. Reid needs to keep the process moving along if he hopes to keep the bill on track for passage by Christmas.
Sen. Mark Pryor (D-Ark.) said the group is still committed to reaching an agreement.
"We do have a framework, a general framework that we're working on in terms of how something might be structured, but certainly we understand that time is of the essence," Pryor said. "We want to get it done right, but we also understand that we're under some time constraints."
Added Rockefeller: “All in all, I have to say we are in a pretty good place right now. You can see a kind of overarching sense of ‘Well, yes, let’s do this,’ but we have to see what the (Congressional Budget Office cost estimate) is.”
Snowe has not attended the meetings, but she has remained in close contact by Reid and been briefed by Pryor, Sen. Thomas Carper (D-Del.) and Sen. Blanche Lincoln (D-Ark.).
Sen. Joe Lieberman (I-Conn.), another undecided moderate who opposes any version of the public plan, hasn’t sat in on the meetings either. But his staff is present, and he speaks with Sen. Chuck Schumer (D-N.Y.) every day, Lieberman told reporters Tuesday.
He said he is encouraged by a proposal to remove the public option and replace it with a national nonprofit insurance program administered by a federal agency. Regarding Medicare and Medicaid, Lieberman said he needed to examine the additional costs.
“I want to make sure that we're not either adding a big additional burden to the Medicare system, which we gotta figure out how to save anyways because it's going bankrupt,” he said. “But again, these are trade-offs."
Snowe would not say she is opposed to the proposed compromise as long as it includes the Medicare and Medicaid expansions. But she said she expressed concerns to Reid about the Medicare “buy in,” which would allow people between 55 and 64 to purchase coverage in the popular insurance program for the elderly.
“It just adds a potential for exponential uncertainties with respect to the Medicare program,” Snowe said. “In addition to that overall is adding to the weight of the providers through lower reimbursements. That is obviously a persistent problem. Now you are adding more to that equation — 2 or 3 million more Americans at a time when you are having lower reimbursements.”
Both the American Hospital Association and the Federation of American Hospitals sent alerts to its members Tuesday urging them to call senators in opposition to the proposals.
"Remember that we worked hard to successfully and significantly change the House bill so its public option was not entirely based on Medicare rates, but largely negotiated rates, and in the Senate we worked to ensure that the Finance Committee bill has a nonprofit, nongovernmental public option based on negotiated rates and not tied to Medicare or Medicaid," read the alert from the American Hospital Association.
"Adding millions of people to these programs at a time when they already severely unfunded hospitals is unwise and should be opposed."
Snowe said she was not aware of the proposal to expand Medicaid coverage to individuals with incomes 150 percent above the poverty line, up from 130 percent. But she was highly critical of the idea when talking to reporters.
“It is a huge burden on the states,” Snowe said.
Schumer said a pure Medicaid expansion is not the only option under discussion.
“There are different things you can do on the Medicaid end of things,” Schumer said.
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Sources: Politico, Google Maps
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