Hoyer Warns GOP: Tone Down Rhetoric, Senate Fight Looms

GOP Gears Up For Senate Theatrics




So much for the “Nuclear” Senate showdown.

After President Barack Obama’s showy Tuesday signing ceremony, the Senate’s cleanup work this week on health care is looking more like a political strategy session, as each party tries to cement public impressions of the bill.

“It’s going to pass here,” Sen. Tom Coburn (R-Okla.) said matter-of-factly. “It’s a matter of what amendments [Democrats] want to be for and what they’re not.”

To be sure, Republicans have lined up a bundle of politically embarrassing amendments and plan to wreak all sorts of procedural havoc.

“I think there’s going to be long nights, and there’s going to be anger and demagoguery from the Republicans,” said Sen. Sherrod Brown (D-Ohio). “But I think the outcome is pretty clear.”

So at this point, Republicans are simply going to continue with their key themes: that the new law will drastically cut Medicare, increase taxes and expand the government’s ballooning budget deficit.

And as Democrats try to downplay the bill as mere “fixes” to the law and vow to kill all GOP amendments, Republicans are inflating the measure’s importance by arguing it would make even more draconian changes to the newly enacted law.

Republicans are challenging several provisions with the Senate’s parliamentarian, Alan Frumin, on the grounds that they violate the so-called Byrd rule — named after Sen. Robert Byrd (D-W.Va.) — which prohibits the addition of extraneous items to budget legislation. Republicans are also pushing uncomfortable amendments, including one by Coburn that prohibits sex offenders from being prescribed drugs for erectile dysfunction.

And Republicans are planning unusual procedural tricks to ensure their objections are heard; the GOP on Tuesday forced committee work in the Senate to essentially come to a halt.

But even if the GOP is successful in delaying action in the Senate and forcing changes to the bill, House Democratic leaders may bring the chamber back to session during the upcoming spring recess to pass the reconciliation bill one last time.

And that fact is not lost on some.

“Obviously, the damage has been done,” said New Hampshire Sen. Judd Gregg, ranking Republican on the Budget Committee, who is leading the fight over the reconciliation bill. “But we have not had an opportunity to address some of the substantive policy questions which are out there that should be discussed in an amendment-type atmosphere.”

Since they began the health care debate last year, Democrats had kept the reconciliation process — a filibuster-proof way to make changes in tax laws and entitlement programs — firmly on the table. Nearly every time the strategy came to the fore, Republicans likened the idea to the “nuclear option” that nearly shut down the Senate in 2005, when the GOP tried to end filibusters for George W. Bush’s judicial nominees.

Gregg said the nuclear option was being referred to in the context of moving the whole health care bill through reconciliation — rather than the smaller set of items now being considered.

“This bill was used to buy votes; it’s a much smaller bill,” Gregg said.

In fact, it was House Democrats who pushed for the reconciliation bill to clean up some of the more politically problematic provisions in the Senate bill, including closing the doughnut hole on Medicare prescription drug coverage, delaying an excise tax on high-end insurance plans and killing the so-called Cornhusker Kickback. The Senate bill also includes a sweeping rewrite of student loan laws that most Republicans strongly oppose.

Democrats, feeling confident, are making fun of Senate Republicans for actually holding up the bill that removes some of the most controversial items.

“I don’t understand what they’re doing, because they’re all going to be for supporting the Nebraska cornhusker provision and will be voting against all the things this bill cleans up,” Brown said.

There is one potential area that could blow up the debate. If Vice President Joe Biden uses his authority to overrule a decision by parliamentarian Frumin, it could cause chaos in the chamber because that is so rarely done.

“They would be very loath to do that because it would clearly be a political act,” said Sen. Orrin Hatch (R-Utah). “And the Democrats have already said they’re going to abide by the parliamentarian, which means they must have some confidence that whatever they said is going to work out their way.”

Democrats downplay the likelihood of such a scenario, and Jim Manley, a spokesman for Senate Majority Leader Harry Reid (D-Nev.), declined to comment on the possibility.

Republicans aren’t sparing Frumin, who is supposed to be an impartial referee on Senate procedure.

Senate Minority Leader Mitch McConnell (R-Ky.) refused to say Tuesday whether he believes the parliamentarian has been a fair arbiter of the Senate rules.

“We’ll have views about that, I suppose, as we move along,” McConnell said Tuesday. “We’ll see what the parliamentarian rules and whether he becomes a player in this exercise or truly a referee, an umpire.”

The theatrics may go beyond rhetoric as well. Republicans could go to lengths to keep the Senate in session by trying to extend the freewheeling amendment process indefinitely — even though Democrats said they may push Frumin to rule such a tactic dilatory and prevent them from doing that.

“Realistically, I think the answer to that question is how long can senators stay awake continuously,” said Minority Whip Jon Kyl (R-Ariz.). “We may see.”

But most Senate insiders don’t think the GOP will go to such lengths, as the real battle is now on the campaign trail.

“I’m not sure the public really differentiates between the [comprehensive] bill and the reconciliation bill,” said Sen. John Cornyn of Texas, chairman of the National Republican Senatorial Committee. “It’s all part of the machinations; it’s part of the process here.”


Sources: AP, Politico

Obama Pens Letter To GOP, Extends Olive Branch On Health Care

President Obama Open To Republican Ideas On Health Care Reform


President Barack Obama on Tuesday outlined four Republican ideas that he is open to including in the final health care reform bill, including efforts to combat waste and fraud in Medicare and Medicaid and rein in medical malpractice lawsuits.

Obama included the ideas in a letter to congressional leaders and said they were the result of last week’s health care summit at the White House, where Obama offered to look at Republican ideas to give the bill a more bipartisan cast.

The four ideas amounted to relatively modest changes in a nearly $1 trillion bill but were a bid by Obama to show that he was serious about incorporating Republican ideas into the bill. “I said throughout this process that I’d continue to draw on the best ideas from both parties, and I’m open to these proposals in that spirit,” Obama said.

But Republicans were swift in rejecting Obama’s ideas as little more than cosmetic changes that do nothing to significantly change the scope and range of a fundamentally flawed health reform bill.

Even Sen. Tom Coburn (R-Okla.), whose ideas for undercover Medicare Inspectors was embraced by Obama said, "That is just one thing."

Republican Sen. John McCain said Obama didn't go far enough when the president agreed with McCain that a Senate provision to exempt 800,000 Floridians from Medicare Advantage cuts faced by other beneficiaries should not be included in the final bill.

"He ought to get rid of all of them," McCain said of the special legislative deals:

But Obama appears to be betting that by including Republican proposals that are rejected out of hand, he can help build a case for a party-line reconciliation strategy.

Obama stopped short of saying that he will include the proposals, but the letter, combined with his positive comments during last week's health reform summit, send a strong signal that they will make it in.

In addition to Coburn’s idea, Obama embraced the idea of $50 million in grants to states that are testing medical malpractice reforms; increasing physicians' Medicare reimbursements and offering health savings accounts in the insurance exchange. The health savings accounts, which allow taxpayers to control how their own dollars are used for medical coverage, are a staple of Republican health reform ideas dating back to President George W. Bush.


The full letter is below:

March 2, 2010

Dear Speaker Pelosi, Senator Reid, Senator McConnell, and Representative Boehner:

Thank you again for the time, energy, and preparation you invested in last Thursday’s bipartisan meeting on health insurance reform. I have always believed that our legislative process works best when both sides can discuss our differences and common goals openly and honestly, and I’m very pleased that our meeting at Blair House offered the American people and their elected representatives a rare opportunity to explore different health reform proposals in extraordinary depth.

The meeting was a good opportunity to move past the usual rhetoric and sound-bites that have come to characterize this debate and identify areas on which we agree and disagree. And one point on which everyone expressed agreement was that the cost of health care is a large and growing problem that, left untended, threatens families, businesses and the solvency of our government itself.

I also left convinced that the Republican and Democratic approaches to health care have more in common than most people think.

For example, we agree on the need to reform our insurance markets. We agree on the idea of allowing small businesses and individuals who lack insurance to join together to increase their purchasing power so they can enjoy greater choices and lower prices. And we agree on the dire need to wring out waste, fraud and abuse and get control of skyrocketing health care costs.

But there were also important areas of disagreement. There was a fundamental disagreement about what role the oversight of the health insurance industry should play in reform. I believe we must insist on some common-sense rules of the road to hold insurance companies accountable for the decisions they make to raise premiums and deny coverage. I don’t believe we can afford to leave life-and-death decisions about health care for America’s families to the discretion of insurance company executives alone.

No matter how we move forward, there are at least four policy priorities identified by Republican Members at the meeting that I am exploring. I said throughout this process that I’d continue to draw on the best ideas from both parties, and I’m open to these proposals in that spirit:

1. Although the proposal I released last week included a comprehensive set of initiatives to combat fraud, waste, and abuse, Senator Coburn had an interesting suggestion that we engage medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs.

2. My proposal also included a provision from the Senate health reform bill that authorizes funding to states for demonstrations of alternatives to resolving medical malpractice disputes, including health courts. Last Thursday, we discussed the provision in the bills cosponsored by Senators Coburn and Burr and Representatives Ryan and Nunes (S. 1099) that provides a similar program of grants to states for demonstration projects. Senator Enzi offered a similar proposal in a health insurance reform bill he sponsored in the last Congress.

As we discussed, my Administration is already moving forward in funding demonstration projects through the Department of Health and Human Services, and Secretary Sebelius will be awarding $23 million for these grants in the near future. However, in order to advance our shared interest in incentivizing states to explore what works in this arena, I am open to including an appropriation of $50 million in my proposal for additional grants. Currently there is only an authorization, which does not guarantee that the grants will be funded.

3. At the meeting, Senator Grassley raised a concern, shared by many Democrats, that Medicaid reimbursements to doctors are inadequate in many states, and that if Medicaid is expanded to cover more people, we should consider increasing doctor reimbursement. I’m open to exploring ways to address this issue in a fiscally responsible manner.

4. Senator Barrasso raised a suggestion that we expand Health Savings Accounts (HSAs). I know many Republicans believe that HSAs, when used in conjunction with high-deductible health plans, are a good vehicle to encourage more cost-consciousness in consumers’ use of health care services. I believe that high-deductible health plans could be offered in the exchange under my proposal, and I’m open to including language to ensure that is clear. This could help to encourage more people to take advantage of HSAs.

There are provisions that were added to the legislation that shouldn’t have been. That’s why my proposal does not include the Medicare Advantage provision, mentioned by Senator McCain at the meeting, which provided transitional extra benefits for Florida and other states. My proposal eliminates those payments, gradually reducing Medicare Advantage payments across the country relative to fee-for service Medicare in an equitable fashion (page 8). My proposal rewards high-quality and high-performing plans.

In addition, my proposal eliminates the Nebraska FMAP provision, replacing it with additional federal financing to all states for the expansion of Medicaid.

Admittedly, there are areas on which Republicans and Democrats don’t agree. While we all believe that reform must be built around our existing private health insurance system, I believe that we must hold the insurance industry to clear rules, so they can’t arbitrarily raise rates or reduce or eliminate coverage. That must be a part of any serious reform to make it work for the many Americans who have insurance coverage today, as well as those who don’t.

I also believe that piecemeal reform is not the best way to effectively reduce premiums, end the exclusion of people with pre-existing conditions or offer Americans the security of knowing that they will never lose coverage, even if they lose or change jobs.

My ideas have been informed by discussions with Republicans and Democrats, doctors and nurses, health care experts, and everyday Americans – not just last Thursday, but over the course of a yearlong dialogue. Both parties agree that the health care status quo is unsustainable. And both should agree that it’s just not an option to walk away from the millions of American families and business owners counting on reform.

After decades of trying, we’re closer than we’ve ever been to making health insurance reform a reality. I look forward to working with you to complete what would be a truly historic achievement.

Sources: Politico

GOP Planning To Repeal Obama's Health Care Legislation?

Will The GOP Promise To Repeal "ObamaCare" If Returned To Power?


ABC News’ Teddy Davis reports: If health-care legislation makes it through Congress and is signed into law by President Obama, Republicans are going to face a big choice between accommodation and repudiation.

The GOP will have to decide in the years ahead if it wants to accept the program with minor modifications or whether it wants to try to dismantle it.

Although Republican senators have been extremely united in their opposition to Obama’s health-care overhaul as it has moved through the legislative process, it is not yet clear how the GOP will approach the “repeal” question if the president’s top domestic priority makes it into law.

The GOP’s uncertainty on this issue was evidenced on Wednesday by Republican Sen. John Barrasso of Wyoming.

Barrasso, a leading Republican voice on health-care reform who is one of only two U.S. senators who has practiced medicine, sidestepped the repeal question twice while appearing on ABCNews.com’s “Top Line.”

Asked if he wants Republican Senate candidates to advocate repeal in 2010, Barrasso called the bill an “historic mistake” for the country but did not say whether Republicans should promise to dismantle the program if voters were to return them to power in Congress.

“”You used a word earlier that it’s going to be an ‘historic’ vote, and I think it’s going to be a historic mistake for the country if this is what happens to health care,” said Barrasso. “Now, as you know, the changes don’t actually go into place until four years from now so people aren’t going to be able to see immediately what the problems are.

But they are going to notice the cuts in Medicare and, specifically, the increased taxes which go into effect the day that this bill is signed into law.”

Asked a second time if he wants Republicans to campaign on a “repeal” message in 2010, Barrasso once again dodged the question and instead voiced his concern about the federal budget deficit.

“The message should be ‘the debt is the threat,’” said Barrasso. “That is the problem with our nation right now.”

Appearing on ABC’s “Top Line” after Barrasso, Politico’s Jonathan Martin predicted that Republicans would divide on the repeal question in next year’s midterm elections.

“I think you’re going to see a split in the party on it,” said Martin. “There certainly are going to be some elements that are emphatically campaigning on a repeal but I think that’s probably not going to be a part of the party platform because there are going to be some who don’t want to be tagged with that ‘party of no’ rap.

They’re going to want to be the ‘party of reform ‘-- ‘let’s improve it.’ Now, that said, in some places in this country, certainly Red States -- places like Wyoming come to mind -- an out-and-out campaign of ‘let’s repeal it’ will certainly play well.”

Appearing on ABC’s “Top Line” from Capitol Hill, Barrasso sharply criticized Senate Majority Leader Harry Reid, saying that the Nevada Democrat has stifled debate on the Senate floor.

“I brought 19 amendments to improve it and I didn’t even get a chance to offer them after Harry Reid brought his 383-page amendment and said, ‘this is it, take it or leave it,’” said Barrasso.

Barrasso, who brought four of his 19 amendments to the floor on Sunday, would not say if he would be voting for final passage even if they had been adopted.

Democrats tightly controlled the offering of amendments because they concluded that Republicans, who favor a radically different, mandate-free approach to health care, were more interested in stopping Obama’s overhaul than in winning passage of minor modifications.

With the Senate scheduled to vote on health-care reform at 8:00 am ET on Christmas Eve, Barrasso suggested that Democratic members of Congress should talk to their constituents about health-care reform during the holiday break.

“Now is the time for Americans all across this country to go face-to-face with their members of Congress . . . to say, "If this bill does pass the Senate, that they should vote against it in the House’ . . . because it does increase taxes, it does cut Medicare by huge amounts, and it’s going to cause … premiums to go up."



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Sources: ABC News, Senate Doctors Show, C-Span, AP, Youtube, Google Maps

Final Congressional Health Care Reform Negotiations Still In Progress

Health Care Bill Plans On Collision Course



Despite a last-minute weekend deal that put the Senate on the brink of passing health care reform this week, liberal and moderate Democrats remain on a collision course over the bill, as both sides dug in Sunday for the next phase of negotiations.

President Barack Obama’s liberal base and powerful union leaders once hoped the expected House-Senate conference would partly undo a year of retreats and compromises, with Obama weighing in to nudge the moderate Senate bill to the left.

But the titanic struggle to lock in Sen. Ben Nelson (D-Neb.) as the 60th senator for the first key test vote early Monday morning has changed all that. The need to hold Nelson and other moderates in line means major changes on the public option, abortion, taxes, Medicare and Medicaid are unlikely — and that the Senate’s vision of health reform is likely to prevail over the House’s in the final talks.

“It is very clear that the bill — the final bill — to pass in the United States Senate is going to have to be very close to the bill that has been negotiated here,” Sen. Kent Conrad (D-N.D.) said on “Fox News Sunday.” “Otherwise, you will not get 60 votes in the United States Senate.”

Nelson, who received assurances of a “limited conference” to secure his vote for the Senate bill, has already laid down at least two deal breakers in the House bill that he can’t support: the inclusion of a government insurance plan and an income tax increase on wealthy individuals.

“That would break it,” Nelson said on CNN’s “State of the Union.”

House Democrats acknowledge that they will be limited in how far they can tweak the Senate compromise. But House leadership also knows that its rank and file need to force some changes, however small, before they will accept the final package — as a face-saving measure to be able to swallow late changes to the bill in the Senate, most notably the decision to eliminate a public option.

But on the left, the sentiments of a liberal base that revolted over concessions to moderates were channeled Sunday by Howard Dean, the former Democratic National Committee chairman, who last week repeatedly called on Democrats to scrap the bill.

“This can’t be the final version of the bill,” Dean said on NBC’s “Meet the Press.” “It simply sets us on a track in this country which is expensive and where we’re going to have lots more political fights.”

In a slight shift, however, Dean tempered his words, saying the bill is better than it was earlier in the week.

“I would certainly not vote for this bill if this were the final product,” Dean said. “I would let this thing go to conference committee, and let’s see if we can fix it some more.”

Andy Stern, president of the Service Employees International Union, identified areas beyond the public option in which Democrats in both chambers could agree, including boosting the federal insurance subsidies for middle-income Americans and strengthening insurance regulations.

“It is about progress, and we now have to fight for the changes in the conference committee and decide, when it is over,” whether to support it, Stern said on CNN’s “State of the Union.”

Senior administration officials contend the conference will not be as difficult as predicted because the differences between the two chambers have been known for months. “Once the Senate passes this bill, obviously there’s work to be done,” White House senior adviser David Axelrod said on “State of the Union.”

Two big voices in the health-reform debate came out with endorsements of the measure moving ahead in the Senate this week: the Federation of American Hospitals, which represents private community hospitals, and AARP, the nation’s largest seniors organization, which urged the Senate to move ahead with debate.

In addition, Democrats desperately tried to avoid an ugly public fight over abortion, but it looks as though the issue will haunt them right up until the end.

Abortion-rights supporters and foes alike blasted the compromise Senate Majority Leader Harry Reid (D-Nev.) cut with Nelson late Friday night. But it’s unclear whether their opposition will be enough to sink the broader bill.

“I have some deep reservations with this Nelson language on first examination,” Rep. Diana DeGette (D-Colo.), a co-chairwoman of the Congressional Pro-Choice Caucus, told POLITICO on Sunday.

Rep. Bart Stupak (D-Mich.), a leading abortion opponent, said during the weekend, “While I and many other pro-life Democratic House members wish to see health care coverage for all Americans, the proposed Senate language is unacceptable.”

The final Senate bill grants state legislatures the right to prevent insurance plans that operate in the proposed health insurance exchange from covering elective abortions. The changes also require people who seek abortion coverage through the exchange to pay two separate checks each month to their insurance company to “segregate” federal funds from private funds that pay for abortion.

Reproductive-rights advocates argue the new system would create a more onerous burden for women seeking coverage for the procedure, while abortion opponents have argued throughout the debate that segregating payments still violates the existing prohibition on federal funds being used to pay for abortion.

Douglas Johnson, the legislative director of the National Right to Life Committee, called the changes “book-keeping contortions” and said that his group plans to put pressure on any senator who votes to consider the changes Reid unveiled.

But the real fight will occur in negotiations between House and Senate leaders over a final bill.

House Speaker Nancy Pelosi of California can’t afford to lose any Democrats. And with Stupak threatening to vote against the Senate compromise, she’ll need to offset his vote with other Democrats who voted against it the first time. She might be able to pick up some moderate-to-conservative Democrats who favor the Senate approach, but many of these lawmakers will need to be OK with the final abortion restrictions.

On the other side, a bloc of abortion-rights backers, led by DeGette, has already promised to vote against any bill that includes Stupak’s amendment, which would prevent people who receive government subsidies from purchasing coverage for elective abortions through the exchange. DeGette believes many of the 41 Democrats who voted for Stupak and “yes” on the House health care bill are willing to work with party leaders to find a middle ground.

The opposing camps are similarly entrenched on the public option and the method for financing the health care expansion. The House would create a government-sponsored insurance plan, but the Senate bill is silent on this point. After several attempts at compromise, Reid nixed the public option altogether.

The taxes could prove difficult to bridge. The House relies on a so-called millionaires’ tax, and has refused to consider the tax on expensive insurance plans. The Senate has taken the exact opposite posture. But because the White House has weighed in several times in favor of the tax on “Cadillac” plans, as a key component to slow the growth rate in health care spending, the Senate is likely to win this round.

Meanwhile, Republicans increaed their attacks on the bill Sunday, criticizing a variety of deals cut to win the votes of Democratic senators, such as Nelson, who got the federal government to pick up the cost of any Medicaid expansion under the health reform bill in the state of Nebraska forever. Republicans said Democrats have refused to say which state would get about $100 million inserted into the bill on behalf of a still unidentified university hospital.

“This process is not legislation. This process is corruption,” said Sen. Tom Coburn (R-Okla.). “And it’s a shame that that’s the only way we can come to consensus in this country is to buy votes.”

But Nelson defended his efforts. “I always put Nebraska first,” he told POLITICO in an interview Saturday. “But I looked at this through the standpoint of Nebraskans and the country. ... There is a difference between holding out for something and holding up. I was holding out for something to make it better.”


Sources: Politico, Washington Post, AP

GOP Succeeds In Health Care Reform Slowdown

Senate debate stalls as GOP forces reading


The debate on the health care reform bill stalled Wednesday as Senate Republicans forced the Senate clerk to read a 767-page amendment establishing a government-financed health care system.

"Republicans have a number of tools at their disposal that can be used, this is an option that was discussed for some time and our conference is unified in its execution," said a Senate Republican leadership aide.

Don Stewart, a spokesman for Minority Leader Mitch McConnell (R-Ky.), added, "This will take several hours, if not the balance of the day."

Senate staff estimate the reading could take eight hours.

Sen. Bernie Sanders (I-Vt.) offered the amendment, and asked to dispense with the reading of it, which is almost always agreed to by unanimous consent. But Sen. Tom Coburn (R-Okla.) objected -- it takes only one senator -- which then forced the reading.

Sanders called it a "bit absurd" that Coburn was objecting. Coburn insisted he wasn't intentionally stalling the bill. "We're going to understand what single payer is all about and read the bill," he said.

Republicans appear to have no immediate plans to stop the reading.

This development will prevent senators from offering, debating or voting on any other amendments. While it might seem like the reading would set back efforts to finish the bill by Christmas, the timetable doesn't really depend on what happens on the floor.

It depends entirely on Majority Leader Harry Reid's ability to reach a compromise on the bill that can pick up 60 votes.

“The only thing that Sen. Coburn’s stunt achieves is to stop us from moving to the DoD appropriations bill that funds our troops – not exactly the kind of Christmas gift that our troops were expecting from Dr. No,” said Jim Manley, a spokesman for Reid.

Manley said the amendment will take 12 hours to read. The reading can only be interrupted to ask that it be waived, which presumably would be objected to by Coburn, who is sitting in the chamber.

Before forcing the reading, Coburn asked to certify that every senator has read and understands the bill. But Democratic Sen. Max Baucus said it would be impossible for the Senate to certify that all its members understand the bill.


Sources: Politico