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JANUARY 8, 2010

This Week in Health Care Reform     

While still technically in recess, members of Congress trickled back to Washington, D.C. this week to get a jump start on reconciling the health care reform bills passed by the House and Senate last year.

On Tuesday, Democratic leaders began conversations around a final package, pledging to overcome differences and aiming to have a bill passed by the President Barack Obama’s State of the Union Address, anticipated in early February. Members of the news media, however, have highlighted the difficult negotiations ahead, given some major differences in the proposed packages and the time pressure being imposed by President Obama.

We continue to encourage you and others to engage members of Congress during this debate by visiting the Health Action Network.        

Health Reform Negotiations

Senate Passes Reform Bill:  At 7:05 a.m. on Christmas Eve, Senate Majority Leader Harry Reid (D-NV), along with 59 other Senate members, voted to pass reform legislation that, according to the Congressional Budget Office (CBO), would expand health coverage to approximately 31 million people at a cost of $871 billion over 10 years. The bill passed on party lines (60-39), without a single Republican vote in favor. Republicans believe the bill would impose many regulatory and financial burdens on taxpayers and businesses while increasing government debt.

Reconciliation Poses Difficult Road Ahead: Before lawmakers can present a final health care reform bill to President Obama, the approved Senate bill needs to be merged with the House version passed in November 2009, which extends coverage to 36 million Americans at a cost of about $1 trillion. However, the bills have some major differences that will need to be addressed as lawmakers shape the final package, including:

* Insurance market reform and exchanges - Both bills would bar insurers from denying coverage to those with pre-existing conditions and from dropping coverage for those who get sick. Both would also create insurance exchanges through which small businesses and individuals could shop for insurance. The Senate bill would create state-based exchanges, however, whereas the House bill would create a national exchange with an option for states to run state-based programs if they meet certain requirements.
* The government-run plan - A government-run plan was a central component to the House bill. The Senate bill would instead direct the U.S. Office of Personnel Management to contract with private insurance companies to offer policies on the exchanges. Despite much commotion over the need to include the public option, House leaders conceded Tuesday that they may be willing to agree to a bill without a public option if other parts of the bill fulfill the same goals, with the hope of expanding available subsidies.
* Reform financing - Members of the House would pay for the reform effort  - which carries a price tag of about $1 trillion - through a 5.4 percent surtax on individuals making more than $500,000 a year and couples making more than $1 million and by imposing a 2.5 percent excise tax on medical devices.  Members of the Senate, on the other hand, plan to pay for their $871 billion plan through several measures:

- a 40 percent excise tax on high-cost health insurance plans;
- an increase in payroll taxes for Medicare on individuals making more than $200,000 a year and couples making more than $250,000 per year;
- fees on insurers, medical device manufacturers and drug companies;
- and, a 10 percent tax on indoor tanning salons.

On Wednesday, President Obama expressed his preference for the insurance tax contained in the Senate bill, but the excise tax is strongly opposed by labor unions.

* Coverage Mandates - Both bills require that individuals obtain health insurance and impose a penalty on those who do not. The House bill also includes an employer mandate for companies with payrolls above $750,000. The Senate bill does not include this mandate but would require companies with more than 50 employees to pay a fine if employees obtain federally subsidized coverage on the insurance exchange.
* Medicaid expansion - Both bills expand Medicaid. The Senate bill makes Medicaid available to those with incomes up to 133 percent of the poverty level, whereas the House allows for coverage for those with incomes up to 150 percent of the poverty level.
* Abortion - While both bills bar the use of federal funds for abortions, the House bill includes stricter language requiring anyone seeking abortion coverage to buy separate insurance riders. The Senate bill would let the states choose whether or not to include plans with abortion coverage in the insurance exchange and would require those with abortion coverage to write a separate check for this insurance.

President Obama Pushes Swift Action: In a meeting at the White House Tuesday, President Obama encouraged House Speaker Nancy Pelosi (D-CA) and House Majority Leader Steny Hoyer (D-MD), as well as Senate Majority Leader Harry Reid and Sen. Dick Durbin (D-IL), who participated via phone, to bypass the traditional conference committee used to negotiate reconciliation, in the interest of time. The move, which creates a three-way negotiating construct involving top Democrats in the House and Senate and the White House, will exclude Republican lawmakers from the debate and reduce their ability to delay the voting.

Further, President Obama indicated that he would be taking a hands-on approach to the final stages of the negotiations. The President held another meeting with leading Democrats on Wednesday to help iron out differences between the House and Senate bills. Democrats also held a noon meeting and conference call on Thursday to discuss how reconciliation will proceed and some of the priorities for the final bill.

Additional Activities

C-SPAN Calls for Transparency: Noting that President Obama mentioned several times during his campaign that health care negotiations would be transparent and broadcasted on C-SPAN, Brian Lamb, C-SPAN CEO, sent a letter to House and Senate leaders on December 30 asking for negotiations to be opened up for public viewing. Republicans pointed out that the most critical discussions on health reform have taken place behind closed doors so far. Top House Democrats deflected the C-SPAN request, saying the process has been highly transparent through more than 100 public hearings held by the House. They pledged to make the final stages transparent in part via the Internet.

Opponents Question Constitutionality: On Wednesday, December 30, Republican attorneys general in 13 states - including Colorado, Florida, Idaho, Michigan and Virginia - sent a letter to Sens. Nancy Pelosi and Harry Reid stating that Congressional leaders must remove the amendment exempting Nebraska from having to pay for the state’s Medicaid expansion. The prosecutors are calling the deal unconstitutional and threatened legal action. Members of the news media report that South Carolina Attorney General Henry McMaster and Oklahoma top prosecutor Drew Edmondson are asking attorneys general across the country to call on Sens. Pelosi and Reid to remove the provision.

In addition, a contingency of legal scholars as well as many Republican lawmakers are calling the measures passed by both the House and the Senate unconstitutional , primarily due to the inclusion of an individual mandate. “In the history of this country, the federal government has never required every American to enter into a contract with a private company,” said Randy Barnett, a professor of constitutional law at Georgetown University Law Center.

Looking Ahead

Formal sessions in Congress are scheduled to begin January 19, 2010. Sen. Pelosi, however, plans to continue to work with key committee chairs and other Democratic leaders prior to the official sessions..

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Article Source:http://www.articlesbase.com/politics-articles/this-week-in-health-care-reform-1687026.html

President Obama met Wednesday with House Democratic leaders who face the likelihood of having a final health care bill look much more like the Senate’s version than their measure.

The meeting with House Speaker Nancy Pelosi and the chairmen of the three House committees that approved health care legislation was part of efforts by Obama and top Democrats to merge the separate House and Senate bills into a final version capable of winning approval in both chambers.

Senior Democratic sources say Democrats are prepared to short-circuit the traditional legislative process of a formal conference committee comprising House and Senate members to exclude their Republican counterparts during final congressional health care deliberations.

Obama gave his blessing Tuesday for that move, according to two congressional Democratic leadership sources.

Democrats are trying to prevent the Republicans from using Senate rules to slow the push for final passage of a comprehensive reform bill, the sources said.

“There’s clearly a tactic of slowing down progress on behalf of the American people,” White House Press Secretary Robert Gibbs said Wednesday of GOP maneuvers in the Senate. When asked if Obama supported avoiding a formal conference committee, Gibbs said: “The president wants to get a bill to his desk as quickly as possible.”

Republicans, in turn, are pushing to allow open media coverage of the final negotiations — a move many observers believe would complicate House and Senate Democrats’ ability to forge a consensus.

The full House of Representatives is not scheduled to return from vacation until January 12; the Senate meets January 19. But top representatives and senators, as well as their aides, have already been discussing the issue.

Congressional leaders are working to merge an $871 billion Senate bill and $1 trillion House bill that differ on several critical details.

Democratic leaders hope to get a bill to Obama’s desk by early February, near the time of the president’s State of the Union address, several Democratic sources have said. Pelosi, D-California, admitted last month that this deadline could slip.

Should the measure that emerges from House-Senate negotiations become law, it would constitute the biggest expansion of federal health care guarantees since the enactment of Medicare and Medicaid more than four decades ago.

Formal House-Senate negotiations, under the ordinary legislative process, would likely have started shortly after both houses of Congress reconvene.

In order to hold a formal conference, the committee members from both the House and Senate must be formally appointed by both bodies, with resolutions passed by both chambers. One Democratic leadership aide said getting those resolutions passed in the Senate could delay and even derail Democratic efforts, because Republicans would be allowed to offer amendments and hold lengthy debates on the resolutions to appoint conferees.

Another potential complication: a recent request from C-SPAN head Brian Lamb to allow television coverage of House-Senate negotiations.

C-SPAN is a nonprofit cable entity largely devoted to coverage of Congress.

“Hard-working families won’t stand for having the future of their health care decided behind closed doors,” House GOP Leader John Boehner of Ohio said in a letter to Lamb released Tuesday. “Secret deliberations are a breeding ground for more of the kickbacks, shady deals and special-interest provisions that have become business as usual in Washington. Too much is at stake to have a final bill built on payoffs and pork-barrel spending.”

Gibbs avoided commenting directly on the C-SPAN request Wednesday, saying the health care debate so far had been fully covered in the news media.

Democrats said it was impossible to predict what kind of coverage might be possible, given that it is unclear if there will be any formal negotiations.

“We will continue to keep the American people informed,” said Maryland Rep. Chris Van Hollen, a member of the House Democratic leadership.

“There has never been a more open process for any legislation,” Pelosi said. But “we will do what is necessary to pass the bill.”

Many observers believe the more liberal House measure will be largely forced to conform to the Senate bill. The traditionally fractious 60-member Senate Democratic caucus struggled to unify behind a single measure, and needs to remain united in order to overcome solid Republican opposition.

However, the House also narrowly passed its health care bill on a 220-215 vote.

The different approach to financing in the House and Senate bills is one of the many differences to be reconciled.

The House measure is paid for through a combination of a tax surcharge on wealthy Americans and new Medicare spending reductions. Individuals with annual incomes over $500,000 — as well as families earning more than $1 million — would face a 5.4 percent income tax surcharge.

The Senate bill also cuts Medicare by roughly $500 billion. But instead of an income tax surcharge on the wealthy, it would impose a 40 percent tax on insurance companies that provide what are called “Cadillac” health plans valued at more than $8,500 for individuals and $23,000 for families.

Proponents of the tax on high-end plans argue it’s one of the most effective ways to curb medical inflation. However, House Democrats oppose taxing such policies because it would hurt union members who traded higher salaries for more generous health benefits.

In December, Obama predicted the final bill will probably end up with a variation of both the income tax surcharge and the tax on high-end plans.

The Senate bill also would increase Medicare payroll taxes on families making more than $250,000; the House bill does not.

Another key sticking point is the dispute over a government-run public health insurance option. The House plan includes a public option; the more conservative Senate package would instead create nonprofit private plans overseen by the federal government.

Pelosi, when asked about the public option on Tuesday, said that Democrats’ goal has always been to hold insurance companies accountable while increasing competition and affordability.

“There are other ways to do that” aside from the public option, she said. Insurance companies will be held accountable and will “be crying out for the public option one of these days.”

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