The cost and the level of public involvement continue to be sticking points in the effort to pass health care reform.

health care reform, health policy, Chris Dodd, Olympia Snowe, John Boehner, Joe Biden, Rahm Emanuel, Medicare Part D, Charles Schumer, Edward Kennedy, Max Baucus

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Hard bargaining on health care reform under way

July 20th, 2009

WASHINGTON – The cost and the level of public involvement continue to be sticking points in the effort to pass health care reform.

While the White House reached deals this month and in June with the hospital and pharmaceutical industries for combined 10-year savings of over $200 billion, some lawmakers questioned if government offerings were worth the concessions.

Senators Chris Dodd, (D., Conn.) and Olympia Snowe (R., Maine) were among legislators who said they were awaiting details of the give-backs — which followed a promise by a consortium of physicians, insurers, hospitals and drug manufacturers to slow spending growth by 1.5%.

And House GOP leader John Boehner of Ohio faulted the hospital deal, saying it was negotiated behind closed doors. “The administration and congressional Democrats are literally bullying health care groups into cutting back-room deals to fund a government takeover of health care,” he said.

In announcing the deal, Vice President Joe Biden said reform “is on track; it is coming. We have tried for decades to fix a broken system, and we have never, in my entire tenure in public life, been this close.”

Addressing lawmakers, he added, “We must — and we will — enact reform by the end of August.”

Biden said hospitals would give up about $155 billion in government payments. The money could help provide coverage for millions of uninsured people, he said. Biden’s remark followed President Obama’s commendation of drug manufacturers’ $80 billion concession as “a significant breakthrough on the road to health care reform.” Obama has said he wants to sign a reform bill in October.

The administration’s assurances and the cooperation of industry players notwithstanding, funding for a plan costing an estimated $1 trillion or more remains elusive. New taxes will be inevitable, but few politicians will support them.

House and Senate members came back from their July 4 recess with concerns about a proposal to tax workers’ health insurance once its value passes a certain level. Republicans are for the benefits tax, but Democrats are resisting it.

“I don’t see it as having any viability,” said Dodd.

Snowe, a centrist who has been negotiating for a bipartisan bill, said the tax had little support among Democrats. She called for going “back to the drawing board” on some issues “to see where we can achieve greater cost savings.”

With the president saying that reform must not swell the deficit, legislators must develop untapped revenue sources while making cuts in such areas as Medicare.

Besides the expense, the nature of an overhaul continues to vex policy makers. While the call for a public insurance option has been controversial, it should be seen as a means rather than an end, according to White House chief of staff Rahm Emanuel.

The nonnegotiable goal, he said, is to foster competition among insurance plans. One way to get there would be by having a public plan that would only be triggered by private monopolization.

Congressional Republicans produced a similar mechanism with the creation of Medicare Part D in 2003, notes Emanuel. But vigorous private competition for the prescription benefit has precluded the need for a public program.

Yet the trigger mechanism is not palatable to all Democrats. For instance, Sen. Charles Schumer of New York said supporters of a public option would have a problem with reform that didn’t have government-run insurance “on day one.”

While Obama has pressed for public insurance, he said he won’t draw a “line in the sand” over the issue. He said in late June that a government-run option is “one of the best ways to bring down costs, provide more choices, and ... force the insurance companies to compete and keep them honest.”

While Obama can be expected to have the backing of the Democratic-controlled House and Senate, five congressional committees have jurisdiction over health care and none are standing on the sidelines. In the House, three committees are crafting legislation: Ways and Means, which drafts tax laws; Energy and Commerce, which oversees public health; and Education and Labor, which is responsible for employee benefits.

In the Senate, the Health, Education, Labor and Pensions Committee chaired by liberal Sen. Edward Kennedy (D., Mass.) handles health policy. The Finance Committee, a more moderate group, has responsibility for taxes, Medicare and Medicaid.

While two more committees are working on the issue in the House than in the Senate, the legislative process is simpler there because a single bill is being crafted. And Democrats have a greater majority in the House than they do in the Senate.

While Democrats now have the 60 seats needed to pass a Senate bill, Kennedy and Robert Byrd of West Virginia have been on medical leave. And centrists may find the health committee’s proposal too liberal. If there is to be a bipartisan bill — which Obama is demanding — it can be expected to come out of the Finance Committee.

The chairman of that panel, Max Baucus of Montana, said in June, “President Obama and I are on the same page ... We are going to get this done.”

Still, not one committee has yet to approve legislation, which must take place before it’s taken up by the full House or Senate. The upshot is that representatives or Senators must work fast to get bills through both bodies before leaving Washington for their August recess.

Deadlines have already been missed, but the House could have a bill before the break. Senate rules allow prolonged debate, and senators must address bills from two committees that could be at cross purposes.

If legislation passes both chambers, it must be unified by Senate and House negotiators in a conference committee, a process that has brought down more than a few bills. Only after approval in conference and passage of the revised legislation by both chambers can Obama sign it.