Health Care Reform Update From the Capitol for the Week of June 15
The Administration's Message
- At a Brookings Institution seminar Tuesday, White House Office of Management and Budget Director Peter Orszag said any health reform proposal must gain the approval of "an appropriately skeptical" Congressional Budget Office, CQ HealthBeat reports. Also on Tuesday, Orszag said that the Obama administration plans to propose an additional $200 billion to $300 billion in Medicaid and Medicare cuts to help fund health reform. With those reductions, total savings from Medicare and Medicaid cuts and other revisions could amount to $500 billion to $600 billion, CQ HealthBeat reports (Reichard, CQ HealthBeat, 6/9).
- Last week, Christina Romer, chair of the president's Council of Economic Advisers, said, "Good health care reform is good economic policy," adding that the 6% annual increase in health care costs is a threat to the federal budget and a burden to employers and families. According to Romer, if current health care spending increases continue, health care will consume one-third of gross domestic product by 2040, compared with 18% now. She added that the Obama administration is looking to reform the current system rather than start from scratch and implement a single-payer system (Abate, San Francisco Chronicle, 6/9).
- Earlier this month, HHS Secretary Kathleen Sebelius said that a public health insurance option needs to be established in order to undo monopolies by private health insurers in some parts of the country (Adamy, Wall Street Journal, 6/5).
Dollars and Sense
- CBO is expected to issue its budget score on Democratic health care reform proposals today, and some Senate Democrats expect the price tag to be so large that they are suggesting "changing the chamber's normal accounting procedures," The Hill reports. According to The Hill, some lawmakers have talked about using cost estimates from OMB, instead of CBO's, which could provide them with hundreds of billions of additional dollars to use as they design reform plans. However, Republican lawmakers "would call it an accounting gimmick and a huge spending loophole," The Hill reports (Bolton, The Hill, 6/11).
- On Tuesday, Senate Budget Committee Chair Kent Conrad (D-N.D.) and ranking member Judd Gregg (R-N.H.) sent a letter to CBO requesting an analysis of proposals that would "most effectively bend the health care cost curve over the long term" (Edney/Hunt, CongressDaily, 6/9). The letter asked the agency to submit by June 16 an analysis of policies that could stabilize health care spending (CQ HealthBeat, 6/9).
- House Ways and Means Health Subcommittee Chair Pete Stark (D-Calif.) on Thursday called for a 2% income tax surcharge to fund health care reform, the San Francisco Chronicle reports. He said, "If you wanted me to bet how would I pay for this, I would tell you not to bet against a surtax." He added that when it comes to funding a reform bill, "it'll be, 'Swallow hard, take the tough vote'" (Lochhead/Lewis, San Francisco Chronicle, 6/12).
Senate Finance Committee Proposal
- The Senate Finance Committee's proposal for overhauling the health care system likely will include government-organized health insurance cooperatives that would have a role similar to a proposed public insurance plan, committee Chair Max Baucus (D-Mont.) said, CQ Today reports (Wayne, CQ Today, 6/11). The co-op plan, proposed by Conrad , would be publicly owned and operated for the benefit of its members -- individuals and businesses with fewer than 10 workers. Conrad said that health insurance co-ops already exist in some states and have proven successful (Simmons, HealthLeaders Media, 6/11). Democrats believe that a new public plan is the only way to make affordable care available to more U.S. residents, and many are dubious of the co-op plan (CQ Today, 6/11). House Speaker Nancy Pelosi (D-Calif.) and House Energy and Commerce Committee Chair Henry Waxman (D-Calif.) oppose the co-op plan as a replacement for a public option, noting that it would not achieve their reform goals (Edney, CongressDaily, 6/11).Â Republicans have said a public plan would drive insurers out of the market and force people to give up coverage they are happy with. According to CQ Today, most Republicans, insurers and business groups also oppose the co-op proposal.
- A draft of the Finance Committee bill that will include scoring by CBO is expected to be released Wednesday. Baucus Chief of Staff Russell Sullivan said the draft likely will not include details of some provisions, such as a public option and the bill's total cost. Baucus expects a week-long mark up to begin June 23 (CQ Today, 6/11).
Senate HELP Committee Plan
- Republicans criticized the details of the Senate Health, Education, Labor and Pensions Committee's health care reform legislation soon after they were released, CongressDaily reports. Republicans are opposing the legislation -- drafted under the guidance of HELP Committee Chair Edward Kennedy (D-Mass.) -- because they say it lacks their input (Edney, CongressDaily, 6/10). Committee ranking member Mike Enzi (R-Wyo.) and 15 other Republican senators on Tuesday sent a letter to senior Democrats asking for additional time to consider the legislation and evaluate its cost (Levey, Los Angeles Times, 6/10). The letter also asked for several concessions from Democrats before the committee begins mark up of the legislation. Republicans asked that Democrats allow all committee members seven to 10 days to review legislation; notify all committee members of the cost of different initiatives as estimated byÂ CBO and the Joint Committee on Taxation; and that Democrats "identify the offsets used to pay for health reform" (CQ HealthBeat, 6/9). The HELP Committee will mark up its bill Tuesday, according to CongressDaily (CongressDaily, 6/10).
- After a Wednesday Senate HELP Committee health reform "walk-through," Sen. Orrin Hatch (R-Utah) criticized HELP Committee Democrats for releasing a bill earlier this week that he said abandoned efforts at bipartisanship, calling it "about as anti-bipartisan as any bill I've seen in the whole time I've been here." He added that Democrats made "no attempt whatsoever" to seek Republican input, although he suggested that this may have been different had Kennedy, rather than his staffers, overseen the process (Reichard, CQ HealthBeat, 6/10).
- In a HELP Committee hearing Thursday, representatives of insurers, hospitals, doctors and business groups told the panel that they oppose several elements of the committee's health reform draft bill released this week. According to CQ HealthBeat, lobbyists for many groups believe that the White House and Congress "would shut them out of negotiations if they were perceived as trying to torpedo an overhaul," but "fears about the level of government involvement in health care" included in the HELP Committee proposal "have loosened their tongues" (Reichard/Norman, CQ HealthBeat, 6/11).
- On Wednesday, the U.S. Chamber of Commerce said that it is concerned about some proposals included in draft legislation released by the SenateÂ HELP Committee, the Wall Street Journal reports. The group is concerned that requiring employers to help pay for workers' health coverage would create an additional expense at a time when businesses are struggling to remain profitable. In addition, the group is concerned that a public health insurance option would undermine the employer-based system (Adamy, Wall Street Journal, 6/10).
- Democrats on the House Ways and Means Committee met Wednesday to discuss options for preserving employer-based health insurance while establishing a public health insurance option, CongressDaily reports (Cohn, CongressDaily, 6/10). Republicans have argued that a public plan option would encourage U.S. residents to drop private insurance and employers to suspend coverage, which would overwhelm the government plan and result in rationed care (Wayne/Armstrong, CQ Today, 6/10).
- On Wednesday, Senate Finance Health Subcommittee Chair Jay Rockefeller (D-W.Va.) proposed legislation that would establish and offer a public plan option within a national health insurance exchange. Under the bill, the public plan would be operated by a new HHS office and the president would appoint an administrator of the plan. The plan would be funded by premiums from individuals and by contributions from employers who do not provide health insurance benefits. The new office would be required to "promote consistent standards" for information about the plan and "to promote transparency in coverage" for consumers and health care providers (HealthLeaders Media, 6/11).
- In a letter to President Obama, the Congressional Black Caucus earlier this month said that a public option similar to Medicare should be included in health care overhaul legislation (Soraghan, The Hill, 6/7). Black, Hispanic and Asian lawmakers said Obama must focus more on racial disparities in medical treatment, as lawmakers work to overhaul the health care system, the AP/San Diego Union-Tribune reports. The lawmakers are planning to introduce an alternative health care proposal that they say would improve services in low-income areas, eliminate language barriers and improve data collection to help identify gaps in care for racial and ethnic groups (Evans, AP/San Diego Union-Tribune, 6/9).
- The New Democrat Coalition and the Blue Dog Coalition were scheduled to meet Friday in an effort "to show some strength in numbers as they haggle with party leaders" and the three House chairs drafting health care legislation, Politico reports. The groups' discussion will center on a proposed public plan option and how lawmakers can ensure that reform proposals do not undermine the private market (O'Connor/Budoff Brown, Politico, 6/12).
- On Thursday, some GOP senators and health care lobbyists met with companies that likely would incur the costs of Democratic health care reform proposals, according to Sen. John Thune (R-S.D.), CQ Today reports. Thune said the goal of the meetings was to feel out the reaction of health care companies, and possibly recruit stakeholders who will oppose options like a requirement that employers help employees cover the cost of health insurance (Jansen/Vadala, CQ Today, 6/11).
- Some health industry lobbyists are considering joining Republicans in a campaign to stall health reform efforts that include mandates on employers or a public health insurance option that would compete with private insurers, Roll Call reports. According to Roll Call, advocacy groups for insurers, hospitals, provider groups and employers so far "have been engaged in a marriage of convenience, hoping that by maintaining radio silence in exchange for a seat at the negotiating table they could influence the process and obtain a reform bill to their liking." However, some "of their member companies are starting to worry that keeping quiet will only make matters worse," Roll Call reports (Drucker/Ackley, Roll Call, 6/9).
- Enzi and other Republican members of the HELP panel held a news conference Thursday in which they criticized the proposed public insurance option (Drucker, Roll Call, 6/11).
- During an appearance on "Fox News Sunday," Sen. Richard Shelby (R-Ala.) said that now is not the time to overhaul the U.S. health care system because of the recent hike in government spending and looming budget deficits (Ackley, Roll Call, 6/7).
Influencing the Debate
- The 20 largest health insurance companies and drugmakers in the first quarter of 2009 spent nearly $35 million on lobbying efforts related to health reform, a 41% increase from the $10 million spent during the same period in 2008, according to a USA Today analysis of disclosure reports. CQ MoneyLine data show that all health care sectors spent $149 million on lobbying this year -- a 10% increase -- even though overall spending on lobbying is down 2.6% for the year (Fritze, USA Today, 6/12).
- Organizing for America -- a Democratic political group -- has been gathering stories from Obama's supporters about how existing health care policy affects their lives. According to USA Today, the organization hopes "that the weight of testimony will pressure Congress into translating Obama's vision for health care reform into legislation" (Jackson, USA Today, 6/11).
- A coalition of unions and liberal organizations called Montanans for Healthcare has urged constituents of Baucus to contact the lawmaker and push for a public plan option, The Hill reports. The coalition includes the AFL-CIO; the Service Employees International Union; the American Federation of State, County and Municipal Employees; the National Education Association; the American Federation of Teachers; and Health Care for America Now (Bolton, The Hill, 6/10).
- At a news conference Tuesday, members of America's Agenda introduced priorities for health reform that leaders from business, labor and health care-provider communities favor, CQ HealthBeat reports. The group supports access to care for all U.S. residents, improved chronic disease prevention, a plan to boost care efficiency, strengthened primary care and a uniform health information technology program. Also, the organization backs legislation (S 803) introduced by Sen. Tom Harkin (D-Iowa) that would provide a tax credit to employers who start wellness programs. The group strongly objects to a proposal to tax employer-sponsored health benefits (Stephenson, CQ HealthBeat, 6/9).
- Earlier this month, Conservatives for Patients' Rights launched a $1.2 million television advertising campaign that criticizes the inclusion of a public option in health care reform legislation (Drucker, Roll Call, 6/4).
- In a YouTube video, Sen. Christopher Dodd (D-Conn.), who is leading health reform efforts on the SenateÂ HELP Committee in Kennedy's absence, asked the U.S. public for ideas on health care reform and for constituents to inform lawmakers about what aspects of the U.S. health care system do and do not work (Phillips, "The Caucus," New York Times, 6/5). In the video, Dodd said, "It's clear [to] everybody the current system isn't working" (Rhee, "Political Intelligence," Boston Globe, 6/5).
- The American College of Emergency Physicians has launched a letter-writing campaign urging lawmakers to address the needs of emergency patients, HealthLeaders Media reports (Commins, HealthLeaders Media, 6/8).
- Health care reform proposals being considered in Congress could save small companies $546 billion to $855 billion over the next decade in health care costs, even if there is a mandate requiring employers to help pay for workers' medical coverage, according to an analysis released Thursday by the Small Business Majority, the New York Times reports. The report, by Massachusetts Institute of Technology economist Jonathan Gruber and colleagues, examined health reform proposals that would require small businesses to contribute a portion of their payroll toward health coverage in exchange for tax credits to help cover the expense (Abelson, New York Times, 6/11).
- A national health insurance exchange and revised policies that would help more people gain access to health insurance could help create a more patient-centered health care system and reduce the number of uninsured U.S. residents, according to a report released Thursday and co-sponsored by the Commonwealth Fund and Consumers Union, CQ HealthBeat reports. The report suggests that a high-quality health care system can be established with a mixed public-private insurance system, a requirement for all employers to offer or contribute to coverage of their workers, and an individual coverage mandate (Stephenson, CQ HealthBeat, 6/11).