White House, House Democrats Reach Deal on Medicare Payments
Members of the fiscally conservative House Blue Dog Coalition and House Energy and Commerce Committee Chair Henry Waxman (D-Calif.) left a meeting at the White House on Tuesday with a tentative verbal agreement to grant an independent panel power to influence payment rates for government-run health care programs, such as Medicare, as part of House reform legislation (HR 3200), Politico reports (O'Connor, Politico, 7/22).
In the current system, Congress has more influence over payment rates and often abstains from politically tough votes to restrain Medicare costs, according to fiscal conservatives.
Under the proposal, the executive branch would have the power to implement Medicare cuts recommended by the independent panel.
Congress would have the ability to halt the cuts (Hitt/Bendavid, Wall Street Journal, 7/22).
Waxman canceled markup sessions in the committee on Tuesday and Wednesday so he could meet with the Blue Dogs, who hold seven seats on the committee.
The Blue Dogs could stop the bill if they aligned with the 23 Republicans on the committee in voting against it, making their votes a crucial aspect of reform discussions (Pear/Herszenhorn, New York Times, 7/22).
Rep. Mike Ross (D-Ark.), the chair of the Blue Dog health task force, said the coalition entered the White House sessions with a list of 10 concerns that he said must be resolved in order for the group to support the bill (Dennis/Newmyer, Roll Call, 7/22). He said Blue Dogs were concerned about issues including greater cost containment, a more generous exemption for small businesses from an insurance mandate and changes to the government-run public plan option that Democrats want to create to compete with private insurers (Wayne/Epstein, CQ Politics, 7/22).
Sources said the House Democrats spoke with President Obama for close to an hour and then continued negotiations for an additional hour with White House Chief of Staff Rahm Emanuel and other top members of Obama's staff (Koffler, Roll Call, 7/21).
Ross said the meeting "focused specifically on cost containment" (Pulizzi/Yoest, Wall Street Journal, 7/21).
Ross said the agreement to support an independent commission with the power to control Medicare spending is a "significant breakthrough," although the details must still be worked out and the other issues of concern for the Blue Dogs remain unresolved (Roll Call, 7/22).
Ross also said that "no final decisions have been made" because he and the rest of the coalition are waiting for the Congressional Budget Office to score the potential savings impact of the proposal (Youngman, The Hill, 7/21).
White House Office of Management and Budget Director Peter Orszag called the proposal "probably the most important piece that can be added" to the House reform bill (Politico, 7/22).
Waxman said he still had "personal misgivings" about the independent advisory council but went along with the general agreement to lessen the Blue Dogs' cost concerns (Hunt et al., CongressDaily, 7/22). He also said that while he and the coalition have other issues to discuss, he sees the tentative agreement as "a major turning point" in the House reform debate (Wayne/Epstein, CQ Today, 7/21).
House Reform Timeline
After reaching the agreement, Waxman said he is optimistic that he can move the bill through his committee this week (Roll Call, 7/22).
House Speaker Nancy Pelosi (D-Calif.) shared Waxman's optimism and said she believes the full House can approve the legislation before its month-long recess in August (Politico, 7/22).
However, House Majority Leader Steny Hoyer (D-Md.) said the House could go on recess before finishing the reform legislation. He said, "If we get consensus, we'll move on it" next week, but he added, "If we don't get consensus, I don't think staying in session is necessarily necessary" (New York Times, 7/22).
Hoyer also said that the Blue Dogs are not the only House members with concerns regarding the bill.
Hoyer said, "I want to make it very clear that there's progressives, Blue Dogs and everybody in between who have expressed concerns, and we're working on that." He said points of contention about the bill include a surtax on high-income individuals and families and the public plan option (Khan/Karl, ABCNews, 7/21).
Hoyer said he would make the decision next week on whether to postpone the vote (Newmyer, Roll Call, 7/21).
In a statement to another lawmaker that was overheard by a reporter, House Ways and Means Committee Chair Charles Rangel (D-N.Y.), said, "No one wants to tell [Pelosi] she's moving too fast and they damn sure don't want to tell the president," (Alonso-Zaldivar, AP/Chicago Sun Times, 7/22).
Blue Dog Charlie Melancon (D-La.) said, "Our deal is: Slow this train down." He added, "The president said he wanted a bill by the end of the year. He didn't say Aug. 1" (Hunt/House, CongressDaily, 7/21).
However, House Majority Whip James Clyburn (D-S.C.) said on Tuesday that legislators "cannot keep putting this off." He added, "I have absolutely no problems with us working through the August recess if that's what it takes" (Soraghan, The Hill, 7/21).
House To Consider Pay/Go
On Thursday, the House is expected to consider the Democrats' pay/go legislation (HR 2920), which would require any new tax or mandatory spending legislation that would add to the deficit to be offset with cuts or cost alterations elsewhere.
Hoyer said the bill is "one of the most important actions" the House "can take toward fiscal discipline in this Congress."
The White House on Tuesday came out in favor of the bill.
According to CongressDaily, Republicans believe the bill would not reduce the deficit and would instead raise taxes. GOP members cited a CBO analysis of the bill released last week that found that the pay/go bill could result in an increase to the deficit of $3 trillion over 10 years because of an exemption for four types of legislation from the law:
- Middle-class tax cuts;
- The estate tax;
- A patch keeping the alternative minimum tax from affecting middle-income U.S. residents; and
- Providing higher Medicare payments to physicians (Sanchez, CongressDaily, 7/22).
Members of the Senate also oppose the bill.
Senate Budget Committee Chair Kent Conrad (D-N.D.) said the bill is actually weaker than current pay/go rules because of the four exemptions (Alarkon, The Hill, 7/21).
Senate Majority Whip Richard Durbin (D-Ill.) said there are no current plans to bring a pay/go bill to the Senate floor (Clark, CQ Today, 7/21).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.