Health Reform Debate Heats Up During August Recess

by Anthony Wilson, California Healthline Contributing Editor August 12, 2009

Although both chambers of Congress are quiet during the August recess, the volume of the health reform debate has increased nationwide. Protesters have swarmed town-hall meetings arranged by congressional lawmakers, loudly advocating against Democratic reform plans. Democrats have responded by meeting with key White House aides to develop strategies to handle the opposition.

House Speaker Nancy Pelosi (D-Calif.) “barnstormed” through California on Monday to rally support for health reform. Pelosi’s tour, amid “friendly crowds and political allies,” came one day after she and House Majority Leader Steny Hoyer (D-Md.) wrote in a USA Today opinion piece that protesters who shout down lawmakers attempting to explain facets of the reform proposals are “simply un-American.”

Another lawmaker who has been quite vocal over the previous few weeks is Sen. Jay Rockefeller (D-W.Va.). In an opinion piece, Rockefeller advocated for an Independent Medicare Advisory Council, saying IMAC would be empowered to make Medicare decisions that “have become increasingly complex” and would help control overall health costs.

Rockefeller also took advantage of the relative silence of his fellow lawmakers by introducing two bills that tackle health reform in piecemeal fashion. The Medicare Prescription Drug Coverage Improvement Act, introduced Thursday, would allow the HHS secretary to negotiate directly with drugmakers on behalf of Medicare. The following day, Rockefeller introduced the Affordable Access to Prescription Medications Act of 2009, which aims to reduce U.S. residents’ prescription drug spending by placing a cap on out-of-pocket spending.

On the other side of the aisle, Senate Budget Committee ranking member Judd Gregg (R-N.H.) noted in a release (.pdf) that the federal deficit hit $1 trillion in July for the first time ever and asserted that nothing is being done to address the shortfall. Gregg writes that Democrats instead are “forging ahead with wildly expensive health care reform proposals.”

The volume of the reform debate might be escalating because lawmakers are unsure of what details are in health reform legislation. According to a pair of studies appearing on the Health Affairs Web site, research on health reform is “too often flawed and poorly targeted toward the questions that are most important to decisionmakers.” One study suggests that “policymakers and the public do not always know what to believe” because of flawed research, while another says that researchers and policymakers have different priorities.

While you attempt to hear your own thoughts on health reform above the din, here is a recap of the major events of the past week related to a health system overhaul.

Administration Message

The White House on Monday launched a “reality check” Web site aimed at dispelling false claims made by opponents of Democratic health reform plans, the Los Angeles Times reports. The Web site includes an array of videos featuring top administration officials and health care experts repudiating charges that reform legislation being drafted in Congress would result in euthanasia, rationed care and a government takeover of health care. Melody Barnes, head of President Obama’s Domestic Policy Council, said, “We’ve been really surprised by some of the wild rumors we’ve heard flying around” (Parsons, Los Angeles Times, 8/11).
In his weekly radio and Internet address on Saturday, Obama responded to recent opposition and criticism to his health reform plan and sought to make the case that reform is essential to the country’s economic recovery, the AP/Miami Herald reports. Obama said, “We’ve begun to put the brakes on this recession and … the worst may be behind us,” adding, “We must lay a new foundation for future growth and prosperity, and a key pillar of a new foundation is health insurance reform” (Sidoti, AP/Miami Herald, 8/8).
On Saturday, White House officials said several options were being considered — including a Web site and public appearances by the president — to address false claims in the media and from opposition groups to Obama’s reform plans, the Washington Post reports. According to the Post, recent polls have found that only about one-third of seniors favor a health care overhaul. Many seniors have expressed fears that proposals to cut more than $500 billion in Medicare spending over the next 10 years to extend health coverage to millions of younger, uninsured people would affect their medical care (Connolly, Washington Post, 8/9).
The pharmaceutical industry has authorized its lobbyists to spend about $150 million on television advertisements supporting health reform, people close to the issue said on Saturday, the New York Times reports. Top officials of the Pharmaceutical Research and Manufacturers of America are scheduled to meet this week to finalize plans for the fall, according to unnamed sources who were briefed on the group’s plans (Kirkpatrick, New York Times, 8/9).
The cost of expanding access to preventive care services would outweigh any benefits, according to Congressional Budget Office Director Douglas Elmendorf, the Washington Post reports. In a letter to House Energy and Commerce Committee leaders, Elmendorf said, “Although different types of preventive care have different effects on spending, the evidence suggests that, for most preventive services, expanded utilization leads to higher, not lower, medical spending overall” (Montgomery, Washington Post, 8/8).
On Thursday — one day after the White House reiterated its commitment to a deal struck with drugmakers to reduce spending to help pay for health reform — some lawmakers said they still intend to seek further concessions from the industry, the New York Times reports. Under the deal, reached by the Senate Finance Committee, the drug industry would reduce spending by $80 billion over 10 years and would not be subject to other savings methods, including a provision in the House health reform legislation that would permit the government to negotiate drug prices through Medicare (Kirkpatrick, New York Times, 8/7).
Obama on Thursday told a group of six Senate Finance Committee members to continue working toward a bipartisan consensus on health reform legislation, but stressed the need to pass reform this year, Roll Call reports (Pierce, Roll Call, 8/6). Emerging from the hour-long meeting, committee Chair Max Baucus (D-Mont.) told reporters, “[Obama] wants us to keep working together,” adding, “He prefers a bipartisan agreement, I do, and I think most members of the Democratic caucus do, too, and it’s just a question of how we get there” (Smith/Frank, Reuters, 8/6). Senate Budget Committee Chair Kent Conrad (D-N.D.) confirmed that the meeting included a brief discussion about whether Senate Democrats would invoke reconciliation if negotiations and progress on the reform legislation stall. That option is “not a preferred alternative,” Conrad said. White House press secretary Robert Gibbs, in his daily media briefing on Thursday, said Obama would prefer a bipartisan bill, adding, “It means the president is interested in doing this first and foremost by regular order” (Pierce, Roll Call, 8/6).
Obama administration officials on Aug. 5 told drugmakers that they plan to uphold a deal to cap federal spending reductions on pharmaceuticals at $80 billion and that they will oppose a House Energy and Commerce Committee cost-cutting plan proposed this week, the New York Times reports. The House health reform bill (HR 3200) would require additional rebates from drugmakers and allow the government to negotiate drug prices. The Times reports that upon hearing of the proposal, PhRMA demanded that the administration acknowledge that it had promised to ensure that no more than $80 billion in savings generated to pay for reform would come at drugmakers’ expense. Details of the deal had not been disclosed previously. PhRMA President Billy Tauzin said, “We were assured: ‘We need somebody to come in first. If you come in first, you will have a rock-solid deal,'” adding, “Who is ever going to go into a deal with the White House again if they don’t keep their word? You are just going to duke it out instead.” White House Deputy Chief of Staff Jim Messina said, “The president encouraged this approach. He wanted to bring all the parties to the table to discuss health insurance reform” (Kirkpatrick, New York Times, 8/6).
Speaking before a crowd in Wakarusa, Ind., on Aug. 5, Obama said that he will make sure Congress sends him a health reform bill by the end of the year, with or without the support of Republicans, Reuters reports. Obama in an interview with MSNBC after the Indiana appearance said, “I think that at some point, sometime in September, we’re just going to have to make an assessment,” noting that he favors a plan that would reduce the growth of health care costs, improve quality of care and regulate the insurance market. He added, “I would prefer Republicans working with us on that because I think it’s in the interest of everybody. That shouldn’t be a partisan issue” (Whitesides/Smith, Reuters, 8/5).
On Aug. 5, Senate Democrats gathered at a private White House luncheon with Obama to discuss strategies on moving forward with health reform legislation, McClatchy/Philadelphia Inquirer reports (Lightman/Douglas, McClatchy/Philadelphia Inquirer, 8/5). Obama said that lawmakers should continue to seek a bipartisan agreement on legislation but left open the possibility that legislation could be passed without Republicans’ support if necessary. Obama also said he will respond swiftly to Republican attacks on Democrats’ reform plans (Pear/Herszenhorn, New York Times, 8/5).

Town-Hall Meetings

As senators head back to their home districts for the August recess, many are rethinking holding large constituent events because of the protests being staged at town-hall meetings across the U.S., the Wall Street Journal reports. Many Democratic lawmakers are starting to consider alternatives to the traditional town-hall meeting, opting instead for holding office hours for constituents, smaller events and teleconferences (Adamy/Bendavid, Wall Street Journal, 8/8). Conservative commentators and Web sites have been encouraging opponents of reform to attend the events and be disruptive (Urbina, New York Times, 8/8).
Republican Govs. Haley Barbour (Miss.), Linda Lingle (Hawaii) and Sonny Perdue (Ga.) during a conference call with reporters on Monday defended the protests taking place at town-hall meetings, Politico reports. On the call, organized by the Republican Governors Association, Perdue called the outbursts at the town halls “democracy in action,” adding that the protesters are “citizens who are very concerned” and “just want answers to their questions” (Barr, Politico, 8/10).
Former Alaska Gov. and vice presidential nominee Sarah Palin (R) on Friday posted a comment on her Facebook page saying that the Democratic health care plan would require the elderly and disabled to appear before a “death panel,” a claim that is entirely false, the AP/San Francisco Chronicle reports. Republican governors are avoiding discussing Palin’s comments (Fouhy, AP/San Francisco Chronicle, 8/10).
White House senior adviser David Axelrod and Deputy Chief of Staff Jim Messina on Thursday briefed Senate Democrats on how to promote health reform and respond to protesters at constituent events over the August recess, Politico reports (Budoff Brown [1], Politico, 8/6).
As Congress returns home for the August recess, Democrats have been bombarded in their home districts by conservative opponents of Democratic health reform proposals, the Los Angeles Times reports. According to the Times, protesters are interrupting town-hall meetings, disrupting constituent outreach events and have hung a member of Congress in effigy. Many Democrats had hoped that the break would give them an opportunity to explain the legislation to their constituents, but opponents are using the time to characterize the pending bills as a government takeover of health care (Hook, Los Angeles Times, 8/6).
Senate Democrats on Aug. 5 held a two-hour meeting to discuss strategies for promoting health reform over the August congressional recess, The Hill reports (Young, The Hill, 8/5). Sens. Max Baucus (D-Mont.) and Kent Conrad (D-N.D.) told the senators to emphasize that the chamber’s reform proposals do not include an individual tax increase. In contrast, the House reform bill would levy surtaxes on the highest-income residents (Budoff Brown [2], Politico, 8/6). According to The Hill, many attendees emerged from the meeting confident that a pledge not to increase taxes on U.S. residents will be a “winner” in discussions with their constituents during the recess (The Hill, 8/5).
Senate Majority Leader Harry Reid (D-Nev.) on Thursday painted the use of reconciliation by Democrats only as a final option, adding, “We’re not even discussing that. We believe health care should be bipartisan.” Baucus said he plans to keep working toward a Sept. 15 deadline for completing a bipartisan bill, adding, “We’ll take stock when we get back, and at that point, if things are going great, fine. And if not, then we may have to go in some other direction” (Pierce, Roll Call, 8/6). He said the negotiating group has settled on a tentative schedule to conduct teleconference meetings over the recess, with additional in-person meetings (Drucker, Roll Call, 8/6).

Interest Groups

On Tuesday, a multidenominational coalition of religious groups launched a 40-day campaign to encourage about 100 members of Congress in 18 states to pass health care reform legislation this year, CongressDaily reports. The campaign will include television advertisements, special sermons and a telephone conference call and webcast with President Obama on Aug. 19 (Dann, CongressDaily, 8/10). The coalition’s members said one of their objectives is to challenge the false information that has surfaced about health reform efforts (Dennis, Roll Call, 8/10).
The U.S. Commission on Civil Rights questioned some provisions in the House health reform bill (HR 3200) that would help minority medical students with scholarships and favor certain medical schools and organizations, the Washington Times reports. The commission on Friday also approved a draft letter that says health reform “programs are unlikely to reduce health care disparities among racial and ethnic groups. A growing body of evidence indicates that increasing access to high-quality physicians — whatever their racial or ethnic ancestry — is the best way to mitigate such disparities.” The letter must be approved again before it can be sent to Obama and Congress (Haberkorn, Washington Times, 8/11).
In a Aug. 4 conference call with reporters, America’s Health Insurance Plans President and CEO Karen Ignagni decried the recent emphasis by Democrats that insurers are standing in the way of health reform and pledged to “correct the record” on her group’s stance, The Hill reports (Young, The Hill, 8/4). Since the beginning of August, Obama has begun referring to the proposed overhaul as “health insurance reform” rather than “health care reform,” and House Speaker Nancy Pelosi (D-Calif.) last week said that insurers are “immoral,” adding, “They are the villains in this.” Ignagni also criticized the idea of creating local not-for-profit health insurance cooperatives, suggested by some as a compromise between supporters and opponents of a public plan (Wayne, CQ Today, 8/4).

Coverage Expansion

Senate Finance Committee Chair Max Baucus (D-Mont.) on Thursday said that under the committee’s health reform plan, states would be asked to help finance an expansion of Medicaid, CQ Today reports. Before returning to a meeting that included a conference call with some governors, Baucus said that the federal government “just can’t foot the entire bill for the states.” However, he did not say how much states would be asked to contribute (Wayne/Armstrong, CQ Today, 8/6).
The two leaders of the Congressional Progressive Caucus on Tuesday sent a letter to House Speaker Nancy Pelosi (D-Calif.) restating their opposition to any health reform bill that would have a public plan negotiate payment rates with health care providers, rather than basing these rates on Medicare rates, Politico reports (O’Connor, Politico, 8/4).

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