Officially, almost all sectors of the health care industry back some version of health care reform — it’s the details that they disagree on. 

So it should come as no great surprise that opposition to Democratic health care reform plans is becoming more pronounced as President Obama provided the most detailed account yet of what he wants Congress to include in health care legislation and the Senate Finance Committee’s plan comes out.

The most emphatic resistance came from America’s Health Insurance Plans on Sept. 15 when the group released an analysis of federal data indicating that Medicare beneficiaries enrolled in Medicare Advantage plans spent fewer days in hospitals, were readmitted to hospitals less frequently and were admitted to hospitals for “potentially avoidable” causes less often.

The release came in response to President Obama’s proposal to reduce federal payments to MA plans, payments he said “do everything to pad their profits but don’t improve the care of seniors.”

AHIP’s release sparked an immediate response from California’s Pete Stark (D), chair of the House Ways and Means Health Subcommittee.  Stark backed up Obama’s characterization of the payments and argued that they translate to higher Medicare premiums for all beneficiaries.

A proposal under consideration by the Senate Finance Committee caught the eye of the Advanced Medical Technology Association and a number of other groups with a stake in the medical device and diagnostic technology spheres. 

A bill draft that committee Chair Max Baucus (D-Mont.) circulated over the weekend included a provision that would tax medical device and diagnostic products to generate $4 billion annually starting in 2010 to help cover the cost of a health care overhaul. 

AdvaMed and the other groups fired off a letter to Baucus and committee ranking member Chuck Grassley (R-Iowa), arguing that the new tax would apply to products including eye glasses and test kits for HIV and diabetes. Moreover, the groups asserted that some industry sectors would be hit by both the new tax and proposed reimbursement cuts. Instead of controlling health care costs, the groups suggested that the proposal would send consumers’ medical costs even higher.

The administration seems to be taking all of this in stride.  The president sent a message to his Organizing for America supporters and went on “60 Minutes” to make his case to the American people, reasserting his pledge to shoot down misinformation about reform proposals that critics disseminate.

That pledge prompted Conservatives for Patients’ Rights to assert that its “No Promises” campaign, which opposes the Democratic reform proposals, is factually accurate.  Airing nationally on CNN and Fox News, the ad states that neither Obama’s plan nor congressional Democrats’ proposals would guarantee that Americans could keep their current doctor, wouldn’t wait longer for care, keep their current health plan or have their health care rationed.

A CPR release states, “Silence from the White House regarding the content of the ‘No Promises’ ad can only mean the president concedes that the ad is an accurate representation of his plan.”

Here’s a rundown of other efforts by Obama to build support for a health care overhaul, as well as other highlights of the week’s reform news. 

Meetings With the President

• On Sept. 10, President Obama met with members of the American Nurses Association at the White House as part of a continued push toward passing health reform legislation, The Hill reports. Members of ANA reaffirmed the group’s support for current overhaul efforts (Youngman [1], The Hill, 9/10). According to White House officials, the event marked the beginning of a final phase of the health care debate (Stolberg/Zeleny, New York Times, 9/11).
• Later in the day, Obama met with a group of 17 moderate Senate Democrats led by Sens. Evan Bayh (Ind.), Tom Carper (Del.) and Blanche Lincoln (Ark.), Roll Call reports. Attendees left without speaking to reporters regarding the topics discussed during the meeting, which lasted about one hour. In a prepared statement released after the meeting, Sen. Herb Kohl (D-Wis.) suggested the meeting focused on the cost of reform efforts (Drucker, Roll Call, 9/10).
• Leaders of the Congressional Progressive Caucus have requested a meeting with the president to lobby for a strong public plan, Roll Call reports.  In a letter to Obama, Reps. Raul Grijalva (D-Ariz.) and Lynn Woolsey (D-Calif.), co-chairs of CPC, asked for the meeting “as soon as possible” (Newmyer, Roll Call, 9/10).

What’s in the Bill: Public Option

• During appearances on Sunday talk shows, a number of congressional Democrats downplayed the importance of a public option in health reform legislation while Obama officials indicated that the president is willing to consider alternatives, the New York Times reports (Berger, New York Times, 9/14). During a CNN appearance, White House press secretary Robert Gibbs said that President Obama “prefers the public option. However, he said what’s most important is choice and competition” (Davis, Wall Street Journal, 9/13).
• Senate Majority Leader Harry Reid (D-Nev.) said that a network of not-for-profit health cooperatives can be just as beneficial as the public option, “a stance that could draw strong criticism from liberals,” according to The Hill. He said, “The purpose of a public option is to create competition, which is so important, and to create quality health care,” adding, “If we can come up with a concept of a cooperative that does just that, that is, it makes more competition and makes insurance companies honest, yes, I think that would fill the bill” (Bolton/Young, The Hill, 9/10).

What’s in the Bill: Malpractice Reform

• President Obama‘s call for HHS to examine possible changes to the medical malpractice system “stopped considerably short of the federal limits on awards in malpractice lawsuits” that Republicans and physicians have been seeking for years, the Washington Post reports (Goldstein, Washington Post, 9/11). In his speech, Obama endorsed a program proposed under the administration of President George W. Bush in which states can receive grants for experiments aimed at reducing medical malpractice lawsuits (Koppel/Martinez, Wall Street Journal, 9/11). White House and HHS officials said that they have yet to determine how much funding would be available for the grants, how many states would qualify for them, how many different kinds of experiments would be allowed or when they could get under way (Washington Post, 9/11).
• According to Sen. Kent Conrad (D-N.D.), the Senate Finance Committee‘s so-called “Gang of Six” negotiators are considering including a provision in their legislation that would establish special courts in which a judge with medical expertise would rule on malpractice suits (Alonso-Zaldivar/Werner, AP/San Diego Union-Tribune, 9/11). Conrad also said that the group is considering a safe-harbor provision that would exempt from lawsuits physicians who follow best-practice clinical standards. Jurisdiction over medical malpractice lawsuits primarily falls on the Judiciary Committee in each chamber (Edney/Dann, CongressDaily, 9/11).

What It’s Going to Cost

• On Sept. 10, House Ways and Means Committee Chair Charles Rangel (D-N.Y.) suggested that he is giving greater thought to a proposal to impose a tax or fee on high-cost insurance plans, a plan that President Obama endorsed in his health reform speech to Congress, CQ Today reports. Rangel said that he does not plan to introduce the tax on so-called “Cadillac plans” to the House reform bill (HR 3200) but added, “It was new, and it’s something that can’t be ignored” (Rubin, CQ Today, 9/10).

Deadline

• On Sept. 10, top congressional Democrats pledged to unite their efforts to deliver final health reform legislation by the end of November, echoing a similar prediction from Vice President Biden earlier in the day, the Washington Post reports (Murray/Kane, Washington Post, 9/10).
• The House is unlikely to bring its health reform legislation (HR 3200) to the floor before October, a delay from an earlier timeline of September, CQ Today reports. House leaders are waiting to see what provisions the Senate Finance Committee‘s bill contains (Epstein, CQ Today, 9/14).

Tea Party Opposition

• Tens of thousands of protesters took to the National Mall Saturday to denounce President Obama‘s health reform efforts and other Democratic initiatives, the Washington Post reports. The group’s sponsors included Tea Party Patriots, ResistNet and FreedomWorks, the group headed by former House Majority Leader Dick Armey (R-Texas). The group included many of the same people who participated in the spring’s anti-tax rallies and protested at the summer’s health reform town-hall meetings (Brown et al., Washington Post, 9/13).

Shaping the Debate

• Although the American Medical Association traditionally has been an opponent of health care system reform, AMA now supports the Obama administration in pushing through reform particularly because President Obama’s plan promises to provide millions of U.S. residents with the necessary funds to pay their medical bills, the Chicago Tribune reports (Geiger/Hamburger, Chicago Tribune, 9/13).
• Former Sen. Bob Dole (R-Kan.) is quietly working toward persuading congressional Republicans to work with Democrats to garner what he called “a package that they and the president can live with,” the New York Times reports. Dole said that when he was the chair of the Senate Finance Committee in 1994 “we probably should have passed the Clinton bill, but it got so politicized,” particularly because Dole was running against President Clinton in the 1996 presidential campaign (Seelye, New York Times, 9/12).
• Not-for-profit groups are concerned that federal lawmakers and the Obama administration are not addressing their dramatically rising health care costs in reform legislation, the Times reports. Current health reform proposals would provide tax credits to small businesses that provide insurance benefits to their employees. However, because not-for-profit organizations are excluded from income taxes, they would not benefit (Strom, New York Times, 9/14).

Polls

• U.S. residents are almost evenly divided in their support for passing health reform legislation this year and are more inclined to believe that such a step could make the health care system’s problems worse rather than better, according to a USA Today/Gallup poll taken after President Obama‘s address to a joint session of Congress last week, USA Today reports. The poll of 1,030 U.S. residents found that six in 10 believe Obama’s proposal would fail to expand coverage to nearly all U.S. residents without increasing taxes or lowering quality of care. In addition, the poll found that the majority of respondents disapprove of the way the president is handling the health care debate (Page, USA Today, 9/15).
• U.S. residents continue to be almost evenly split in their views of current health reform proposals, with 46% in favor of the plans and 48% opposed, according to a recent Washington Post-ABC News poll, the Post reports. However, the poll — which started one day after President Obama‘s address to a joint session of Congress and concluded Saturday — found that the percentage of respondents who “strongly” support Obama’s efforts has risen to 32% since mid-August (Cohen/Balz, Washington Post, 9/14).
• A CNN/Opinion Research snap poll conducted before and after Obama’s address to Congress found that voters’ opinions shifted in the president‘s favor after his speech. In the days before the speech, 53% of respondents said they supported Obama’s health care proposals, compared with about two-thirds of respondents after the speech (Alonso-Zaldivar, AP/Houston Chronicle, 9/10).
• An Associated Press-GfK poll released Sept. 9 found 52% of voters disapprove of Obama‘s health reform efforts, up from 43% in July, the AP/Post reports. The poll found that just 42% of 1,001 adult respondents approved of Obama’s handling of health care reform, down from 50% in July. The survey was conducted from Sept. 3 to Sept. 8 and had a margin of error of plus or minus 3.1 percentage points (Fram, AP/Washington Post, 9/10).
• Another poll released on Sept. 9 before Obama‘s speech found that U.S. residents ages 50 and older had significant concerns about current health reform proposals and the impact such plans would have on them, Roll Call reports. The poll — which was commissioned by AARP, the American Medical Association and the American Nurses Association and conducted by Woelfel Research — found that about 50% of seniors were concerned about a shortage of health care providers to care for them (Ackley, Roll Call, 9/9). The survey of 1,101 U.S. residents ages 50 or older was conducted from Sept. 4 to Sept. 7 (Norman, CQ HealthBeat, 9/9).

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