To sum it all up:

The House has adjourned for the summer, and the Senate is days away from following suit.  Neither chamber brought a health care reform proposal up for a vote before leaving Washington, D.C., and the Senate Finance Committee members who are trying to craft a bipartisan overhaul plan are resisting even setting a deadline for when they will wrap up their effort.

That’s where health care reform efforts stand right now, and there are plenty of questions about elements of the proposals under consideration.

One of those questions is whether to create a government-run health plan.  Republicans uniformly have lined up against the proposal, while some Democrats have pledged to oppose any legislation that doesn’t include a public plan.

To bridge the divide, Sen. Kent Conrad (D-N.D.) proposed using not-for-profit health insurance cooperatives, rather than a public plan, to compete with private insurers.  The plan has been floated in the House and Senate, and many political analysts expect co-ops to remain a key element of negotiations as Congress tries to hash out a deal.

But many people — Sen. Jay Rockefeller (D-W.Va.), included — still don’t fully understand how co-ops would work. Rockefeller has set about trying to get some answers to his questions about co-ops, firing off letters to the head of the Government Accountability Office, USDA chief Tom Vilsack and the president of the National Cooperative Business Association.

Rockefeller asked GAO for an overview of state and federal regulatory structures for co-ops and USDA to provide the names and locations of 192 health care co-ops cited in a June report that the agency funded.  Rockefeller also asked NCBA to explain why health-related cooperatives like Group Health of Washington have succeeded while PacAdvantage failed in California.

The letters went out Thursday, and Rockefeller — a proponent of a public plan — requested answers by Wednesday.

While Rockefeller is busy asking questions, White House Office of Management and Budget Director Peter Orszag is touting the administration’s proposal for an Independent Medicare Advisory Council to offer recommendations on Medicare reimbursement rates.

In a posting on his blog yesterday, Orszag announced that a group of health economists, including a number of members of the Congressional Budget Office’s Panel of Health Advisers, endorsed the IMAC proposal as a way to help control rising health care costs.

Neither the answers to Rockefeller’s questions nor endorsements for the IMAC proposal will resolve the question of what to do with the U.S. health care system, but the underlying issues will fuel discussion over the August recess. To prepare you for those debates, here’s an update on recent developments.

What’s In the Plan

• Sen. Kent Conrad (D-N.D.), a member of the Finance Committee negotiating group and chair of the Senate Budget Committee, said that the Finance panel is considering imposing a cap on the amount of tax-exempt money in flexible savings accounts, CQ HealthBeat reports. Conrad did not state a dollar limit that is being considered. During markups of the House reform bill (HR 3200), the House Ways and Means Committee adopted a cap on the tax-exempt amount of money in FSAs (Reichard, CQ HealthBeat, 7/31).
• According to Congressional Budget Office analyses of the health reform plans written by Democrats in the House and Senate, a government-run health insurance option would not have the dramatic impact on the private health insurance industry that Republicans and health industry officials have claimed, the Chicago Tribune reports. CBO estimates that about 11 million U.S. residents likely would enroll in a public plan by 2019, while more than 160 million would obtain health insurance through their employer (Levey, Chicago Tribune, 7/28).
• A provision in the Senate Health, Education, Labor and Pensions Committee proposal that would provide up to $10 billion annually for a “prevention and public health investment fund” directed at infrastructure projects such as bike paths and farmers markets is being criticized by some as “pork-barrel spending,” the Los Angeles Times reports (Sherry, Los Angeles Times, 8/3).
• Reform bills being developed in the House and Senate include “religious conscience” exemptions to the individual coverage mandate for people with religious objections to purchasing health insurance. The provision is intended to apply to people of the Old Order Amish, but might also apply to some other groups, such as Christian Scientists, CQ Politics reports (Reynolds, CQ Politics, 8/3).
• Members of the Senate Finance Committee are considering a “free-rider” penalty that would be an alternative to an employer mandate, but advocates for low-wage workers and labor unions are voicing opposition to the penalty, Kaiser Health News reports. The penalty would require businesses that do not provide insurance to pay a portion of the cost of any subsidies workers would be entitled to when purchasing coverage through proposed health insurance exchanges. The federal government would pay the remaining portion of the subsidies (Galewitz, Kaiser Health News, 7/30).
• The House has addressed nearly all of the concerns expressed by veterans groups last week about the House reform bill (HR 3200), The Hill reports. Rep. Steve Buyer (R-Ind.) addressed most of the worries through amendments proposed during the House Energy and Commerce Committee markup of the bill that would ensure that veterans receiving health services through the Department of Veterans Affairs also could enroll in additional health coverage, and that the VA secretary would keep all authority to operate the VA health care system without interference from any new bodies established by the bill. However, an amendment that would guarantee veterans in the VA system would not be subject to a penalty levied on uninsured or underinsured people was withdrawn before the committee could vote on it. VA said that unless the insurance mandate exemption is removed, the groups still will oppose the House reform bill (Tiron, The Hill, 8/3).

Timeline for Action in the Senate

• On Monday, Senate Finance Committee Chair Max Baucus (D-Mont.) said that the bipartisan group negotiating the panel’s health reform bill has not set a firm deadline to reach an agreement, but that it will set one soon, Roll Call reports (Drucker, Roll Call, 8/3). Sen. Charles Schumer (D-N.Y.), who is not part of the “gang of six” working on the bill, in a conference call on Monday told reporters that lawmakers had set a Sept. 15 deadline to reach a bipartisan deal (Young [1], The Hill, 8/3). The three Republican members of the negotiating group on Monday voiced their opposition to setting a deadline (Armstrong, CQ HealthBeat, 8/3).
• In an interview with Radio Iowa on Monday, Sen. Chuck Grassley (R-Iowa) predicted that a final vote on health reform would not take place until mid-November, The Hill reports. He said, “If we get a bill on the Senate floor by the third or fourth week of September, it’s probably going to take two weeks” for it to pass through the chamber, and then it likely will “take a month to negotiate the difference between the House and Senate provisions, so I would suggest the middle of November” (O’Brien, The Hill, 8/3).
• On Monday, Schumer also told reporters that the budget reconciliation process is “clearly one of the contingencies on the table” if discussions fail to reach a bipartisan compromise on the reform bill, the Wall Street Journal reports. He said that Senate Democrats “want to get a bipartisan agreement, but if we don’t, it’s not going to stop us from moving forward with health care” (Yoest, Wall Street Journal, 8/3). Under the terms of the reconciliation process that were included in the fiscal year 2010 budget resolution, Senate Democrats can pass legislation with a simple majority of 51 votes, rather than the usual 60 votes (Haberkorn, Washington Times, 8/3).

Plans for the Recess

• Democratic leaders have urged members to hold town-hall meetings and other events to allow them to focus on “simpler” issues such as explaining that reform would prohibit insurers from denying coverage to people with pre-existing conditions, rather than “complicated debates” on issues such as a whether to create a new public health plan, the Washington Post reports (Bacon, Washington Post, 7/31). House Speaker Nancy Pelosi (D-Calif.) distributed a pocket-sized card listing talking points aimed at convincing voters that they would benefit under the House reform bill (Rucker, Washington Post, 8/2).
• Coalitions of voters and advocacy organizations, such as FreedomWorks and Americans for Prosperity, have begun using social networking Web sites to mobilize health reform opponents to attend lawmaker events throughout the country, the New York Times reports. Over the past weekend, Rep. Lloyd Doggett (D-Texas) was confronted by protesters when he went to a supermarket to meet constituents, and Rep. Patrick Murphy (D-Pa.) was overwhelmed by health care questions at an event in his home district (Herszenhorn/Gay Stolberg, New York Times, 8/4).
• House Republicans plan to draw attention to what they see as shortcomings in the chamber’s bill, as well as in the economic stimulus bill passed earlier this year (Washington Post, 7/31). On Friday, House Republican Conference Chair Mike Pence (R-Ind.) distributed a packet to members laying out arguments against Democratic reform plans, including claims that the proposals would increase taxes and reduce Medicare benefits (Gay Stolberg/Herszenhorn, New York Times, 8/3).
• House Minority Whip Eric Cantor (R-Va.) plans to send a weekly e-mail to members of his whip team during the August recess that will include key talking points, statistics, schedules and “best practices” for each member’s district, according to a memo from Cantor’s staff, Roll Call reports. The e-mails will attempt to keep members on message by criticizing Democratic health care bills as job-killing proposals that would decrease the quality of care across the U.S. (Kucinich, Roll Call, 8/3).

Administration Message

• President Obama’s administration is “retooling” his health care reform message and strategy, “hoping a more modest approach will reinvigorate Obama’s signature domestic policy initiative and give him a first-year victory for Democrats to carry into the 2010 midterm elections,” the Washington Post reports. During the August recess, the White House intends to highlight insurance market reforms. White House Office of Health Reform Director Nancy-Ann DeParle said, “I could get 100 votes” in the Senate on the insurance market changes being advocated by Obama (Connolly, Washington Post, 8/2).
• On Tuesday, Obama was scheduled to host a Senate Democratic caucus lunch at the White House before the Senate’s month-long August recess, in part to discuss health care reform, CQ Today reports (Bettelheim, CQ Today, 8/3). Obama’s message in August is expected to explain why the status quo is unsustainable and how reforms to the insurance system will directly affect and improve the lives of U.S. residents (Bettelheim, CQ Politics, 8/4).
• On Monday, HHS Secretary Kathleen Sebelius, Sen. Christopher Dodd (D-Conn.), Rep. Rosa DeLauro (D-Conn.) and Karen Mills, head of the Small Business Administration, held an event in Hartford, Conn., during which they discussed the difficulty small businesses face in providing health coverage for employees and the need for health reform, the Hartford Courant reports. During the event, Dodd stressed the connection between the economic downturn and the need for health reform (Miller, Hartford Courant, 8/4).
• Sebelius and Sen. Arlen Specter (D-Pa.) faced a hostile crowd at an event on Sunday in Philadelphia, where some attendees booed them, the AP/Chicago Tribune reports. Specter said, “I wouldn’t be surprised if that’s the harbinger of things to come” (Hefling, AP/Chicago Tribune, 8/3).
• On Thursday, Housing and Urban Development Secretary Shaun Donovan said that there is “no question” that expanding Medicare and Medicaid would limit the growing number of homeless families and would benefit the tens of thousands of chronically homeless U.S. residents, the Post reports (Mostrous, Washington Post, 7/31).

Republican Opposition

• Although some observers expected a bill last week, House Republicans say they will release their health reform legislation this fall, The Hill reports. The party has been waiting for the Congressional Budget Office to score its bill and for Democrats to finalize their legislation and send it to the House floor. House Republican leaders are expected to use the August congressional recess to work on text for the bill (Hooper, The Hill, 7/30).
• In the GOP’s response to President Obama‘s weekly radio and Internet address on Saturday, Sen. John Thune (R-S.D.) said, “[Democrats’] plan for government-run health care would disrupt our current system and force millions of Americans who currently enjoy their employer-based coverage into a new health care plan run by government bureaucrats.”  Thune said, “We need to get the right reform, rather than just rush something through that could leave us in far worse shape in the future” (Koffler, Roll Call, 8/1).
• Meanwhile, in an appearance on “Fox News Sunday,” Sen. Jim DeMint (R-S.C.) said he believes voters will “take to the street” to protest against Obama‘s health reform plans, The Hill reports (Wilson, The Hill, 8/2).
• Last Friday, House Democrats agreed to allow Republicans to send a health care mailing to their constituents, following two weeks of delays caused by liberals who said the mailing is inaccurate, Roll Call reports. The contentious mailing features a chart created by Rep. Kevin Brady (R-Texas) and Republican staff on the Joint Economic Committee that depicts the Democratic health plans as a confusing mass of agencies and bureaucratic procedures (Kucinich, Roll Call, 8/3).  

Influencing the Debate

• On Friday, the Pharmaceutical Research and Manufacturers of America released a statement that the House reform bill (HR 3200) would “hurt patients” and “kill jobs,” CQ HealthBeat reports. The bill includes a provision allowing the HHS secretary to negotiate with drugmakers for prices in the Medicare prescription drug benefit. According to the release, the measure would “act as a tax increase by raising premiums” on drug plan beneficiaries (Reichard, CQ HealthBeat, 8/3).
• In a letter to House Democrats on Thursday, the National Retail Federation said it “strongly opposes” their reform bill (HR 3200), which NRF says does not offer adequate concessions to reduce the cost burden on small businesses, the Washington Post‘s “Daily Dose” reports. NRF also warned lawmakers that the House will be held accountable on the issue and that it intends to inform its members about the bill in its “voting guide” (Connolly/Kane, “Daily Dose,” Washington Post, 7/30).
• Several lawmakers joined advocates outside of the Capitol on Thursday for a rally endorsing a single-payer health care system in the U.S., CQ HealthBeat reports. The gathering was organized by Health Care for America Now and other organizations (Stephenson, CQ HealthBeat, 7/30).
• In a letter to the Senate Finance Committee Wednesday, the National Association of Wholesaler-Distributors wrote that the organization “will be unable to support and will vigorously oppose any legislation that includes: Any provision that does violence to our voluntary employment-based [insurance] system,” Roll Call reports. In the letter, James Anderson, NAW’s vice president of government relations, said the group will rally against a public insurance plan option and against any increased or new taxes on businesses or employer-sponsored health insurance benefits (Ackley, Roll Call, 7/29).
• A coalition of firms aiming to derail a House proposal to limit the amount of money U.S. residents can put into flexible spending accounts that is tax exempt, is increasing its lobbying, advertising and grassroots efforts as lawmakers leave Washington for their August recess, Roll Call reports. The group, called Save Flexible Spending Plans, says that House proposals to cap such tax exemptions at $2,000 and prohibit the accounts from being used to buy over-the-counter drugs would represent a tax increase on middle-income families who depend on the plans to help pay out-of-pocket health care costs (Ackley, Roll Call, 8/3).
• Members of the Advanced Medical Technology Association are trying to scale back a savings commitment that the group made in May to the White House and Finance Committee leaders to cut health care spending to fund health care reform, CongressDaily reports. AdvaMed was one of six industry groups that made the pledge to President Obama, which has been a topic in recent negotiations in the Finance Committee. Sources familiar with the negotiations say the committee wants the medical device industry to cut costs by $60 billion. However, the industry has offered only $15 billion to $25 billion (Edney, CongressDaily, 7/31).
• The American Medical Association and the American College of Surgeons have publicly opposed plans from the White House and Congress to create an independent commission to set Medicare reimbursement rates, the Wall Street Journal reports. In a letter to House Speaker Nancy Pelosi (D-Calif.) last week, the 74,000-member ACS wrote that it would “vigorously oppose” any bill that included a provision to create such an agency (Goldstein, Wall Street Journal, 7/29).
• In an interview with U.S. News & World Report, AMA President James Rohack said the group is “committed to reducing unnecessary costs in health care” and wants “to make sure patients have access to a health care system that has affordable health insurance coverage for everybody” (Garber, U.S. News & World Report, 7/29).
• Six doctors groups, comprising 450,000 physicians, have launched a “Heal Health Care Now” campaign to push their position that passing health reform should be the first priority when lawmakers return from recess (Clark, HealthLeaders Media, 7/31).
• Conservative talk radio hosts are claiming that a proposal to pay physicians to counsel elderly and terminally ill patients about what treatments they would prefer and how to prepare a living will would lead to end-of-life “rationing” of care and even “euthanasia” in order to save money, the Post reports (Connolly, Washington Post, 8/1).
• Business Roundtable President John Castellani, on behalf of its member CEOs, sent a letter to the Senate Finance Committee on Thursday urging lawmakers to continue their work on seeking a bipartisan reform bill (Connolly/Kane, “Daily Dose,” Washington Post, 7/30).
• Medical supply companies are calling on lawmakers working on health reform legislation to close the Safe Harbor antitrust exemption that is granted to companies that negotiate with medical suppliers on behalf of hospitals, Politico reports (Frates, Politico, 7/31).

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