Members of Congress Divided on House Bill’s Implications for California

The House on Nov. 7 voted 220-215 to pass its version of health reform legislation (HR 3962), which would create a public option with rates negotiated directly with providers. However, California’s representatives are split in their support of the legislation.

Democratic Reps. Anna Eshoo, Doris Matsui and Diane Watson all voted for the bill and celebrated its passage.

Eshoo noted that under the legislation, 84,000 families in her district would receive subsidies to help them purchase health coverage. In addition, Eshoo touted an amendment she wrote along with the late Sen. Edward Kennedy (D-Mass.) that would allow generic versions of biotechnology drugs to come to market, which she said would reduce government drug spending by $6 billion over 10 years.

Matsui said the bill would help 2,000 families in her district avoid declaring bankruptcy because of health insurance costs, among other benefits. Watson estimated that the legislation would allow 138,000 uninsured residents in her district to obtain coverage.

Across the aisle, Reps. Ken Calvert (R-Calif.), Dan Lundgren (R-Calif.) and Ed Royce (R-Calif.) all voted against the legislation and characterized it as a government takeover of health care. Calvert said the bill represents the “first steps toward the creation of a single-payer system.” In addition, Calvert said that the bill would force California to repeal laws that cap fees for trial lawyers and limit punitive damages in medical malpractice cases, forcing the state to choose between receiving federal funding for health care services or maintaining “effective liability reforms.” Furthermore, Calvert said that there is “no requirement for identification documentation whatsoever” in a provision in the House bill that seeks to prevent undocumented immigrants from receiving care under the new law.

Lundgren said the bill would eliminate jobs and cut $440 billion from Medicare.

Royce said the bill would give “bureaucrats an unprecedented and expansive role in our health care sector.”

Lawmakers are not the only ones who have differing opinions on the House reform legislation.

A group of a dozen economists, including Henry Aaron of the Brookings Institution and Len Nichols of the New American Foundation, in a letter urged members of Congress to support the House bill. According to the economists, the legislation would reduce the federal deficit by more than $100 billion in its first 10 years and includes “initial steps to ‘bend the cost curve'” in health care.

However, America’s Health Insurance Plans President and CEO Karen Ignagni in a statement said the legislation “fails to bend the health care cost curve and breaks the promise that those who like their current coverage can keep it.” 

More news on the reform debate is provided below.

Administration Message

• During an address from the White House Rose Garden on Sunday, President Obama called on the Senate to “take up the baton” from House lawmakers and push health care reform “to the finish line,” the New York Times reports (Stolberg, New York Times, 11/9). The president said he is “absolutely confident” that the Senate will follow the House’s lead. In addition, he said, “I’m equally convinced that on the day we gather here at the White House and I sign comprehensive health insurance reform legislation into law, [senators] will be able to join their House colleagues and say that this was their finest moment in public service” (Yager, The Hill, 11/8).
• Obama used the House vote to raise money for the grassroots group Organizing for America, an offshoot of his 2008 presidential campaign, Roll Call reports. Obama told members through an e-mail that the victory precedes a tough debate in the Senate, adding that OFA needs their financial support (Koffler, Roll Call, 11/7).
• A Congressional Research Service memorandum, released by Senate Finance Committee ranking member Chuck Grassley (R-Iowa), says that an HHS Web site inviting visitors to express their support for health reform to Obama might violate the law, Roll Call reports. According to CRS, the site might have violated two provisions in the fiscal year 2009 omnibus spending bill that prohibit federal agencies from involvement in propaganda or lobbying efforts and from any communications on such efforts (Stanton, Roll Call, 11/6).

House

• On Saturday, the House voted 176-258 to reject the Republicans’ alternative to the chamber’s health reform bill (HR 3962) — a vote that largely followed party lines — The Hill‘s “Blog Briefing Room” reports. Rep. Timothy Johnson (R-Ill.) was the sole Republican to vote against the bill, while one Democrat did not vote (Zimmerman, “Blog Briefing Room,” The Hill, 11/7). 
• Rep. Anthony Weiner (D-N.Y.) abandoned his efforts to force a vote Saturday on a plan to create a single-payer health care system by replacing the current employer-based health care system with government-run insurance coverage, Roll Call reports (Newmyer, Roll Call, 11/6). To earn the support of Weiner and other liberals for a compromise in the House Energy and Commerce Committee‘s reform legislation (HR 3200) in July, House Speaker Nancy Pelosi (D-Calif.) had promised Weiner a full floor vote on the single-payer proposal (Soraghan, The Hill, 11/6).

Senate

• On Nov. 9, Sen. Susan Collins (R-Maine) announced that she is working with Democrats to develop an alternative to current reform plans, Politico‘s “Live Pulse” reports.  Speaking during a press conference with Senate Republican Conference Chair Lamar Alexander (Tenn.), Collins said she was unsure whether the alternative would be presented as amendments or as a stand-alone bill (Sherman, “Live Pulse,” Politico, 11/9).
• On Nov. 4, Sen. Mary Landrieu (D-La.) said that she is reconsidering her initial opposition to a public option in the final Senate bill and that she is open to supporting Senate Majority Leader Harry Reid‘s (D-Nev.) proposal to include a state “opt-out” clause, Roll Call reports. However, Landrieu noted that she is not yet prepared to vote for the Senate reform bill (Drucker, Roll Call, 11/4).

Debate Over Abortion Coverage

• On Nov. 10, House lawmakers who support abortion rights sent letters to House Speaker Nancy Pelosi (D-Calif.) and President Obama vowing to oppose the final health care reform bill if the abortion language included in the chamber’s bill (HR 3962) is not removed, Roll Call reports. Rep. Diana DeGette (D-Colo.), co-chair of the 190-member Congressional Pro-Choice Caucus, and Rep. Louise Slaughter (D-N.Y.), the other Pro-Choice Caucus co-chair and chair of the House Rules Committee, gathered at least 40 signatures and requested to meet with Obama next week to discuss the issue (Newmyer/Dennis, Roll Call, 11/10).
• During an interview with ABC News on Nov. 9, Obama indicated that he is dissatisfied with the abortion language included in the House bill and that he would like to see revisions in the final legislation, the New York Times reports (Pear, New York Times, 11/10).
• On Nov. 9, Sen. Ben Nelson (D-Neb.) said that he will insist that the final Senate bill include language banning federal funding for abortion services, similar to an amendment House Democratic leaders recently added to their bill, Politico reports.  Several other key moderate senators, including Sens. Kent Conrad (D-N.D.) and Mary Landrieu (D-La.), also have indicated their preference for tighter language on abortion funding, although they have not specifically indicated that their votes will be on the line, according to Politico (Budoff Brown/Allen, Politico, 11/9).

What’s in the Bills

• On Nov. 4, Senate Health, Education, Labor and Pensions Committee Chair Tom Harkin (D-Iowa) said that little attention has been paid to “a critical transformational element” in the House (HR 3962) and Senate bills for increased prevention measures, CQ HealthBeat reports. Harkin said that the legislation includes a variety of provisions intended to increase prevention against severe and costly health problems that often result in death (Norman, CQ HealthBeat, 11/4).
• The House health reform bill includes about two dozen programs whose funding is listed as “such sums as may be necessary,” meaning that they are not currently appropriated for, the Washington Times reports. Such programs include a child immunization campaign, a nursing recruitment program, and a program to encourage states to reduce medical malpractice lawsuits (Dinan, Washington Times, 11/10).
• The House reform bill includes several “little-noticed provisions,” the New York Times reports. The provisions would: make health benefits provided by employers to employees’ domestic partners tax-free; promote nutrition labeling for vending machines; require chain restaurants to list the number of calories in each menu item; provide states with grants to spur the creation of “home visitation” programs for low-income pregnant women; prioritize the construction of health clinics for American Indians in Minnesota, Nevada and New Mexico; offer scholarships for the training of veterinarians and other health professionals; and institute a fee to help subsidize comparative effectiveness research (Pear, New York Times, 11/8).
• Neither the House health care bill passed on Nov. 7 nor the Senate bill currently being completed would fully end the practice of charging different premiums based on age, the Los Angeles Times reports. The House bill set a 2-1 ratio for age rating, meaning insurers would not be able to charge older U.S. residents more than twice what they charge younger residents. The Senate Finance Committee bill (S 1796) mandated a 4-1 ratio, while legislation from the Senate HELP Committee (S 1679) included a 2-1 ratio (Oliphant, Los Angeles Times, 11/9).

Shaping the Debate

• On Nov. 10, former President Clinton was scheduled to meet with the Senate Democratic Conference during their weekly private luncheon, Senate officials said, Roll Call reports (Drucker, Roll Call, 11/9). Clinton is expected to speak about the ongoing health reform efforts and on his experiences during his attempt to overhaul the health care system in the early 1990s, according to the AP/San Francisco Chronicle (Alonso-Zaldivar, AP/San Francisco Chronicle, 11/10).
• On Nov. 9, the American Medical Association’s House of Delegates voted against a resolution to withdraw its support for the House health reform bill (HR 3962) at a meeting in Houston, CongressDaily reports. The body also rejected a resolution calling on AMA to oppose any bill containing a public health insurance plan option. AMA endorsed the House bill last week, but some societies and state medical associations have rejected that stance (CongressDaily, 11/10).
• On Nov. 9, MoveOn.org launched a $500,000 television campaign attacking Democrats who voted against the bill, the Washington Post reports.
• Health Care for America Now and the American Federation of State, County and Municipal Employees have financed a series of “thank you” ads in 20 battleground House districts applauding freshmen representatives for “standing up to the insurance companies and fighting for us” (Davis/Pershing, Washington Post, 11/10). The HCAN and AFSCME campaign is expected to cost about $650,000.
• Americans United for Change is expected to spend $350,000 to thank Democrats in potentially vulnerable seats (Murray, Roll Call, 11/10).
• In a letter to Senate Majority Leader Harry Reid (D-Nev.) on Nov. 4, former U.S. Surgeon General C. Everett Koop expressed frustration with the Democratic leadership and Obama administration for their lack of transparency in crafting health reform legislation, The Hill reports. Koop — who was the surgeon general during the Reagan administration from January 1982 to October 1989 and is now a professor at Dartmouth Medical School — said that White House officials and Democratic lawmakers have been working on the bills without expert input (Rushing, The Hill, 11/4).
• In a letter to Reid on Nov. 4, a coalition of 20 surgeon groups said they would withhold their support for the chamber’s health care reform bill, citing opposition to several proposals in the measure, The Hill reports (Young, The Hill, 11/4). According to CongressDaily, the coalition’s primary concerns include a proposal to create an independent commission that would be responsible for recommending cost-cutting strategies in Medicare, as well as a provision that would implement a short-term patch on physician payment cuts rather than a more permanent fix (Edney, CongressDaily, 11/5).
• Last month, seven of the 28 Democratic governors refused to sign a letter expressing their support for health reform efforts, citing concerns over proposals aimed at expanding Medicaid as their states face mounting budget deficits, the Washington Times reports (Lambro, Washington Times, 11/5).
• Last month, the heads of Kaiser Permanente, Geisinger Health System and Intermountain Healthcare sent a letter to Senate Finance Committee Chair Max Baucus (D-Mont.) opposing a tax on health insurance companies included in the committee’s reform bill (S 1796), CQ Today reports. The letter says that the tax would affect them disproportionately because it would exempt companies that fund their own insurance pools instead of using a health insurer (Armstrong, CQ Today, 11/4).
• Patient advocates and some insurance experts are criticizing a provision in the Senate Finance Committee’s bill that would require patients to be uninsured for at least six months before they qualify to enroll in a high-risk pool to provide health coverage for the “medically uninsurable,” or people with pre-existing conditions who have been denied coverage by private insurers, the AP/Chronicle reports. A provision in the House bill to create the high-risk pool does not include a waiting period (Alonso-Zaldivar, AP/San Francisco Chronicle, 11/5).
• A coalition of 10 insurance industry groups sent a letter to House lawmakers expressing opposition to language included in the House reform bill that would expand the Federal Trade Commission‘s power to issue reports on the entire insurance industry, saying that such an expansion of power could create oversight problems and add new regulatory costs, CQ Today reports. Under current law, FTC is not allowed to issue reports on any part of the insurance industry unless a congressional committee submits a request (Ives, CQ Today, 11/9).

Poll

• As the focus on health reform legislation moves to the Senate, U.S. residents do not believe reform would benefit their own personal health care or that of the country as a whole, according to a new Gallup poll, Politico‘s “Live Pulse” reports. In addition, 53% of independents want lawmakers to vote against reform, while just 37% want them to support it (Frates, “Live Pulse,” Politico, 11/9).