Obama, Democratic Leaders Push for Swift Action on Reform

Halfway through July, there is a lot of buzz in Washington, D.C., about the prospects for health care reform and what it means if Congress strays from President Obama’s timeline. 

Obama came out swinging after a weeklong trip abroad.  Announcing the nomination of Regina Benjamin as surgeon general on Monday, the president said, “I just want to put everybody on notice because there was a lot of chatter during the week that I was gone,” adding, “We are going to get this done. Inaction is not an option.”

Obama came back to meetings with Democratic leaders from the Senate and House in hopes of reinforcing the urgency he sees in passing health care reform before the August congressional recess.

Those meetings appear to have paid dividends.  House Democrats unveiled health care reform legislation yesterday that includes a public option and other provisions Obama has advocated for, and the Senate Health, Education, Labor and Pensions Committee approved its proposal today.  The Senate Finance Committee is reportedly near a deal on its overhaul plan.

Congressional Democrats are working to move quickly on health care reform to head off attack ads that political analysts say could hit the airwaves in August, undermining public support for reform and therefore reducing pressure on members of Congress to support the plan.

A White House spokesperson said the president might ask Congress to stay in session until legislation is passed, potentially letting Obama and his supporters in Congress retain the upper hand in the debate.  

And the debate is exactly where some major players are directing their energies.

Last week, Organizing for America — a unit of the Democratic National Committee that grew out of Obama’s presidential campaign — e-mailed supporters urging them to write letters to the editor of their local newspapers declaring their support for health care reform.

House Speaker Nancy Pelosi (D-Calif.) and other Democratic House leaders tried to build the momentum this week at a press conference highlighting three people’s experiences with the health care system. 

The advocacy group Conservatives for Patients’ Rights cited recent news stories and internal and external poll numbers to argue that public support for health care reform already is slipping. For months, the group has been warning that the health care reform proposals under consideration in Congress would give government too much power over the health care sector and be unaffordable.

That’s a line of thinking that Senate Budget Committee ranking member Judd Gregg (R-N.H.) returned to this week when he cited the potential cost of health care reform in a statement criticizing the administration’s budget plans.  According to Gregg, the Obama administration’s budget plans, which include health care reform, would result in deficits averaging $1 trillion each year for the next decade.

While the players in the debate stake out their latest battle lines, here’s a review of the past week’s moves on health care reform.

Senate

• Last week, Senate Majority Leader Harry Reid (D-Nev.) met with four Republican members of the Senate Finance Committee, assuring them that bipartisan health reform discussions will continue and not be subject to a strict deadline, Roll Call reports (Drucker, Roll Call, 7/8). The senators discussed the cost of the bill, proposals to tax employer-sponsored health care benefits, employer mandates and a public health insurance option (Jansen, CQ Today, 7/8).
• Senate Finance Committee Chair Max Baucus (D-Mont.) has set July 16 as his goal of releasing the committee’s health reform bill, committee ranking member Chuck Grassley (R-Iowa) said Monday, Roll Call reports. However, committee spokesperson Scott Mulhauser declined to confirm Grassley’s comments (Drucker, Roll Call, 7/13).
• Last week, Baucus continued working toward a bipartisan agreement on key provisions included in health reform legislation, Roll Call reports. Early in the week, Reid urged Baucus to adopt proposals favored primarily by Democrats, such as a public health insurance plan. “Everything’s on the table,” Baucus said Wednesday, indicating that he was still trying to generate Republican support for the legislation while making the language more inviting for Democrats (Pierce/Drucker, Roll Call, 7/9).
• During a mark-up session of its health reform bill on Monday, the Senate Health, Education, Labor and Pensions Committee rejected about six abortion-related amendments, CongressDaily reports. The panel also rejected an amendment that would have permitted providers with religious or moral objections to abortion to opt against performing the procedure. It did approve an alternative amendment that would require the federal government to contract with providers regardless of whether they provide abortion services (Hunt, CongressDaily, 7/14). According to NPR.org, “abortion has the potential to throw a wrench into the already fragile gears” of the health care reform debate in Congress. Although the HELP Committee rejected the amendments, “the abortion issue hangs over the health overhaul effort like a dark, menacing cloud” (Rovner, NPR.org, 7/14).

House

• Twenty-nine members of the New Democrat Coalition recently sent House Majority Leader Steny Hoyer (D-Md.) and Pelosi a letter renewing their concerns that a public plan option would align reimbursement rates to Medicare reimbursement rates, Politico reports. In addition, the lawmakers lent their support to the pharmaceutical and biotechnology industries over Medicaid rebates and patent protection. The lawmakers also encouraged Hoyer and Pelosi to allow small businesses to be exempt from certain requirements in order to prevent the businesses from being hurt by higher costs (O’Connor/Frates, Politico, 7/13).
• Members of the House Blue Dog Coalition met with House leaders late last week to discuss the chamber’s health reform bill, Politico reports. Coalition members — including Reps. Mike Ross (D-Ark.) and Joseph Crowley (D-N.Y.), chair of the New Democrat Coalition — met with Hoyer and Majority Whip James Clyburn (D-S.C.) for a two-hour negotiating session. The three House committee chairs writing the reform bill — Education and Labor Committee Chair George Miller (D-Calif.), Ways and Means Committee Chair Charles Rangel (D-N.Y.) and Energy and Commerce Committee Chair Henry Waxman (D-Calif.) — also joined the discussion. Much of the discussion at the meeting dealt with Medicare rates. Coalition members voiced long-standing complaints from physicians and private insurers that the current rates are too low, especially in underserved rural areas. They also said that using reimbursement rates similar to those of Medicare would give a public plan option an unfair advantage over private insurers, resulting in bigger losses for physicians and other medical professionals (O’Connor, Politico, 7/13).
• On Thursday, Miller confirmed that leaders of the House Ways and Means Committee are considering a surtax on high-income U.S. residents as a way to finance health reform, CQ Today reports (Schatz, CQ Today, 7/9). Pelosi also has said the House bill will not include a tax on employer-sponsored health benefits. Pelosi said that, in addition to proposing new ways to finance reform, she has instructed the chairs of the three committees working on reform legislation to “wring every possible dollar” out of the current health system (Epstein, CQ Today, 7/9).
• White House Office of Management and Budget Director Peter Orszag wrote a letter to the three House committee chairs expressing the administration’s support for Medicare spending cuts included in the chamber’s health reform bill, CQ Today reports. Orszag recommended that the House further reduce Medicare and Medicaid payments to hospitals that treat uninsured and low-income patients and that lawmakers include “changes to the process through which Medicare policies are set” in the bill (Wayne, CQ Today, 7/9).
• The chairs of the three House committees jointly working on health reform legislation said that they might not adhere to terms of agreements reached by the Obama administration, the Senate Finance Committee, and hospital and pharmaceutical groups because House members were not involved in the negotiations, Roll Call reports (Dennis, Roll Call, 7/9). Pharmaceutical companies agreed to $80 billion in cost savings and hospitals agreed to $155 billion in cost savings over 10 years (Frates, Politico, 7/9).  Waxman said that he would hold additional conversations with White House officials to learn more details of the agreements.  Meanwhile, Reps. Debbie Halvorson (D-Ill.) and Heath Shuler (D-N.C.) on Thursday gathered at least 70 signatures for a letter to Waxman and Rangel that urges the lawmakers to include the industry agreements in the chamber’s health reform legislation (Dennis, Roll Call, 7/9).

What It’s Going To Cost

• After a meeting with President Obama on Monday, Rangel said that the president did not explicitly ask him to abandon a plan to charge the wealthiest residents a surtax to pay for health reform (Politico, 7/13). According to Rangel, the surtax — which would be levied in 2011 — could produce about $540 billion over 10 years for health care reform and would only affect families with annual incomes higher than $350,000 (Dennis, Roll Call, 7/13). In a news conference on Monday, Obama said, “I promised that Americans making $250,000 a year or less would not pay more in taxes. These are promises that we’re keeping as reform moves forward” (Cohn [1], CongressDaily, 7/14).
• House Ways and Means Democrats also are considering further delaying new flexible tax rules for multinational corporations to fund health reform, according to Ways and Means Select Revenue Measures Subcommittee Chair Richard Neal (D-Mass.).  Delaying the tax rules, which were enacted in 2004 and already have been delayed until 2011, would raise $18.6 billion. The plan failed in the Senate because of Republican objections, but Neal said the proposal “seems to be back in the mix” for the House bill (Cohn [2], CongressDaily, 7/14).
• Health care reform that includes a health insurance exchange could save small-business owners billions of dollars annually, witnesses told lawmakers at a Senate Small Business and Entrepreneurship Committee roundtable on Thursday, CQ HealthBeat reports. John Arensmeyer, founder of the not-for-profit advocacy group Small Business Majority, said that unless lawmakers take steps to reduce the cost of coverage, small-business owners will be faced with $2.4 trillion in health insurance costs over the next 10 years. Sen. Ron Wyden (D-Ore.) said, “You can’t have any clout in the marketplace unless you’re in big groups.” According to Sen. Olympia Snowe (R-Maine), 52% of U.S. residents who do not have health coverage are self-employed or work for companies with fewer than 100 employees. Many at the hearing praised Sen. Richard Durbin‘s (D-Ill.) bill (S 979) that would establish purchasing pools for small businesses and grant tax credits to offset the cost of employee premiums. According to Len Nichols, director of the Health Policy Program at the New America Foundation, most employers that do not offer health insurance cannot afford to (Stephenson, CQ HealthBeat, 7/9).
• Labor and business groups have begun expressing concerns that recent health reform proposals would not do enough to address growing health costs, the Los Angeles Times reports. Labor officials are expected to have a closed-door meeting with Obama on Monday, while business groups are pushing the Obama administration and lawmakers to change how care providers are paid (Levey, Los Angeles Times, 7/13).
• On Friday, American Public Media’s “Marketplace” examined the impact of a proposal to eliminate the tax deduction that drugmakers receive for television ads for their products. The additional tax dollars would be used to help pay for health reform (Herships, “Marketplace,” American Public Media, 7/10).
• The House and Senate health reform bills both include billions of dollars worth of “add-ons” for walking paths, jungle gyms, streetlights and farmers markets, the Boston Globe reports. While the provisions are criticized by some as pork-barrel spending, others argue they are part of a broad approach to improve the U.S. health “infrastructure,” the Globe reports. The Senate HELP Committee‘s bill does not include a specific amount for the community projects, but the House bill puts a $1.6 billion annual price tag on the provisions (Kranish, Boston Globe, 7/9).

Republican Opposition

• A recent memo from Republican strategist Alex Castellanos delineates the GOP’s key talking points for criticizing the pace at which Democrats and Obama are moving on health reform and is being used by Republicans to reshape the debate and give the party time to push alternative reform efforts, CongressDaily reports (Edney, CongressDaily, 7/14).  The memo uses information from a June survey conducted by OnMessage of 2,200 likely voters that found most U.S. residents think of health reform as “reducing health care costs” (Rothenberg, Roll Call, 7/13).
• Republicans “seeking to derail Democratic progress on comprehensive health care legislation” are planning a forum in the coming weeks to expose what they view as the flaws of universal and single-payer health care systems in other countries, CongressDaily reports. House Minority Whip Eric Cantor (R-Va.) on Friday said, “Do we really think that the American people understand when we say, ‘You don’t want a system like the U.K. and Canada?'” adding, “I don’t know if most people do or not, but it’s not the system that Middle America understands” (McPike, CongressDaily, 7/10).
• Senate Republican Conference Chair Lamar Alexander (Tenn.) has launched the “Senate Doctors Show,” a live, 30-minute Web-based talk show that uses real-life stories to argue against Democrats’ health reform plans, CongressDaily reports. The show, which airs Tuesdays and Thursdays, encourages viewers to submit questions and comments via video, e-mail and Twitter to legislators from the medical profession instead of “career politicians, lawyers, lobbyists and unelected committee staff who have little first-hand experience in the health care arena,” according to a spokesperson for Sen. Tom Coburn (R-Okla.) (Dann, CongressDaily, 7/10).
• Republican lawmakers with medical backgrounds have expressed concern that Congress is moving too quickly on health reform, CQ HealthBeat reports. The lawmakers participated in a forum last week sponsored by the Medical Society of the District of Columbia. Reps. Michael Burgess (Texas), Bill Cassidy (La.), John Fleming (La.), Phil Gingrey (Ga.), Tim Murphy (Pa.), Tom Price (Ga.) and Phil Roe (Tenn.) attended (Stephenson, CQ HealthBeat, 7/8).

Elements of the Proposals

• Lawmakers developing health reform legislation in Congress would emphasize the “comparative effectiveness” of medical treatments, but the bills do not incorporate cost-benefit analysis or require that health care providers follow conclusions of comparative effectiveness research, the Washington Post reports. According to the Post, a federal panel has held hearings on allocating $1.1 billion for comparative effectiveness research, and while industry and patient groups support such research, they do not want cost to be factored into the findings. A senior Obama administration official said that while cost effectiveness research might offer information about wasteful practices, health reform legislation will not address the “harder question” of what needs to be done “if new technology does work better and reduces risks but costs a lot more, and how to evaluate that” (MacGillis, Washington Post, 7/8).
• The debate over health reform has renewed the discussion of whether government-subsidized health insurance programs should cover abortion procedures, Time reports. For 30 years, Medicaid has been prohibited from paying for abortion services with federal money (Tumulty, Time, 7/8).
• There is currently no health reform proposal in Congress that addresses the estimated 11 million undocumented immigrants in the U.S., NPR’s “Morning Edition” reports (Ludden, “Morning Edition,” NPR, 7/8).

Influencing the Debate

• The National Retail Federation, the largest trade group for the retail industry in the U.S., is launching a broad attack against Wal-Mart for supporting a congressional proposal to require all large businesses to provide health benefits to their workers, the Wall Street Journal reports. NRF planned to send an “aggressively worded” letter to its members, urging them to oppose Wal-Mart’s endorsement of an employer mandate, according to the Journal. NRF is the primary lobbyist for the retail industry, which is comprised of 1.6 million businesses and employs about one in five working U.S. residents. Wal-Mart is not a member of the group (Bustillo/Adamy, Wall Street Journal, 7/13).
• The American Hospital Association, one of the three groups involved in the hospital industry’s cost-savings deal, released a “special bulletin” to its members that favorably contrasted the terms of the agreement with other proposals being considered in Congress and noted the financial benefits to the industry of expanded health coverage, CQ HealthBeat reports (Reichard, CQ HealthBeat, 7/9).
• Although many labor unions are fighting among themselves, some union presidents say they are working together “where it counts,” such as urging for universal health care coverage, the New York Times reports. In terms of health care, the Times reports that labor unions are most concerned about Congress including a provision in the legislation taxing employer-provided health benefits as a way to help finance universal coverage (Greenhouse, New York Times, 7/9).
• Several small-business organizations are asking members to express their views on health reform to lawmakers, Kaiser Health News reports. The groups are urging members to use e-mail, letters, phone calls and personal visits to make their views known (Gold, Kaiser Health News, 7/9).
• Last week, religious leaders from various faiths held a summit at the Capitol to bring a “moral vision” to the health reform debate, CQ HealthBeat reports. Although the group said it does not intend to advocate for a specific bill or component, it said it will advocate for the poor as Congress continues to draft reform legislation. Members of the group said they would use advertising, social networking, calls and letters to members of Congress, and communication among their members to make their views known (Norman, CQ HealthBeat, 7/7).

Polls

• A recent USA Today/Gallup poll found that 56% of U.S. residents said it is important to enact health reform this year, while 33% believe otherwise, USA Today reports. The poll surveyed 3,026 U.S. adults (Page, USA Today, 7/14).
• Meanwhile, a recent survey by Rasmussen Reports found that more U.S. residents now oppose health reform efforts by congressional Democrats than support it, Politico’s “Politico 44” reports. The poll found that 49% of those surveyed said they were at least somewhat opposed to the reform bill currently being generated in Congress, while 46% at least somewhat favored it. The results differ from Rasmussen’s survey from two weeks ago, in which 50% of respondents supported the reform plan and 45% opposed it (Andersen, “Politico 44,” Politico, 7/14).