With the status of health care reform legislation in question after Democrats lost their 60-vote, filibuster-proof majority in the Senate, many members of the party had a similar refrain: Keep an overhaul alive.

President Obama opened the chorus during his State of the Union address last week. Although much of the speech was focused on the U.S. economy, he insisted that he would not give up on passing health reform legislation.

While the president did not signal defeat, he did not detail a strategy, leaving the door open for health policy experts to weigh in. On the Health Affairs blog, three entries in recent days consider the options — using the budget reconciliation process, devising a scaled-back proposal or starting completely from scratch.

Henry Aaron, a senior fellow at the Brookings Institution, urges Democrats to stick with what they have and communicate the legislation’s benefits better to the public. He argues against restarting the entire process and agrees with fellow Health Affairs blogger Timothy Jost — a professor of law at Washington and Lee University — that using reconciliation is the best procedural option.

For his part, Jost cautions lawmakers from taking an incremental approach, saying that “it is not possible to unravel the reform legislation and still come up with a plan that guarantees Americans that they can keep the coverage they have if they like it and offers them coverage if they need it.”

On the other end of the spectrum, Joseph Antos, a health care scholar at the American Enterprise Institute, calls for a complete rethinking of the health reform process, positing that even using current proposals as a base for reform would be a bad move. He writes, “Taking either the Senate or House bill as a starting point will inevitably lead to arguments that a popular provision (such as guaranteed issue) will not work without other, less popular requirements (like a mandate on individuals to purchase insurance), which in turn will create the need for even more requirements.” 

In Congress, lawmakers are falling out around similar lines of thinking. House and Senate leaders already have considered several options to pass the current legislation, including having the House pass the Senate bill as is.

Although House Speaker Nancy Pelosi (D-Calif.) previously had indicated that there were not enough votes in her chamber to pass the Senate bill unchanged, House Democrats began considering whether they could attach rider legislation with members’ preferred changes, which could then be passed in the Senate with a simple majority vote. There also has been talk of working on a scaled-back reform bill that would include some of the more popular provisions in the larger overhaul legislation.

Meanwhile, Republicans carried out a counter-message: Start over. The message was similar from senior members of the party down to the newest Republican senator.

Sen. Orrin Hatch (R-Utah), reacting to Obama’s SOTU address, said, “If the President is serious about real reform, he should scrap the current proposal, start over from scratch, and work with all of us in an open and transparent manner on a bill that confronts the number one concern across the country: reducing health care costs.”

While lawmakers and analysts continue to hash out the options to move forward, here’s a look at the action this week.

GOP Annual Retreat

• President Obama on Friday criticized House Republicans at their annual retreat for obstructing beneficial health reform legislation, The Hill‘s “Blog Briefing Room” reports (Romm, “Blog Briefing Room,” The Hill, 1/29). Obama said GOP members have told U.S. residents that he is “doing all kinds of crazy stuff that’s going to destroy America” and that Republicans have sought to cast reform efforts as some “Bolshevik plot.”  Obama said he is willing to consider Republican ideas for health reform and disagreed with arguments that they had been shut out of the reform debate (House, CongressDaily, 1/29).

Republican Resistance

• Some Republican lawmakers have expressed skepticism over working on reform with President Obama and Democrats. Sen. Jim DeMint (R-S.C.) said he is concerned that the White House would only reach across the aisle to moderate Republicans rather than work with members of the whole caucus.
• Eleven House Republicans on Wednesday released a “Declaration of Health Care Independence” that is intended to lay the foundation for GOP health care policy, Politico reports. The first half of the document — which is strongly modeled both in language and style after the Declaration of Independence — criticizes attempts to enact a government “takeover” of health care, while the second half lists 10 Republican principles for reform (Hohmann, Politico, 1/27).

Renewed Calls for Passage of Health Care Reform

• A letter from the U.S. Conference of Catholic Bishops on Wednesday urged lawmakers to “recommit themselves to enacting genuine health care reform,” the AP/Washington Times reports. The letter continued, “The health care debate, with all its political and ideological conflict, seems to have lost its central moral focus and policy priority, which is to ensure that affordable, quality, life-giving care is available to all,” adding, “Now is not the time to abandon this task, but rather to set aside partisan divisions and special interest pressures to find ways to enact genuine reform” (Werner, AP/Washington Times, 1/27).
• HHS Secretary Kathleen Sebelius and Sen. Al Franken (D-Minn.) on Thursday urged supporters not to abandon hope for the passage of health reform during Families USA’s 15th annual grassroots meeting, CQ HealthBeat reports (Norman, CQ HealthBeat, 1/28). Franken said Democrats should adopt a “pass and pledge” strategy in which the Senate would vow to alter its bill using the budget reconciliation process if the House agrees to pass the current version of the Senate bill. Franken said he understood that some House members consider parts of the Senate legislation “distasteful” but that it provided a good foundation for further work (O’Brien, “Blog Briefing Room,” The Hill, 1/28).
• Pharmaceutical Research and Manufacturers of America Chair David Brennan said his group “hasn’t withdrawn support” for the Senate’s health bill even though the recent election of a 41st Republican senator has “thrown everything up in the air a bit,” the Wall Street Journal reports. Brennan, who also is AstraZeneca’s CEO, said it is unclear if the pharmaceutical industry’s pledge to find $80 billion in savings over a decade is still in place (Whalen, Wall Street Journal, 1/28).
• At a press conference last week organized by the National Coalition on Health Care, representatives from the 80-member coalition — including small-business groups, labor unions, religious organizations and other institutions — pledged to launch a lobbying campaign to urge action on reform (CongressDaily, 1/27).
• In a recent letter to President Obama and congressional leaders, the business group Main Street Alliance wrote, “This is no time to consider scaling back a reform bill that must make health insurance affordable for businesses and our employees, share the responsibility of improving coverage fairly among individuals, employers and the government, and reform the health insurance market to keep insurance companies honest.”
• The American Cancer Society also recently released a statement that said, “Cancer patients, survivors and their loved ones are calling on the president to continue to make meaningful health care reform a top national priority” (Wangsness, “Political Intelligence,” Boston Globe, 1/27).

Jobs, Economy Take Priority

• Last week, congressional Democrats expressed confidence that they would pass major health reform legislation this year but made it clear that their immediate legislative focus has shifted to jobs and the economy, leaving the timeline for completing reform legislation open ended,  Politico reports (Budoff Brown, Politico, 1/28).

Push for Smaller Health Reform Measures?

• Last week, House Speaker Nancy Pelosi (D-Calif.) indicated that the House could pass some smaller health reform measures, saying, “Some things we can do on the side,” Reuters reports (Whitesides, Reuters, 1/28). However, Pelosi said that the bills would not be “a substitute for comprehensive reform.” Instead, they would be “sidebar issues we can move quickly,” such as an elimination of health insurance companies’ antitrust exemption (Epstein, CQ Today, 1/28).

Budget Reconciliation

• Rep. Alan Grayson (D-Fla.) last week joined leaders from the Progressive Change Campaign Committee, Democracy for America and Credo Action to deliver a petition to congressional leaders, urging them to use the budget reconciliation process to pass comprehensive health reform legislation, The Hill‘s “Blog Briefing Room” reports (Romm, “Blog Briefing Room,” The Hill, 1/27).

Health Care Reform Transparency

• House Energy and Commerce Committee Chair Henry Waxman (D-Calif.) last week joined Republicans on his committee to urge the Obama administration to disclose more information regarding the deals it struck with health industry groups in exchange for their support of health reform legislation, the Christian Science Monitor reports (Russell Chaddock, Christian Science Monitor, 1/27).
• During the GOP retreat on Friday, Rep. Jason Chaffetz (R-Utah) said negotiations on overhaul bills should have been televised in accordance with President Obama‘s pledge during his campaign. Obama said Chaffetz’s comment is “a legitimate criticism,” adding, “I take responsibility” (Epstein, CQ Today, 1/29).

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