Sen. Dianne Feinstein, California’s senior senator, has been under pressure from supporters of Democratic health care reform efforts since late June, when she questioned whether health care reform legislation would make it out of Congress this year.

Days later, advocates descended on Feinstein’s offices around the state, urging her to back President Obama’s health care efforts more forcefully, and members of the Service Employees International Union Local 1021 took the same message to the senator at her San Francisco home on Aug. 31. 

The rally came days after Feinstein issued a release spelling out her positions on health care reform, making it clear that she has some serious concerns for what proposals in Congress could mean for California. Noting that the six senators negotiating the Finance Committee’s proposal hail from small states, Feinstein wrote that she is “doubly concerned that the final bill will not take into consideration California’s needs, which vary considerably from smaller states.”

Feinstein also wrote that she would not support a bill that leads to higher costs for California, whether it be at the state or county level. She specifically addressed reports that Medicaid would be expanded to Americans whose incomes do not exceed 133% of the federal poverty level, a move she said would increase the cost of Medi-Cal by about $2.05 billion annually.

It isn’t clear whether the federal government would cover that cost, in part or in whole, for a few years or for the foreseeable future. 

Feinstein voiced support for efforts to:

• Rework Medicare to eliminate duplication of services and waste;
• Control health insurance premiums;
• Permit Americans to keep their current health insurance coverage; and
• Enact new regulations on the health insurance industry.

Feinstein pledged to update her health care reform position paper as provisions of the Senate Finance Committee bill are made public.

In Congress’ other chamber, Reps. Henry Waxman (D-Calif.) and Bart Stupak (D-Mich.) sent letters to six major health insurers asking for information about the practice of “purging” small businesses when employees get sick and health insurance claims increase.

Stupak likened the practice to rescissions in the individual health insurance market and said lawmakers needed more information about how common “purging” is in the small group insurance market. 

A day after Waxman and Stupak sent their letters to insurers, the Sausalito-based Small Business Majority released a report indicating that 86% of small-business owners in California who don’t offer health care benefits to their employees say they can’t afford to.

The survey also found that:

• 62% of California small-business owners say they believe that employers have an obligation to provide health insurance coverage to employees; and
• 68% of small-business owners in the state believe individuals, employers, insurers, health care providers and government share a responsibility to make health care more affordable.

In the days ahead, Obama is expected to make clear to the American people what he wants a health care proposal to include, and the Senate Finance Committee likely will lay out the specifics of its plan.  In the meantime, here’s a rundown of what transpired since the Aug. 26 edition of Road to Reform.

Administration’s Message

• On NBC’s “Meet the Press” on Sunday, White House senior adviser David Axelrod said that President Obama “believes the public option is a good tool,” but noted that it “shouldn’t define the whole health care debate” (Berger, New York Times, 9/7). According to Axelrod, Obama continues to believe that the public option is “important,” but declined to say whether Obama would withhold his support for legislation that does not include such a plan. He also described the public option as “a valuable tool” to spur competition and choice.
• In an appearance on ABC’s “This Week” on Sunday, White House press secretary Robert Gibbs said that Obama plans to generate more support for the public option in his speech scheduled on Wednesday during a joint session of Congress. Gibbs added that Obama “believes and continues to believe that [a public plan] is a valuable component of providing choice and competition that helps individuals and small businesses [and] at the same time provides a check on insurance companies” (Fields, Wall Street Journal, 9/7).

Pushback in the Senate

• Delivering the GOP’s weekly radio and Internet address, Sen. Mike Enzi (R-Wyo.) on Aug. 29 said that Democrats’ current reform plans “will actually make our nation’s finances sicker without saving you money,” the Washington Post reports (Pershing, Washington Post, 8/30). In the address, Enzi said that Democrats’ proposals would “raid Medicare” and intrude “in the relationship between a doctor and a patient” (Washington Post, 8/30). Enzi said that any reform plan should have medical cost-control measures that do not raise deficits or the national debt. “The bills introduced by congressional Democrats fail to meet these standards,” he said (AP/Philadelphia Inquirer, 8/30).
• On Aug. 31, White House press secretary Robert Gibbs called Sen. Enzi‘s criticism “tremendously unfortunate” because it shows that Enzi has “clearly turned over his cards on bipartisanship” and “decided to walk away from the table,” The Hill reports (Youngman, The Hill, 8/31).  A spokesperson for Enzi declined to comment on Gibbs’ comments but said that the senator “remains committed to working toward a bipartisan solution to provide real health care reform” (Haberkorn, Washington Times, 9/1).

House Resistance

• Twenty-three House Democrats have already told their constituents that they will oppose the House’s health reform bill (HR 3200), citing cost concerns and fear that the bill will subsidize abortions. In addition, other House Democrats who were berated by protesters at town-hall meetings over the break have said that they are undecided (Soraghan/Gleeson, The Hill, 9/8). According to the Washington Post, some Democrats are hesitant to support legislation that includes a public health insurance option.
• Members of the Congressional Progressive Caucus are considering pulling their support from any bill that does not include a significant public plan (Washington Post, 9/8). However, according to Roll Call, members of the Progressive Caucus might be able to consider a “trigger” approach — in which a public insurance plan option would be introduced only as a fallback if other reform measures were determined to be insufficient (Newmyer/Dennis, Roll Call, 9/8).
• In an appearance on CNN’s “State of the Union” on Sunday, Rep. Keith Ellison (D-Minn.) — vice chair of the Congressional Progressive Caucus — said he hopes President Obama “understands the essentiality of the public option” (Haberkorn, Washington Times, 9/7).

What It’s Going To Cost

• The Congressional Budget Office released its scoring of prescription drug provisions in the House health reform bill and found that most Medicare Part D beneficiaries would pay higher premiums for their drug plans but many would experience a decline in total drug spending. CBO also estimated that drug-related provisions in the bill would save the federal government $30 billion over the next decade (Goldstein, “Health Blog,” Wall Street Journal, 8/31).
• A Health Affairs study released on Sept. 1 indicates that the potential cost savings from increased preventive health care would not be realized within the 10-year window typically used in CBO analyses. Thus far, CBO has refused to score preventive health provisions included in Democrats’ health reform plans as potential cost-saving measures. The study suggests that CBO use a 25-year window to score preventive health measures rather than the 10-year span (Montgomery, Washington Post, 9/1).

Shaping the Debate

• The National Republican Campaign Committee is scheduled to launch a television advertisement in northern Illinois as part of a nationwide campaign criticizing Democrats at risk in the upcoming elections for their stances on current health reform proposals, Politico reports. The ads also are running in Alabama, Colorado, Maryland, Missouri, New Mexico and Pennsylvania (Isenstadt, Politico, 8/29).
• On Sept. 1, Richard Trumka, the incoming president of the AFL-CIO labor union, said that the organization would not support current health reform proposals if they do not include a public plan option, as well as an employer mandate, while leaving out a tax on employer-sponsored health benefits. Trumka said that health insurance reform is not possible without a public plan option to “break the stranglehold of insurance companies.” He said without the option, the “system goes on and on and on as it has,” where costs “go up” and “quality of care goes down” (Cook, “The Vote Blog,” Christian Science Monitor, 9/2).
• Various interest groups have begun buying Internet advertisements that pop up when people type key words like “death panels” and “euthanasia” into Google, hoping to debunk various claims by health reform opponents, the Los Angeles Times reports. One of the ads directs users to a “Setting the Record Straight” page on barackobama.com, while another ad links to a MoveOn.org page that examines “five health care reform lies” (Wallsten, Los Angeles Times, 9/4).

 

 

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Road to Reform The Health Law