D.C. Healthcare Reform... What We're Hearing
August 03, 2009 by Kevin Phillips
As a time to catch up with what’s happening inside the Beltway, I was in D.C. last week for a round of visits on the Hill and with some healthcare associations. What was true about the wording and contents of the healthcare bill – any of them – last week is likely different this week. In fact, it changes hourly. But, here are some general observations that likely hold true today…we didn’t want to spare you any details…
The Status of the Healthcare Reform Bills
Healthcare reform is as convoluted as you think it is. Even those who are closely involved do not know what is ultimately going to happen. But, they are enjoying participating in it.
On the House side, we have what is dubbed Pelosi's bill. The Democrat leadership and White House were able to turn enough of the Blue Dog opposition last week to vote it out of committee. This was largely a perception move so that leadership and Obama could claim progress going into recess. Conventional wisdom is, this was bad political move. The bill is now a document that can be studied and scrutinized for the 5-week recess. Members will be in their home districts and get an earful everyday from voters about how they don't like reform, especially the House version.
White House Chief of Staff Rahm Emanuel is putting a lot of pressure on the Blue Dogs. He is particularly irked because when he headed up the Democrat Congressional Campaign Committee, he helped elect many of the Blue Dogs. They were conservative Democrats in largely GOP districts (think NC’s Heath Shuler). Now, like all Members, they are trying to protect their seats -- and voting for the Pelosi bill doesn't do that.
On the Senate side, we still have several options.
First, Ted Kennedy’s bill in the HELP Committee. It started strong, but now remains idle. Of the Senate versions, it is closest to resembling the Pelosi bill. But, it doesn't have the votes to get out of committee and will not pass the Senate as is.
Second is the Finance Committee bill, drafted by the Group of 6. This is the one being sold as bipartisan. It removes the mandates to businesses and the public payor system – two essential components of the Pelosi bill for the left wing. The Group of 6 has announced general agreement on language. However, they smartly will not mark up the bill prior to recess. Instead, they'll send Senators home with talking points and general messages -- but without a document to review. Today, no one knows if the Finance bill has the votes in the full Senate to pass, but it might. Problem is again, it is so different from the Pelosi bill that if the House passes the Pelosi version, no one can see how a conference committee can effectively combine the two efforts. They are just too different.
Lastly, there is the Wyden-Bennett bill which had steam early on and dropped off the radar. Some are trying to revive it -- mainly the Republicans because it focuses on free market, regulations on insurance companies, and financial incentives for healthy living. We'll see if it can get back into the discussion.
Whatever comes out of the Senate, while the House has childishly and publicly fought in the media, the Senate thus far has done a fair job appearing reasonable and statesmanlike.
One point to ponder: If the Senate goes with the Group of 6 bill over the HELP bill, what does Obama do? Does he support it because it has a chance to pass? If he does, he abandons the Kennedy-crafted HELP bill. So, he has a potential political problem in the works.
The Timing of Healthcare Reform
We have two, maybe three, bills in the Senate and one in the House. Recess starts now for 5 weeks. In short, all the Members go home, hear a lot of negatives, and come back in September skittish. Do they start editing what they have? Do they start over? How do they combine the House and Senate versions? No one knows. So debate lingers on about reform. Problem is, there are more breaks to come for holidays. If nothing is final, we enter 2010 – an election cycle year. Filing deadlines for Congress are in February. If we make it that far without reform, it all grinds to a halt. No one will dare talk healthcare reform as an election nears. After the 2010 elections, we are begin to ramp up for the Presidential re-elect.
What to do? Current efforts can easily get delayed too long and stall for 2010 cycle. Or, maybe Congress agrees to pass Healthcare Reform Lite where they pass the 80% of reform that everyone already agrees on, including insurance industry regulation. That’s unlikely – it’ll be a loss for Obama. Or, the whole thing collapses under its own weight and either starts over or never moves. Collapsing is where the bets are being placed on the Hill right now. Is it possible that after all this discussion and posturing, nothing happens? Maybe.
Oh, and a couple of other things that will make Congress interesting. In September, the Climate bill is up for debate. It too is controversial. It will take every ounce of Obama's political strength to the get the votes for healthcare. It will take a lot of it -- and he won't have any left -- for Climate. Snag is, he can't trade one for the other. On climate and healthcare, he has two different liberal constituencies to appease and neither feels like they've gotten anything from him in 7 months. His campaign promises aren’t being fulfilled. They ain't happy.
Water Cooler Discussion…
Did you realize that the Senate Finance Committee Group of 6 who are leading healthcare reform on the west side of the Capitol do not have an urban population center among them? They are Senators from Montana, Wyoming, North Dakota, New Mexico, Iowa and Maine. Their perspectives on healthcare delivery are likely different from the majority of the country.
While the Blue Dogs have done a good job of wielding their power – even one House GOP chief of staff credited them with “holding back the barbarians at the gate” – there are some who are grumbling that they’ve received so much attention that they’ve begun to believe their own press. They say some of the Blue Dogs have become legends in their own minds. That did not include our own Jim Cooper, of course.
Have you wondered why the American Hospital Association supported the reform bill early? At least two reasons: the proposed ban on physician-owned hospitals and an increase in reimbursement rates. Hospital executives as individuals may not like the personal financial ramifications of reform, but from a business standpoint, it makes sense. What about the AMA? All they wanted was the removal of reimbursement caps and increases each year. They got it.
If you’re looking for some government action that actually does work to make life more convenient? How about a one sentence change in policy that will allow for Medicare to reimburse for recurring prescription drugs by mail? Right now, those have to be picked up at a store. That wording change will eliminate one more errand for those on Medicare who choose to participate. It’s not in the bill yet, but pharmaceutical associations are poised to introduce it. Who is against? Big drugstore chains like Walgreens and CVS, of course.
Regarding the accuracy of available information: Hill staffers involved in healthcare lament that what the public is reading or hearing in the media is mostly either 1) flat out wrong or 2) out of date. They say “mostly” because some of it is correct, you’re just not sure what part. They say if we’re just reading news reports, we’re getting a skewed and inaccurate view of what’s actually in the bill and its progress.
If you’d like someone to blame for the bureaucratic, political stalemate, little if any of this has anything to do with the Republicans. The GOP has marginal power. Instead, this is due to the Democrat majority fighting amongst themselves. It is an entanglement of Pelosi vs. the Blue Dogs vs. Rahm vs. the Senate vs. Henry Waxman vs. the Congressional Black Caucus vs. lobbyists vs. conservative Democrats vs. left wing Democrats. What was once touted by Pelosi and Obama as a plus -- four or five committees each working on healthcare reform, is now a curse. They came up with their own ideas independently and now there are too many egos, too many factions, too many agendas involved to agree. What the process lacked from the start was adult supervision, a leader, who outlined reform and forged a consensus.
