by Jocelyn Richgels
August 7, 2009

 

As August recess begins for Congress, progress has been slower than hoped for on health reform, but further along than any reform efforts that have been undertaken in numerous decades.   Members are back in their districts, hoping to hear constructive ideas from their constituents, but also prepared to confront well-reasoned concerns and what have turned out to be very angry gatherings at some health care town halls. 

 

Legislative language for reform has passed out of four of the five committees that are charged with drafting the legislation.   The Senate HELP committee had four weeks of marking up the bill and finally passed it on a party line vote.  It was a more liberal bill than the one that will eventually emerge from the Senate Finance Committee.  This is the only committee that has not produced legislative language because of intense negotiations with three Republican committee members to produce a bipartisan bill.  The gang of six - Senators Max Baucus (D-MT), Kent Conrad (D-ND), Jeff Bingaman (D-NM), Chuck Grassley, (R-IA), Michael Enzi (R-WY) and Olympia Snowe (R-ME)  have set a September 15 deadline to produce text, which also sounds like a deadline that the President is using to continue trying to achieve a bipartisan bill before taking steps, such as reconciliation, that would forgo the need for bipartisanship.  Emerging ideas from the Finance committee include taxing the highest cost employer-provided insurance plans to raise revenues and installing a member-driven coop insurance plan instead of a public insurance option.

 

In the House, bills have been passed out of all three responsible committees, but not without some major negotiating in the Energy & Commerce with Congressional Blue Dogs.  The Blue Dogs, conservative Democrats who hail primarily from conservative leaning rural districts, have been forceful and effective in voicing their concerns and in turn ensuring they are addressed.  This was particularly true on the Energy & Commerce committee, where they hold a number of seats.  Before agreeing to support a bill in committee, they asked for a delay in voting on the floor until after the August recess; more enforceable cost cutting measures, such as an independent Medicare commission that would be in charge of setting provider payment rates instead of leaving it in the hands of Congress, who yearly forgo anticipated cuts in provider payments; and excusing more small businesses from the employer mandate to provide insurance.  Being from rural districts, many of them were also concerned with the low payment rates to Medicare providers and geographic disparities in Medicare payments to providers in their districts.  They secured two provisions that would directly address these concerns.  The first would require any public plan to negotiate payment rates with providers, rather than paying Medicare rates plus 5%.  This significant change will prove to be very contentious in the final merging of the three bills before it hits the House floor for a vote.  They also secured a provision that would require a study to understand how the disparities in payments between higher-cost urban areas and lower-cost rural areas happen and suggest concrete steps to fix them. 

 

Normally sleepy August will be a critical month for the future of health reform.  Senator Evan Bayh, Democrat of Indiana effectively sums up the status of health reform, "Let's not lose sight of the fact that there are historic advancements that we all agree we can make, starting with eliminating pre-existing conditions as a reason for people not getting insurance; no lifetime caps, so if you get a catastrophic illness you're not going to lose your coverage, ­ the insurance company can't cut you off for a variety of reasons; a significant expansion of Medicaid to help the less fortunate," Bayh said. "Subsidies for middle-class families so that they can afford individual insurance policies; strong incentives for small businesses to provide insurance to their employees," he continued. "Closing the donut hole, so that seniors will no longer face a cliff where they can't afford their medicines. All those things I strongly support. You'd get 60 votes for those right now." Asked why a broad agreement among Democrats continues to be elusive, Bayh responded, "Well, you didn't hear me say how it was going to be paid for, did you?"