House Democrats set to move bill after accord with Blue Dogs, Liberals objecting

House Democrats on Wednesday made a deal with fiscally conservative Blue Dog Democrats on a health reform bill that "would reduce the overall cost of the package and ensure more funding for rural hospitals, concessions that could allow the Energy and Commerce Committee to finish its consideration of the legislation," The Washington Post reports.

The deal will be considered on the House floor no earlier than September, according to several lawmakers. House lawmakers plan to conclude their markup of the legislation in the Energy Committee Thursday.

"The new proposal includes a public health insurance option to compete against private insurers, but it does not tie the payments to Medicare's rates of reimbursement to health-care providers, something many liberal lawmakers had sought. Instead, it calls for the health secretary to negotiate rates with hospitals and doctors, just as private insurance companies do. Rural health-care providers generally receive less in Medicare reimbursements than their urban counterparts, and delinking the public plan from Medicare was considered critical for conservative Democrats"  (Kane and Murray, 7/30).

The New York Times: "Medicaid would be expanded, as under the original bill, but states would pay a small share of the additional costs, perhaps 7 percent. The federal government would have paid all the additional cost under the original bill. People with low or moderate incomes could still get federal subsidies to help them buy insurance, but they might have to spend slightly more of their own income - a maximum of 12 percent, rather than 11 percent" (Pear and Herszenhorn, 7/29).

Kaiser Health News reports that Rep. Mike Ross, D-Ark., "said that, all told, the revised bill would cost $100 billion less over 10 years, although precisely how that would be accomplished will be unclear until the CBO prepares a cost analysis of the overall bill. House senior Democratic aides said that the demands for revised reimbursement rates and more protection for small businesses would actually add $100 billion to the cost of the bill, and would have to be offset with savings elsewhere."

KHN notes that White House Chief of Staff Rahm Emanuel helped forge the agreement, which was not unanimous among the Blue Dogs: "Meanwhile, three of the seven Blue Dogs involved in the negotiations declined to support the agreement. Rep. Jason Altmire, D-Pa., a Blue Dog member of the Ways and Means Committee who voted against the bill when it came before that panel, said he's still not sure whether he will ultimately support the measure" (Carey and Pianin, 7/30).

The Christian Science Monitor: "In a move to trust but verify, the Blue Dogs are also calling for a full scoring by the Congressional Budget Office before the full House considers a bill to 'ensure it appropriately reflects the principles we have articulated'" (Chaddock, 7/29).

McClatchy Newspapers: "(President) Obama had said as recently as July 15 that he hoped for floor votes in the House and Senate before the recess. Wednesday, he offered only praise for the incremental progress, thanking the Blue Dogs for 'working so hard to find common ground. Those efforts are extraordinarily constructive in strengthening this legislation and bringing down its cost'" (Lightman and Douglas, 7/29).

The Associated Press: "Senior congressional aides cast it as a temporary deal, saying leaders had not committed to support it once the bill advances to the floor of the House in the fall" (Espo, 7/29).

The Washington Post in a second story: Ross "speaking for The Washington Post's online video series "Voices of Power," said the deal was 'absolutely' contingent on not having a vote before the August recess, as Pelosi had hoped to do. 'Somewhere along the way, people started imposing this artificial deadline,' he said. 'The American people are ready for us to slow down and . . . read what we are voting on'" (Romano, 7/30).

Los Angeles Times: "Democrats still face big obstacles in their quest to send legislation to the White House. Those hurdles include mollifying liberal lawmakers, who expressed outrage at the deal reached Wednesday. 'I think they've had an inordinate amount of input,' Rep. Pete Stark (D-Fremont) said of the more conservative 'Blue Dog' Democrats. 'And every time people have given them some consideration, they want more'" (Levey and Hook, 7/30).

The Hill: "Liberals aimed to win 50 signatures on a letter to their leaders opposing the deal to make it clear they could defeat the healthcare bill on the floor. 'Fifty is our threshold,' said Rep. Raúl Grijalva (D-Ariz.), a co-chairman of the caucus. 'That'll kill anything'" (Soraghan, Young, Allen, 7/29).

Politico: "'Waxman made a deal that is unacceptable,' said Rep. Jerrold Nadler (D-N.Y.), one of about 10 progressives who met repeatedly with (House Speaker Nancy) Pelosi (D-Calif.) and Majority Leader Steny Hoyer (D-Md.) on Wednesday. 'We signed a pledge to reject any plan that doesn't include a robust public option, and this plan doesn't have a robust public option,' he added" (Thrush, 7/29).

Roll Call: The bill "'has to be much stronger to get our support,' (Congressional Progressive Caucus Co-Chairwoman Lynn) Woolsey (D-Calif.) said after a meeting with Speaker Nancy Pelosi (D-Calif.), who tried in a meeting Wednesday to sell them on the deal. Woolsey said progressives fear that without basing health care reimbursements on Medicare rates, the public option will not be able to hold down costs and force savings from private insurance companies. She said that was 'great for the insurance companies' and would allow them to keep doing business as usual" (Dennis and Drucker, 7/30).

CongressDaily reports that there may be some room for reconciliation when the bills are negotiated and made into one: "But liberal members who emerged from meetings with leadership Wednesday suggested many of their concerns could also be assuaged when the three committee bills are melded. 'A lot can take place in that reconciliation,' said Rep. Sam Farr, D-Calif., a member of the Progressive Caucus" (Hunt, 7/30).

http://www.kaiserhealthnews.orgThis article is republished with kind permission from our friends at The Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery of in-depth coverage of health policy developments, debates and discussions. The Kaiser Daily Health Policy Report is published for, a free service of The Henry J. Kaiser Family Foundation. Copyright 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.



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