The Power of A

Before the House left for the August district work period on Friday, the Energy & Commerce Committee became the fourth Congressional committee to pass comprehensive health care legislation (subscription).  However, the bill passed after a series of amendments negotiated between a number of Democratic caucuses, meaning a long month of merging the committee bills by the House leadership.

Amendments of note that were approved included:

-          The Baldwin amendment to specify rules for electronic medical transactions (approved 32-26).

-          The Eshoo amendment to give biologics companies 12 years of exclusive marketing of their products (approved 47-11).

-          The Ross amendment (aka the compromise) that increases the number of small businesses exempt from an employer mandate from those with payrolls below $250,000 to $500,000, allows for the creation of health care co-ops, and saves $100 billion from the overall bill (approved 33-26).

-          The Schakowsky amendment that prevents insurance companies in the exchange from raising premium costs faster than medical inflation (approved 32-23).

Amendments of note that were not approved included:

-          The Barton amendment to create a Health Care Information Transparency Office with oversight similar to the Security and Exchange Commission (failed 18-28).

-          The Radanovich amendment to subject the public plan to state taxes (failed 23-35).

-          The Terry amendment to allow the uninsured to participate in the federal government health care plan instead of the exchange (failed 28-31).

Committee Democrats also told the press that Speaker Pelosi had promised an up-or-down vote on a single-payer health care bill on the floor of the House during the health care debate.

Do you think the changes to the Energy & Commerce bill improve it?

Quick Hits

Associations that work together through the Coalition on Human Needs honored their executive director (subscription)… Congressional Democrats plan their message for the month-long August break… Administration officials do not close the door on a health care middle class tax increase, but say unlikely… Senator Rockefeller publicly questions the co-op proposal.

Facing the August recess and constituents who have a wide range of opinions on health care, the House and Senate attempts to pass comprehensive health care reform hit major road blocks yesterday.

The much-rumored dissension on the Blue Dogs deal on HR 3200 was made public yesterday.  Some of the House liberal caucuses released a letter yesterday to the Democratic leadership pledging to vote against any bill that incorporated the changes requested by the Blue Dog.  They specifically cited reimbursement rates in the public plan not being coupled to Medicare repayments and the reduction in low-income subsidies.  The letter was signed by 57 members, more than enough to defeat any bill brought to a vote on the House floor.  However, news broke Friday morning that a deal had been struck to allow the Energy & Commerce Committee to pass the bill, although complete details have yet to be released.

On the Senate side, Finance Committee negotiators and Senate Democratic leaders admitted that a bill would not be released from the committee before the August recess.  Finance Committee Chair Max Baucus (D-MT) spent most of the day deliberating with his Democratic members on controversial aspects of the bill.  It may have been erroneous news reports, however, that helped torpedo the negotiations.  After some newspapers reported Wednesday that a bill was close to being released, Finance Committee Republicans stated that negotiations were still a ways off, with Senator Mike Enzi (R-WY) calling negotiations “a train wreck.”

The one place where progress was made on health care legislation was in the Energy & Commerce Committee, which held its fourth day of mark-ups on HR 3200.  Among the amendments adopted by the committee:

-          The Markey amendment: directs HHS to conduct a pilot program on physician home-care (agreed by voice vote)

-          The Rogers amendment: states the government will not use specific research to ration or deny health care (agreed by voice vote)

-          The Capps amendment: prohibits spending of government money by private insurers to cover abortions, and requiring all state exchanges to have at least one plan covering abortion and one not covering (agreed 30-28)

-          The Stupak amendment: codifies a conscience clause on abortion (agreed by voice vote)

Notable amendments that were not approved include:

-          The Burgess amendment(1): prohibits the creation of a public plan (failed 24-35)

-          The Burgess amendment(2): decouples the public plan payments from Medicare (failed 29-29)

-          The Deal amendment: prohibits illegal immigrants from receiving medical benefits (failed 28-29)

-          The Blunt amendment: requires the president, vice president, and members of Congress to enroll in the Exchange (ruled non-germane by a 36-22-1 vote)

Quick Hits

The House Democrats memo on how to discuss health care reform over the August recess was leaked… Senator Grassley promises not to sell out party… Are health care reform proponents blaming too much on the insurance companies?

Update: After protests by some of the Energy & Commerce Committee’s liberal members forced a cancellation of Wednesday’s mark-up, chair Henry Waxman has rescheduled the mark-up for Thursday.  This was after a lengthy session reviewing the proposed changes to the bill with committee members.

Two major stories on health care broke this afternoon from both chambers.  On the House side, Energy & Commerce Committee Chair Henry Waxman (D-CA) announced a deal with the Blue Dog caucus that allows the committee to finish its markup before the August recess.  Speaking in front of reporters this afternoon, Waxman said the mark-up would continue at 4 PM today and he anticipates the bill will receive a vote out of committee by Friday.  However, the House Democratic leadership pledged that consideration of the bill would be delayed until after the August recess.  In addition, Waxman and the Blue Dogs agreed to exempt all small businesses with payroll greater than $500,000 from the employer mandate (up from the earlier $250,000 limit) and add language allowing doctors to negotiate their own rates on government health care plans.

On the Senate side, Finance Committee Chair Max Baucus (D-MT) announced that the Congressional Budget Office has scored his committee’s bill as costing under $900 billion over ten years, with the bill being fully paid for within those ten years.  The legislation would also cover 95% of Americans, fulfilling the major requirements for health care reform laid out by the president and Congressional leaders.  The bill’s cost could actually cost as little as $750 billion, according to reports.

Stay tuned to the Power of A for the latest in health care reform.

With Senate Majority Leader Reid’s announcement that the Senate would not pass a comprehensive health care reform bill before the August recess, the end of July and August recess will no longer be a frantic time to try and pass health care reform, but a time of preparation for a push in the fall.  All members of Congress will be spending a few weeks in August back in their districts and states, and it is very likely health care will be one of the top issues they discuss with their constituents.  Both chambers are in different positions with their bills, and their next seven weeks will be worth watching:

-          In the Senate, the HELP Committee has already voted a bill to the floor.  The legislation, which went through a complete mark-up, received no Republican votes and is seen as the more Democratic health care bill.  The HELP bill however cannot be voted on until it married to the Finance Committee bill, which has yet to be released.  Finance Committee chair Max Baucus (D-MT) yesterday said the removal of the deadline would help his negotiations (subscription) in finalizing their bill.  The Senate leaves for recess August 7; by then the Finance Committee may release their version of the bill, but it is unlikely it will be passed from committee before August.  Over the recess, look for staff and members to negotiate how they can merge the HELP and Finance bills while trying to ensure 60 votes for passage.

-          In the House, negotiates continue between the Blue Dogs and Democratic leadership.  The House recess begins a week earlier than the Senate’s (July 31), so it will be nearly impossible for the House to pass its bill before leaving (although Rahm Emanuel said this morning it will do just that).  Some media sources have suggested that the Democratic leadership could bypass the Energy & Commerce committee and just bring the health care bill to the House floor, but such a maneuver would likely torpedo discussions with the Blue Dogs.  Over the next seven weeks, look for how the Democratic leadership balances negotiations with the Blue Dogs while trying to maintain support for the bill with more liberal caucuses, such as the Congressional Black Caucus.

Quick Hits

House Republicans are almost ready to release their health bill… The president says he is unconcerned with Senator Reid’s announcement and is focused on signing a bill before the end of the year… The White House chief of staff directly involves himself in the House negotiations… The US Chamber of Commerce outlines its concerns with the proposed health care bills.

At her press conference yesterday, Speaker of the House Nancy Pelosi (D-CA) told reporters that she had enough votes to pass comprehensive health care reform.  That assertion has been called into question over continued negotiations between House leadership and the Blue Dog coalition, and now one of the newest health care compromises threatens to open a new front in the battle.

On Tuesday, Energy & Commerce Committee chairman Henry Waxman (D-CA) announced that he had an agreement with Blue Dog leaders that HR 3200, America’s Affordable Health Choices Act, would contain language authorizing the Medicare Payment Advisory Committee (”Medpac”), as a newly independent executive agency, to review Medicare costs and make binding recommendations to cut costs to the program.  Blue Dog Democrats like the proposal because it creates an independent entity that can reign in Medicare spending without political pressure; currently only Congress has the authority to make cuts in the program.

However, some members of the Democratic caucus have concerns that the proposal would shift too much authority from the legislative to the executive branch.  “You’re outsourcing congressional responsibility,” said Rep. Richard Neal (D-MA), a member of the House Ways & Means Committee.  “It’s the equivalent of the line-item veto.”  Under the proposal, Congress could stop Medpac’s recommendations from going into effect with a vote within 30 days of the recommendation being made.

Associations are also stepping into the debate with concerns about the proposal (subscription).  The American Hospital Association (AHA) and Federation of American Hospitals put out an alert to their members yesterday asking them to call their members of Congress and voice opposition to the idea.  “We certainly cannot support an additional provision that would allow an entity that would be able to make significant additional reductions to hospitals,” said Tom Nickles of AHA.  Additionally, the American Osteopathic Association sent a letter to Speaker Pelosi expressing concern that its members would be unfairly regulated by Medpac.

Additional concerns were raised in this morning’s Roll Call (subscription) about the role of the House Ways & Means Committee in the negotiations with the Blue Dogs.  The language regarding Medpac and other Blue Dog concerns fall under that committee’s jurisdiction, but the negotiations are being handled primarily by the Speaker and Waxman.  While this is a Congressional procedure debate, the implications could mean additional Democratic members opposing the bill based on their exclusion from the process.

Quick Hits

The Finance Committee has still not released a bill, and the August deadline is now acknowledged by the Senate Democratic leaders to be dead… A summary of the president’s press conference on health care… The difference between health care reform and health insurance reform… The HELP Committee acting chair urges Senate Democrats to move quickly, even if it means sacrificing bipartisanship on health care reform.

As the Senate Finance Committee continues meeting among its members to complete its comprehensive health care reform proposal, committee member John Kerry (D-MA) has floated a funding proposal to help solve the bill’s budget problem.

The Kerry proposal, according to Congress Daily (subscription), would not remove the deduction on all employer-sponsored health care plans, but would tax insurance companies offering expensive health care coverage, commonly referred to as “Cadillac” plans.  This tax could be extended to employers offering the plan, although that had not been determined.

The new plan is an attempt to both provide a bipartisan funding mechanism for the Finance Committee’s legislation while trying to uphold the president’s promise not to raise taxes on individuals making below $250,000.  It also takes into account CBO Director Elmendorf’s testimony last week that one way health care reform could address cost issues effectively is to remove the exemption from employer-sponsored health care.

On the House side, the Energy and Commerce Committee continues its mark-up today, mainly debating minor amendments while negotiations continue behind the scenes between leadership and the Blue Dogs.  Politico obtained a list of negotiated points between the two sides; they include, among others:

-          Effectively bending the cost curve

-          Increasing the small business exemption and index it for inflation

-          Addressing end-of-life care

-          Establishing consumer-driven, state-based co-ops

-          Creating state-based exchanges with a federal fallback

Do you think taxing simply insurance companies or businesses offering “Cadillac plans” is a viable way to pay for health care reform?

Quick Hits

President Obama seemingly hedges on his timeline yesterday for health care… The Wall Street Journal questions if the proposed health care bills would repeal ERISA… The District of Columbia budget crunch means fewer resources for nonprofits… ASAE announces the American Association Day 2010 dates as March 23-24, 2010 and opens registration at www.asaecenter.org/flyin10.

Update - A link to the just released House bill can be found here, and a summary of the legislation here.  The committee also has guidance documents for employers, on the public plan, and other aspects at the Education & Labor committee website.  Check back for ASAE’s summary of the legislation for associations.

Original Post - A ticking clock may be the best image to describe yesterday’s developments in health care in both chambers.

House Democratic leaders are expected to unveil their comprehensive health care legislation today.  The legislation was supposed to be unveiled last week but protests from the Blue Dog caucus and over how to pay for the legislation derailed the timeline temporarily.  ASAE will post an analysis of the legislation on the Power of A, specifically looking at if it addresses Blue Dog concerns over small business costs and how the bill raises revenue.  According to Congress Daily (subscription), the Blue Dogs and House Democratic leader have already failed to compromise on an employer mandate for small business, with leadership setting an exemption for companies with payroll under $250,000, which Blue Dog leadership feels excludes too many small businesses.

On the Senate side, Senate Finance Chair Max Baucus has told his committee that their health care bill’s unveiling will be Thursday (subscription), according to ranking member Charles Grassley (R-IA).  While Baucus publicly has denied this timeline, he has come under increased pressure from the White House and Democratic leadership to release his committee’s bill.  Yesterday, White House officials held a conference with Baucus, Ways & Means Chair Charlie Rangel (D-NY), Senate Majority Leader Harry Reid (D-NV), and Speaker Nancy Pelosi (D-CA) to coordinate their efforts on health care reform.  According to the Associated Press, the president told Baucus directly that he wanted a bill publicly announced by the committee before the end of the week.  When it is released, ASAE will post a summary on this site.

Quick Hits

Congressional Republicans hone talking points on potential health care legislation… HELP Committee approves amendment for 12-year exclusivity window before generic versions of biologic drugs can be marketed… Senator Grassley is profiled by Wall Street Journal and targeted by Health Care for America… Insurance associations hold health care “fly-in”.

In Washington DC, September is the new July as a series of events over the weekend has made passage of health care reform legislation before the August recess unlikely, and even endangered the prospects of a bill’s passage this session of Congress.

On Friday, House Democrats announced a key component of financing to their comprehensive legislation: a surtax on high-income earners.  The plan would be to impose a sliding-scale tax on household earning in excess of $350,000 annually, with the surtax increasing at $500,000 and $1 million.  The bill’s authors estimate that such a surtax would raise $540 billion for their legislation.  The other estimated $600 billion would come from savings from the Medicare system, according to Ways & Means Committee member Allyson Schwartz (D-PA), but if that proposal is not scored by the Congressional Budget Office other ideas are being considered, including adding a trigger to increase the surtax.

The announcement of the savings plan came on the heels of a statement against the current health care proposal by the moderate Blue Dog coalition.  On July 9, 40 members of the coalition sent a letter to Speaker of the House Nancy Pelosi (D-CA) arguing that the current House proposal “lacks a number of elements essential to preserving what works and fixing what is broken.”  The letter states that the Blue Dogs signatories could not support the bill as currently outlined, which includes a lack of support for small business, concerns about the bill’s deficit neutrality, and lack of sufficient delivery system reforms.

On the Senate side, the Finance Committee is no closer to releasing their version of the legislation after internal debate over how to pay for their version of the bill (subscription).  After committee chair Max Baucus (D-MT) last week was told by the party leadership not to include language removing the employer-sponsored healthcare deduction, any number of other revenue raisers are being considered.  Nonprofit hospitals and charitable groups seemed to have been the ones most hurt by the decision from the Democratic leadership; the committee is considering both removing the tax-deduction from charitable hospitals and enacting President Obama’s proposal to limit the itemized deduction, including charitable giving.  Last week, a letter signed by over 600 state and local organizations was sent to Congress supporting the president’s proposal.

Quick Hits

White House calls Baucus and Rangel in for a health care visit… Vice President Biden talks health care with small businesses on Friday… Co-ops as a public plan alternative still being discussed…. Will the climate change legislation vote hurt a health care bill’s chance of passing? (subscription).

From this weekend’s talk shows: Sen. Schumer discussed health care on Meet the Press… Sens. Kyl and Durbin debated health care, plus the health care roundtable, on ABC’s This Week with George Stephanopoulos… CNN’s State of the Union had an interview with HHS Secretary Kathleen Sebelius, and discussed the Senate’s health care bill with Sens. Alexander (R-TN), Conrad (D-ND), Gregg (R-NH), and Stabenow (D-MI).