The Power of A

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.