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.

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).