The Power of A

Despite the seeming setback dealt to the Democrats comprehensive health care reform efforts this weekend by Senator Lieberman (I-CT) and Ben Nelson (D-NE), Senate Democrats are planning a procedural move to set-up a December 23 vote on their health care legislation and have indicated they are close to 60 votes.

Over the weekend, Senator Lieberman publicly stated he would not vote for a bill with a “public option” or the compromise “Medicare buy-in” provision; that left the Democratic caucus with less than 60 votes needed to pass the bill over a filibuster.  However, after a closed-door caucus meeting and a meeting with the president, the Democratic leadership is moving forward with a bill without a public option or Medicare buy-in and expects to have 60 Senators voting for the legislation.

Senate journalists expect Majority Leader Reid (D-NV) to announce the final bill’s language today, have the Senate debate and vote on the Defense Department appropriations bill the rest of the week, and file for cloture on the health care bill Friday.  This would set up the chamber procedurally for a vote as early as the 23^rd.

A few outstanding issues remain:

-          The Congressional Budget Office has not yet released a revised score of the Senate legislation, but that score is expected to be released today.  Some fiscally conservative Democratic Senators have said they will not publicly support the bill until they see that the legislation does not increase the deficit.

-          Senator Ben Nelson, Senator Reid, Senator Robert Casey (D-PA) and the White House are continuing to negotiate over the abortion language in the bill.  An amendment offered by Nelson on abortion was defeated last week, but he has withheld support until the issue is resolved.  The expected compromise will likely include strict segregation of what funds insurance companies can use to cover abortion, as well as subsidies and financial support for a series of pregnant women support programs.

-          Some of the chamber’s public-option supporters have publicly expressed their discontent with a bill lacking a government-run insurance offering.  What remains to be seen is if any of these Senators will vote against a bill without a public option.

Quick Hits

The House agenda is packed today: pass the Defense Department appropriations bill, increase the federal debt limit, pass a jobs bill using left-over TARP money, and pass a continuing resolution to allow the Senate to pass the Defense appropriations bill… Senate Democrats are lining up votes to prevent the estate tax from expiring this year… How will the US find enough conduits for more broadband expansion?  The National Association of Broadcasters and CTIA weigh in at a House Energy and Commerce Communications Subcommittee hearing.

Cooper/CBS

What was last week touted as a potential breakthrough for the Senate health care bill is today being labeled as potentially another failed compromise.  Yesterday, Senator Joe Lieberman (I-CT) publicly stated that a health care bill which would extend Medicare coverage to people over the age of 55 was legislation he could not support, and he would vote to continue a filibuster on the Senate legislation.

The proposal was floated last week as a compromise/replacement for the public option language in the Senate comprehensive health care bill.  The provision would allow Americans as young as 55 with no insurance to be eligible to buy into Medicare, the federal insurance plan for the elderly.  Additionally, the bill would grant the Office of Personnel Management (OPM) the ability to create a national pool for health insurance by contracting with private insurance companies and offering reduced rates to the uninsured.  The idea is similar to the current health care system for federal government employees.  The expected savings provided by these two proposals would allow the Senate to increase the subsidies given through Medicaid to people at 150% of the federal poverty limit, up from 133% currently in the legislation.

The Senate was awaiting a Congressional Budget Office (CBO) score that could come as early as today - something some Senate Democrats will use as a marker to support the legislation.  However, losing the support of Lieberman would prevent Senate Democrats from corralling the 60 votes needed for passage.  If no Republicans indicate their intent to vote for a Medicare-expanded bill, the majority will need to find a new compromise or pursue reconciliation.

Quick Hits

Democrats are working on compromise language on abortion in the Senate health care bill… The Senate passes an omnibus appropriations bill over the weekend, sending it to the president for his signature… The Supreme Court will delay a decision on a major election law case until 2010 at the earliest… USA Today analyzes the pros and cons of the Medicare expansion compromise.

Saturday night, the Senate voted to proceed on the debate on S. 1796, the Patient Protection and Affordable Care Act.  Due to Senate rules, a filibustered bill must receive 60 votes for 30 hours of debate to proceed on it, and Senate Majority Leader Harry Reid (D-NV) was able to line up his caucus against a united Republican caucus to get the 60 votes necessary for the motion to pass.  As it currently stands, the Senate is scheduled to consider a series of amendments and debate the legislation with the majority hoping to pass the legislation before the end of December, but that schedule is very fluid.

Some major political issues remain before the bill can be passed.  Although all 58 Democratic and two Democratic-leaning Senators voted on the motion to proceed, some Democratic Senators expressed public opposition to some components of the legislation as currently written.  A major sticking point is the inclusion of an “opt-out” public option; while Senators such as Lieberman (I-CT) and Lincoln (D-AR) have expressed opposition to a strong public plan, other Senators such as Sherrod Brown (D-OH) have said they will vote against any bill with a public option any weaker than the one already in the bill.  And with no Republicans expected to vote for the bill, the majority needs every Democratic vote, or a few Republican defectors, to pass the bill over a filibuster.

Politico outlines some of the major controversies surrounding the bill.

ASAE has also outlined the major provisions of both S. 1796 and the House comprehensive health care reform bill.

Quick Hits

Lawmakers react to the new mammogram guidelines recommended by the USPSTF (Power of A post on association response seen here)… The face of the turkey industry association on Capitol Hill is profiled in Roll Call (subscription)… The American Association of Suicidology is working with local transit systems on an increase in subway-related suicides… The White House is asking nonprofits, as well as media networks and for-profit companies, to promote science and math to school children.

Updated 1:11 PM: Yesterday evening Senate Majority Leader Harry Reid (D-NV) unveiled his merged comprehensive health care legislation, hours after the Congressional Budget Office (CBO) had released its score of the legislation.  The CBO scored the legislation as costing $848 billion over the next ten years, but would reduce the deficit $130 billion.  The bill according to CBO would also cut Medicare spending by $491 billion over 10 years and cover 94% of non-senior Americans.

Currently, the speculation is that Reid will make a motion to proceed on debate on the legislation on Saturday.  This motion, which will be filibustered, will require 60 votes to pass.  It is expected that all forty Senate Republicans will vote “no” on the motion, requiring a united Democratic caucus to proceed to debate on the bill.  Reid in public statements has sounded confident that he can get 60 votes on a motion to proceed, but the vote may have to be delayed due to Senator Baucus suddenly having to leave town.

The bill, which is over 2,000 pages long, combines the Senate HELP and Finance Committees health care bills passed earlier this year.  The Hill summarizes the major provisions here.

The following are the highlights of the legislation: continue reading

What do you think (vote your opinion)?
When will Congress send the President a comprehensive health care bill to sign?(polls)

Reports this morning from the Senate cast doubt on whether the chamber will be able to pass its version of comprehensive health care reform in the current calendar year. Senate Majority Leader Harry Reid (D-NV) is still waiting for the Congressional Budget Office (CBO) to send him scores of his draft health care proposals, a step the caucus feels is necessary before it can begin to consider any legislation. Reports are that the score could come out as early as the end of the week.

The problem facing Democratic leadership in both the Senate and House is an increasingly unfriendly calendar. Neither chamber will be in November 11-13 in honor of Veterans’ Day and Congress will recess the last week of November for Thanksgiving. December debates will have to be scheduled around the various holidays and religious observances.

Further complicating matters in the Senate are reports that Reid does not have the 60 votes necessary to end a filibuster on the legislation. When he does introduce a bill, he has pledged ample time for the Senate to review the bill before holding any votes. A Republican aide told CongressDaily AM that the rumor is Reid would put the bill out for review before Thanksgiving and begin preliminary debate, pausing for the Thanksgiving break, with the expectation of a vote before Christmas.

On the House side, the Democratic leadership is confident it is close to reaching an inter-caucus compromise on their bill’s abortion and citizenship language, which would lead to debate on the bill beginning Friday and an expected vote before Veterans Day.

Quick Hits

The rule on the health care bill will allow House Republicans to offer a substitute amendment – here is their outline… Senator Lieberman backs off his “no” vote comments from the weekend… Senate Environment and Public Works Committee could lack Republicans during its climate change debate.

Yesterday, Senator Majority Leader Harry Reid (D-NV) held a press conference to unveil a few details of the Senate’s merged comprehensive health care bill.  Earlier in the day Reid sent a few variations of the comprehensive bill to the Congressional Budget Office (CBO) to be scored, so his press conference lacked a discussion of many of the details contained in the legislation.

However, the one detail that has been receiving attention is Reid’s inclusion of the “opt-out public option” in the bill.  The legislation would create a government-run insurance company through which unemployed individuals in a health care exchange could buy health coverage.  The public plan would be a national plan, and under Reid’s proposal, a state could “opt-out” of offering the public plan in their insurance exchange.  Reid noted that every version of his health care bill forwarded to CBO contained this language.

continue reading

The Senate Finance Committee yesterday continued to debate the list of amendments to its comprehensive health care reform legislation, but conspicuously absent from the discussion were any amendments tied to the major issues being discussed by members of Congress and the media, according to Politico.  At the beginning of yesterday’s hearing, the first amendment discussed was Senator John Kerry’s (D-MA) changes to the tax on “Cadillac” insurance plans.  However, the discussion was quickly ended when Kerry stated his intention to withdraw his amendment, stopping the debate over a major proposal to pay for health care reform.  Instead, it looks like he will reintroduce the amendment on the Senate floor.  Public option alternative amendments by Senators Carper and Snowe, which have been discussed by Senate leadership in recent days as major proposals, are also not scheduled to be debated by the committee.

The result is that the Finance Committee markup will be completed by the end of the week, allowing for the merging of the Finance and HELP Committee legislation.  Senate Majority Leader Reid yesterday told reporters he was cancelling the Columbus Day recess, setting aside that time for a floor debate on health care.  It seems likely that it is during that debate that we will see (depending on the content of the merged bill) debates on a version of the public option (or a trigger for the public option) as well as ways to pay for the Senate legislation.

Debate yesterday instead focused mostly on social issues, including abortion and immigration.  A list of all amendments and the votes can be found at the America’s Health Insurance Plans website, but some amendments of note include:

-          The Ensign/Carper amendment that would allow employers to adjust health care premiums based on the workers’ healthy or unhealthy behavior (Passed 19-3).

-          A Grassley amendment to remove the $6 billion fee on insurance companies (Failed 10-13).

-          A Nelson amendment to allow seniors to claim a tax deduction if their catastrophic insurance costs exceeds 7.5% of their income (Passed 14-9).

Quick Hits

The U.S. Chamber of Commerce urges its members to oppose Wyden amendment C-1 that requires large employers to offer at least two health care plans to employees…  CBO failed to include an exemption for hospitals in the Finance bill’s Medicare cost-cutting commission, skewing the score (subscription)… The White House tax reform panel holds its first public hearing yesterday and hears from some associations… Senators Kerry and Boxer introduce the Senate climate change legislation… The Washington Post tries to define a “Cadillac” plan.

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.

ASAE and other travel-focused associations have been sharing stories about how the economy and negative media attention has forced some corporations and associations to cancel or move their meetings from certain high-profile destinations and properties to avoid public criticism.  Today’s Wall Street Journal reports that the federal government has also been pulling meetings from some of these same traditionally popular meeting destinations, due to concerns about how the meeting will be perceived.

The General Services Administration, which issues federal employee travel per diems, has no restrictions on locations for agency meetings, but each agency can set their own internal guidance.  A sample of the guidance obtained by the Journal:

-          A Department of Justice memo states conferences “are not to be held in cities that are vacation destinations/spa/resort/gambling.”

-          The FBI recently issued an internal memo that listed Las Vegas and Orlando as the first two cities “on the chopping block” for meetings.  A conference planner at the MGM Mirage confirmed that the FBI politely declined her proposal for a Las Vegas meeting.

-          The Department of Agriculture issued internal travel guidelines that asked employees to hold meetings in cities that met three criteria: the city is a travel hub, it is low in cost, and it is a “non-resort location.”  The memo includes the following as examples of cities meeting all three criteria: Chicago, Denver, Portland (OR), St. Louis, Washington DC, Milwaukee, Phoenix, and Fort Collins (CO).  The memo also claims “resort locations” aren’t banned, but the planner must “provide robust justification” for the location.

The concern for travel associations and local convention and visitors bureaus (CVBs) is that labeling certain cities like Las Vegas, Reno, and Orlando as resorts discourages associations, businesses, and federal agencies from meeting at these locations and hurts local economies dependent on strong convention bookings and business travel.  Pressure is coming from the media, internal stakeholders and certain policymakers for businesses to avoid holding “junkets” in a bad economy; President Obama earlier this year even singled out Las Vegas as a place for firms receiving Recovery Act funds to avoid.

Earlier this month, Senator Harry Reid (D-NV) sent a letter to White House Chief of Staff Rahm Emanuel asking the White House to reverse the informal guidance which discouraged meetings held in Las Vegas.  He cited numbers showing the affordability of having meetings in the city, including an average hotel room this summer costing $96.  Emanuel responded with a letter saying policy on meeting location was not dictated by destination but by the cost of holding the meeting.

How does an association balance its responsibility to hold a meeting in a destination with first-rate facilities without coming across as extravagant?

Quick Hits

Energy and Commerce Chairman Waxman and the Blue Dogs strike a deal to allow an independent board to make cuts and set rates for government health care programs…  While the agreement is a step forward, the Blue Dogs still have concerns (subscription) on the House health care bill… Finance Committee deliberations are still ongoing.

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”.