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The Latest News On Healthcare Reform

February 4, 2010

The President 'pivots' and 'resets'

Most pol watchers agreed last week that the agenda for the State of the Union address was this: The President needed to "pivot" and "reset."

The Democratic defeat in the Massachusetts special election last month was a major setback for President Obama and his agenda—specifically, for what had been called his chief domestic priority, health reform. So the thinking about the State of the Union was that he needed to pivot—that is, change the subject from health reform to jobs and the economy. And he needed to press the reset button—start anew with the American people.

And, in fact, that is what he did. Various news organizations described his move in different ways. One noted that he didn't even mention health reform until 25 minutes into the speech. Another said that 3,300 words went by in a 7,000-word speech before the subject of health reform came up. One commentator said it was the eleventh issue the President mentioned, "after community colleges"—a subject that hadn't even been on the radar. And the headline on a progressive blog was, "If you blinked, you missed it: Obama's five minutes on health care."

In the last few weeks, the President has definitely reshuffled his priorities. So where does that leave health reform?

Republicans and Democrats haven't agreed on much lately, but they all agree it's important to pass some version of health care reform sometime soon. "No one in Washington thinks our health-care system is perfect," House Minority Leader John Boehner said on "Meet the Press" on Sunday, "and certainly not Republicans."

House Speaker Nancy Pelosi said reform is so important "We'll go through the gate. If the gate's closed, we'll go over the fence. If the fence is too high, we'll pole-vault in. If that doesn't work, we'll parachute in.

"But we're going to get health care reform passed for the American people, for their own personal health and economic security, and for the important role that it will play in reducing the deficit."

She also pointed out, "The problem is still there. The financial aspects of it, the cost to individuals, to their families, to small businesses, to big businesses, to all businesses, to our deficits, our federal budget, to our economy are huge. We cannot sustain financially the current system."

The question remains, however, how House and Senate leaders will forge an agreement among enough people to actually pass a bill. The reform bills passed by the two chambers contain significant differences, and although Democrats control both, they have not yet found a way to come together.

Now that the Senate has lost its 60-seat filibuster-proof majority, the clearest path would seem to be for the House to pass the Senate's bill. But as Speaker Pelosi keeps pointing out, the differences between the two bills involve more than "minor tweaks," and House members don't want to give in on issues that are important to them.

So a new strategy is quietly evolving on Capitol Hill, and it relies on several steps. Members of the House would agree to pass the Senate's comprehensive bill. Meanwhile, members of the Senate would introduce and pass separate pieces of legislation to complement that bill and make it more palatable to the House.

Senators could do this in two ways: by including some kinds of provisions in this year's budget reconciliation bill (which takes only 51 votes to pass), and by passing other stand-alone bills that, by the rules, can't be passed as part of the budget reconciliation process. The first stand-alone bill could come as early as next week: repeal of the anti-trust exemptions granted to health insurance companies—a provision the House wants but the Senate legislation doesn't include.

If this sounds complicated, that's because it is. The House is reluctant to pass the Senate bill as it is and wants the Senate to act first. But can the Senate approve a package of changes to its bill before the House approves the underlying legislation? Democrats are hoping to answer this question and agree on how to proceed by the end of the week.

Obama's $3.8 trillion budget proposal: What's in it for health care?

The budget is many volumes long, so obviously it will be a while before the details are known. But those who have seen it say it includes items that assume some form of health care reform becomes law. In fact, the President, in his budget remarks, said he was "fighting to reform our nation's broken health insurance system" and that his proposal "includes funds to lay the groundwork for these reforms."

Here are some of the top-line inclusions for health care:

  • $296 million for comparative effectiveness research—that is, to compare the various treatments for common diseases and conditions and see which treatments work best.
  • $78 million to invest in health information technology.
  • A $110 million data improvement initiative.
  • $25 billion to help states pay their share of Medicaid costs. This represents a six-month extension of last year's stimulus funding.
  • $6 billion for an extension of premium assistance for COBRA coverage for people who have lost their jobs.
  • $290 million for community health centers.
  • $10 billion over 10 years to reduce childhood obesity rates and increase access to healthier foods, specifically through school lunch programs.
  • Funding to make communities more "livable" through investments in walking and biking options.
  • Assumes a "doc fix" to the Medicare program (cost: $371 billion over 10 years).
  • Does not include broad-based cuts to Medicare Advantage because those would be in the reform bill itself.

Into the opposition's territory

For an hour and a half last week, President Obama met with Republican members of the House during their annual retreat, in Baltimore. He began his remarks by saying, "I don't believe the American people want us to focus on our job security. They want us to focus on their job security." He said Americans want bipartisanship, not gridlock—but gridlock is what they've gotten so far.

The New York Times called the conversation that followed between the Republicans and the President "a lively and robust public debate...a remarkable encounter." The paper described the President as "sparring with the leadership of the opposition party in a way that is rarely seen in carefully scripted American politics."

The President hoped his visit would begin to change the dynamics of the very politicized conversation that has been taking place in Washington. Maybe that will happen and maybe it won't. But in Baltimore, as in his State of the Union address two days earlier, Obama promised to invite Republican leaders to the White House once a month to talk through issues with him and their Democratic counterparts.

Bits and pieces

  • The Associated Press says conservative lawmakers in 34 states are moving forward with constitutional amendments that would ban government health insurance mandates. Even if they pass, it's questionable whether the measures could stop federal health insurance mandates. Federal laws generally trump state laws.
  • The Center for Responsive Politics released preliminary numbers on money spent lobbying for and against health reform. More money was spent on TV ads for health reform than against ($99.5 million vs. $85 million). Health care and insurance lobbyists spent more than $648 million in 2009—"the most money ever spent by a business sector for federal lobbying," said Dave Levinthal, a spokesman for the center (some of that money was spent lobbying for reform; some against). Drug companies alone spent more than $245 million—more than any single industry has ever spent on lobbying on behalf of any issue

Get involved. Contact Congress about health reform at

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