President Barack Obama is hitting the road to sell health reform to the American public, delivering what aides have called a "closing argument." On Monday, he pressed his case in a campaign-style stump speech at Arcadia University, outside Philadelphia.
The crowd there heard a familiar refrain. President Obama challenged health insurers, insisted that his health reform plan will control costs, and emphasized that it includes ideas from "across the political spectrum."
"We have debated health care in Washington for more than a year. Every proposal has been put on the table. Every argument has been made," Obama said. "What we've ended up with is a proposal that's somewhere in the middle, one that incorporates the best from Democrats and Republicans, the best ideas."
The president added, "I don't know how passing health care will play politically, but I do know that it's the right thing to do."
Republicans were not on board. "President Obama's latest health care sales pitch is, just like all the others were, heavy on snake oil and light on the harsh reality Americans would face under his plan: higher taxes, reduced Medicare benefits, and lost jobs," House Minority Leader John Boehner of Ohio said in a statement.
The president's Pennsylvania appearance is part of a larger effort to mount what could be a final push for health reform. The president is scheduled to speak in St. Louis on Wednesday, and during his weekend radio and Internet address, he called on Congress to "schedule a final vote on reform." .
The health care reform clock is ticking. Each passing day brings the 2010 mid-term election one day closer, and conventional wisdom says lawmakers are more likely to think about re-election and less likely to cast tough votes as Election Day comes into view.
At a briefing late last week, White House Press Secretary Robert Gibbs told reporters that the president would like to see the House vote on health reform by March 18, before he leaves on a scheduled trip overseas. House Majority Leader Steny Hoyer of Maryland has said he hopes a vote will happen before March 29, when Congress adjourns for its Easter break. Democrats are no doubt hoping to avoid a repeat of the August congressional recess, when contentious town hall meetings became a forum for health reform opponents.
Before any vote, though, the president's proposal must be translated into legislative language, and the Congressional Budget Office (CBO) must analyze its cost impact. The current plan is for the House to first pass the same bill the Senate passed before Christmas. Then, the Senate and House would both pass a "sidecar" bill that tweaks the original bill through the controversial budget reconciliation process. Read more about reconciliation in this Q/A from USA TODAY.
Reportedly, House and Senate leaders are sending elements of the reconciliation bill to CBO and revising the draft bill in a piecemeal manner. That reconciliation bill would have to be introduced sometime this week in order to meet the administration's March 18 deadline for a House vote.
Meantime, Democratic House leaders continue to count votes. They'll need at least 216 to pass the Senate's reform bill. But, few House members are willing to commit until they've seen the legislative language and CBO score. Many also want assurances that the Senate will follow-through with a reconciliation bill. One option under consideration is having 51 senators sign a letter pledging support.
President Obama also held two meetings late last week with key House Democrats - one with liberals and the other with moderates - in an effort to secure votes. Rep. Raul Grijalva, D-Ariz., said the president told the liberal Democrats that although a public option would never pass the Senate now, he is "personally committed" to pursuing it later.
At the same time, anti-abortion Democrats still have reservations about the Senate bill, which does not go as far to block federal funding of abortion. "I think given the vote dynamic, abortion may be the decisive issue," said Rep. Jason Altmire, D-Pa., on Fox News Sunday.
Where does your representative stand on health reform? The Wall Street Journal analyzes the potential health reform vote of each House member in a new, online vote tracker .
The administration's push comes in the face of public sentiment that's running against health reform.
An average of recent health reform polls compiled by RealClear Politics shows 41 percent of Americans
in favor of the Obama plan, with 50 percent opposed. See the full political sentiment analysis.
Hear What Congressman Paul Ryan had to say at the last Bi-partisan Healthcare debate.
HHS faces off with insurers
Health and Human Services Secretary Kathleen Sebelius sent a letter this week to the heads of five health insurance companies (Aetna, Cigna, Health Care Service Corp., UnitedHealth and WellPoint) asking them to publicly justify their premium increases.
The HHS letter comes just days after Sebelius met with CEOs of the five companies at the White House. During that meeting, part of which was televised, Sebelius asked the companies to begin posting information online about administrative costs and other factors contributing to rate increases. She also called for "greatly increased transparency about what indeed is going on."
At one point, President Obama dropped by the meeting. According to a White House spokesman, the president shared a letter from a 50-year-old cancer survivor who received an "unjustifiable" 40 percent premium increase.
Sebelius said the companies had earned a collective $12 billion in profits last year, but the trade organization representing health insurers said the industry's average profit margin was just 2.2 percent, below other health care industries.
In a letter to Sebelius, Karen Igagni, the president and CEO of America's Health Insurance Plans (AHIP) wrote, "We believe the data clearly show that premiums are increasing primarily because of soaring medical costs and a slowdown in the economy...Far too often during the health care reform debate, sound bites and media events have taken the place of substance and thoughtful discussions." Read the entire AHIP letter here .
The White House has proposed that the federal government review premium increases, and Sen. Dianne Feinstein, D-Calif., and Rep. Janice Schakowsky, D-Ill., have introduced legislation, dubbed the "Health Insurance Rate Authority Act," which would require insurers to submit justification for rate increases.
The insurance industry says such a requirement would duplicate the role states already play in regulating health insurance rates.
Meantime, the CEOs of WellPoint, UnitedHealth, Aetna and Humana last week received letters from the House Energy and Commerce Committee asking them for information on claim denials related to pre-existing conditions and maternity care coverage in the individual market. They have been asked to go to Washington for a hearing on March 23. To read the letter to Humana, United, and Aetna here
Physician payments and COBRA extensions get a 31-day reprieve
Sen. Jim Bunning, R-Ky., finally gave in to Democrats and many members of his own party over an emergency aid bill that extends unemployment benefits and Medicare physician payment rates for 31 days. Bunning had been unapologetic about blocking the bill because he was enraged that with soaring deficits, there was no provision to pay for its approximately $10 billion cost. "We want a country in which my 40 grandchildren have the same abilities that I did growing up," he said. "We want a country that doesn't owe everybody in the world for our existence."
Since the bill had already been passed by the House, it will go to the president for his signature.
The future according to MedPAC
Last week, the Medicare Payment Advisory Commission, or MedPAC, released its annual report to Congress about changes to Medicare payment policies it is recommending for 2011. The report's findings include:
A calculation that if physician fees are not cut for the rest of this year - and Congress has blocked scheduled reductions so far - then Medicare Advantage payments will be about 109 percent of fee-for-service payments
Support for a Medicare Advantage payment policy that would reimburse plans based on benchmarks set at 100 percent of local fee-for-service program costs and redistribute any savings from bids below benchmarks to reward plans that provide higher quality care
Information that says in 2009, 24 percent of Medicare beneficiaries were enrolled in Medicare Advantage Plans, and this year, virtually all Medicare eligibles have access to an MA plan, with an average of 21 plans available in each county
The calculation that Part B premium holders paid $3.35 per month more than they would have had to if Medicare Advantage spending were the same as in original Medicare
The calculation that Part D enrollees on average will pay a monthly premium of just over $30, an increase of about $2 per month (6 percent) over 2009