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Health On The Hill – Transcript

KHN’s Eric Pianin and NPR’s Julie Rovner discuss recent and upcoming activities on the Hill — part of a weekly series of video reports.

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Health On The Hill

Transcript:

JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill, a conversation about efforts to pass health care reform legislation. Joining me, Julie Rovner of National Public Radio, welcome back, and Eric Pianin of Kaiser Health News. Welcome to you as well, Eric.

ERIC PIANIN: Thank you.

JACKIE JUDD: Administration officials were fanned out across all of the Sunday talk shows yesterday. Did we get any signals about where things stand from their perspective regarding health care reform legislation?

ERIC PIANIN: Well, I think that the Administration is sensing that it has a real opportunity to score a victory on health care reform this fall. It is not going to be easy, but I think they feel that they are much further along than they were let’s say in August during the hubbub over health care at a lot of these Town Meetings around the country.

But I think that the message that came through loud and clear from David Axelrod, Rahm Emanuel and other top administration officials is that this is a very pragmatic president and what he wants more than anything is some legislation, a Bill, and while the White House feels fairly strongly that an important element of any legislation would be the public insurance option, something that is very important to the liberal wing of the party, that they are not going to throw over the entire Bill.

JACKIE JUDD: It’s not a line in the sand for them.

ERIC PIANIN: I don’t think it’s a line in the sand and I think they signal that very clearly that they think it’s important but it’s not the end all and be all for health care legislation.

JACKIE JUDD: Okay now let’s move up Pennsylvania Avenue to Capitol Hill, what is the stated play in terms of negotiations both on the House side and then the Senate side?

JULIE ROVNER: Well, of course now with the Finance Committee finally having finished its Bill last week, basically, the Senate has caught up to the House, which is to say we are in the melding process in both chambers. We have three Committee Bills in the House, the House is still trying to put together. They seem to have these, I think, every other day meetings which have been variously described as Pep Rallies and Mind Melding Sessions where they are trying to come up with on Bill from these three Committee Bills. They can get 218 votes, which means they have got to please their liberals and please their conservatives.

JACKIE JUDD: So does that mean public option or not?

JULIE ROVNER: I think there will be a public option on the House side. What will it look like? Will it have Medicare rates that would be the more robust public option? Will it have some kind of negotiated rates? That would be the less robust public option. They are waiting I think at this point for the Congressional Budget Office to give them some numbers about how much that would save.

Remember, the public option will probably be a cost saver, so they are waiting for CBO to report back. That is pretty much where we are in the House. They keep pushing back the date of likely floor debate now. We are looking at the first week of November, probably.

In the Senate, of course, they have just started this melding process since Finance Committee has just finished, we have got the Finance Committee Bill, the Health, Education, Labor and Pensions Bill, the HELP Bill of course has a public option. The Finance Committee Bill does not. They have these co-ops instead, which the Congressional Budget Office said probably wouldn’t do that much because there probably wouldn’t be that many, so that is another issue, the co-ops as a compromise issue, probably not such a robust compromise as it turns out.

So, they may be looking for maybe a trigger option or maybe something else. There may be a Senate Bill that would perhaps have a vote to maybe add a public option on the floor or maybe go to the floor without a public option, or maybe go to the floor with a public option and have the more moderates who don’t like it try to vote to take it out.

JACKIE JUDD: Well, Eric, how important is it to the Senate leadership at this point that there be more than the one lone Republican they have at the moment, Olympia Snowe?

ERIC PIANIN: I think in the perfect world they would have maybe two Republicans supporting them.

JACKIE JUDD: That would be double.

ERIC PIANIN: Yeah, that would be very ambitious. I think that the challenge for Harry Reid, the majority leader, is to pull together the Democrats and the two Independents who vote with the Democrats, hope that Olympia Snowe will hang in there, and get something through. I think that Julie was pointing to an interesting dynamic on the Hill. The House and the Senate each has a very different set of challenges and rules under which to operate in trying to craft legislation that they can bring to conference.

Nancy Pelosi made it very clear last week, I don’t really care what is going on in the Senate right now. What I care about is what it takes to get majority support in the House and as far as she is concerned, that Bill has to include some kind of a strong public option. What the final Bill looks like when it comes out of conference, who knows, but the task for each chamber is to get to conference and so they will do whatever they have to do to get to that point.

JACKIE JUDD: The pragmatism of the White House is a bit contagious on the Hill.

ERIC PIANIN: I think it is and it’s interesting, too, on the Senate side, you know, when you think about where things were last winter, this spring, Max Baucus was doing this big tent, very inclusive kind of deliberation over the direction of health care reform.

JACKIE JUDD: He had three Republicans at the table in those days.

ERIC PIANIN: That’s right and then eventually it boiled down to the Gang of Six, six Democrats and Republicans in the room. Now we are down to the Gang of Three, but these are very shrewd politicians, Reid and Chris Dodd, another chairman who is sitting in on these negotiations along with Max Baucus, both of those men have very tough reelection campaigns and they are very concerned about how all this plays back home, so there are many challenges, how do we put together a Bill that attracts 60 votes, how do I win reelection, how do I handle all these challenges? It’s very complicated and interesting.

JULIE ROVNER: You know it’s important, you talk about the pragmatism, but you can’t get a Bill to the president unless you get it out of conference. You can’t get a Bill out of conference unless you get it in to conference, so it’s not just pragmatic. This is the way the legislative process works.

The first thing you have to do is get it through each House, so that is where we are now, each leader in the House and the Senate is doing what they need to do, focusing on what they need to focus now, which is getting each individual Bill through their individual chamber.

Then you have to go to conference and figure out how you can get one Bill that can get through both chambers, but we are still at that place where they need to get it through, there needs to be a Bill that can get through the House and a Bill that can get through the Senate and those two Bills are going to look quite different.

JACKIE JUDD: Right. There is another health care issue that the Senate is going to be tackling this week and that is to set aside $250 billion for higher Medicare reimbursements for doctors. Tell us about that.

JULIE ROVNER: Well this is an issue that has been dogging congress now for almost a decade, actually it’s more than a decade, it’s something called the sustainable growth rate or the SGR that was created actually in 1997 when they balanced the budget, it’s a way to pay doctors. It is actually a way to control doctors’ pay and it works a little bit too well, as it turns out.

Every year, since 2002, it’s been cutting doctors’ pay. We are used to Medicare saying we are going to cut the rate of increase, this is an actual cut, and the first year they let it go into effect, it was a 5.4-percent cut. Every year since then, Congress has stopped the cuts from going into effect, but when the Republicans were in charge, they didn’t pay for it. So what that ended up doing was digging the hole deeper.

So now we are into if Congress wants to actually end this once and for all it will cost as you say $250 billion. In the budget this year, the Obama Administration said let’s just make this whole thing go away and not pay for it. Let’s just put it off budget. There was a deal, the Blue Dogs in the House didn’t like that, but they cut a deal that said okay we are willing to kind of look the other way on that if you make the PAYGO rules, meaning every time you spend money you are going to have to offset it. If you make those permanent, we will look the other way on this, so that was the deal in the House.

And because of that, they put it into the Health Reform Bill. Of course, the CBO wasn’t part of that deal, so the CBO said this costs $250 billion. The Senate, they didn’t put it into the Finance Committee Bill, because they didn’t want to spend the $250 billion but everyone recognizes this is an issue that will have to be done.

If nothing happens, there will be this year a 20-percent cut in doctors’ pay starting next January, which pretty much everybody acknowledges can’t happen. Doctors would basically have to stop seeing Medicare patients, so this is something the AMA wants, it’s something the AARP wants. They don’t want doctors to stop seeing Medicare patients.

The leaders of both Houses have decided to just split this out, do it separately. It becomes very difficult to vote against. After all, it’s stopping at 20-percent pay cut for doctors. You don’t want to vote against seniors. You don’t want to vote against doctors. On the other hand, there are deficit hawks.

Kent Conrad, for instance, the Senate Budget Committee chairman, who says wait a minute, we don’t want to add $250 billion to the deficit. So, there will be quite a little fight about this.

JACKIE JUDD: And does the vote on this tell us anything about the larger health care reform legislation or are they totally separate?

JULIE ROVNER: I don’t know that it does because of the peculiar politics of seniors and doctors. Certainly, the Republicans are going to say this is hypocrisy because after all you are coming in and saying you are not going to add a dime to the deficit and here you are adding $250 billion to the deficit, which is true.

On the other hand, this is pretty much the pot calling the kettle black because Republicans never paid for this every year that they did it, and in fact it was the Republicans who dug the hole this deep and made it $250 billion. So there will be efforts to try to tie this to the health reform effort, and there will be arguments that say why on earth isn’t paying doctors part of health reform, which is a pretty good argument, but it is a little bit. You can see the arguments that can be made on either side, but it is a unique situation.

ERIC PIANIN: There might be one larger connection to the health care reform debate, which is the whole question of how you score the bills, whether there is really truth in budgeting, transparency. A lot of numbers are being thrown around.

The CBO is coming up with all these guesstimates of how much legislation is likely to cost and so I think this controversy may undercut public confidence in the larger discussion about how much this Bill is going to cost, whether it is indeed going to reduce the deficit or add to the deficit. It’s just part of this larger concern about is the government being honest with us about all the spending?

JACKIE JUDD: Well, it will be a busy and interesting week on the Hill. Thank you both very much, as always. And thank you for joining us. I’m Jackie Judd.

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