Jackie Judd, of the Kaiser Family Foundation, and Mary Agnes Carey and Eric Pianin of KHN, discuss this week’s activities on the Hill. Watch the video or listen to the audio version (.mp3). A transcript of the interview is below.
JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill, a conversation about efforts to overhaul the healthcare system. Joining me, as always, Mary Agnes Carey of Kaiser Health News, and also Eric Pianin with Kaiser Health News. Welcome to you both. In the past few weeks, there has been a lull in Senate activity, what is the status in that Chamber?
MARY AGNES CAREY: Harry Reid, who is the majority leader, is hoping that this week the Senate can begin discussion on a motion to proceed to a Health Bill. This requires 60 votes. It would allow the Chamber to start discussion. Many moderate Democrats may have some qualms about voting for the Bill, up or down, even though we haven’t seen the Bill, have said that they will be with Senator Reid to get the 60 votes and to proceed to have that debate but it may take longer than this week and we may head into Thanksgiving week, so members may have to spend a little time in Washington Thanksgiving week.
JACKIE JUDD: He is holding out that threat again, into the holiday.
MARY AGNES CAREY: Absolutely.
JACKIE JUDD: Eric, the majority leader, Harry Reid, has spent a lot of time sending portions of Bills over to the Congressional Budget Office to score it, to figure out what it will cost. What is behind this?
ERIC PIANIN: Well part of it is just the jigsaw puzzle demands of putting together legislation that could attract 60 votes in the Senate. This is a very difficult task. The Bill that Harry Reid is trying to put together is very different from what the House passed just a week ago, but also in doing this he is sort of moving from policy making to politics. And this is not a pure exercise in trying to craft the best health care reform policy the Democrats can come up with, but it’s trying to figure out what you can do to hold together factions and attract others.
For example, there has been a lot of resistance from labor unions and liberal Democrats to the notion of slapping a tax on high end insurance policies to help pay for the health care reforms. Now, Reid is looking at some other alternatives including possibly raising the payroll tax for Medicare to offset some of the lost revenues of abandoning the other approach.
So what I think is going on is there is sort of a constant dialogue between the Senate Majority Leader’s office and CBO in which Reid is saying well, okay if that doesn’t work, how about this? And see what your number crunchers come up with, with this latest scenario.
JACKIE JUDD: So, while there is no full puzzle yet, are there certain threshold issues that we will see when there is a Senate Bill?
MARY AGNES CAREY: The public option, for example. Senator Reid has said he wants an option that would allow states to opt out. We will have to see if that’s where he comes out. Eric mentioned the tax on some of the highest cost health insurance plans. Will those thresholds be raised? How will he deal with the individual mandate? There is a lot of concern that the Senate Finance Committee deliberations weaken the individual mandate and it wouldn’t be strong enough.
Will he toughen that? How will he deal with the level of subsidies, the financial assistance for people who need help to get health insurance? So those will be some of the points of concern and I think people will be focused on.
JACKIE JUDD: Okay, let’s move over the House side now. There has been some troubling news of late for House Democrats. A Republican member of the House asked CMS, the Center for Medicare and Medicaid Services, to analyze the Bill that was passed there. Not all the news was good as far as the Democrats are concerned. Fill us in.
ERIC PIANIN: Well I think that is right and Dave Camp, a Republican leader in the House, requested this analysis of the Bill that the House passed a week ago and what they came up with in this fairly densely stated report are a number of troubling things for the Democrats.
One, it suggests that the $500 billion in proposed cuts in Medicare and Medicare Advantage will drive up costs for some seniors and result in reduced services. There is also a big concern that with this huge expansion in the number of Americans insured under this plan that the network of doctors and hospitals may just not be able to absorb and handle all of this, especially the millions and millions who would be brought in under Medicaid and there are a number of other kind of troubling concerns about efforts at cost savings.
If in fact the plan was to work and to slow the growth of spending for Medicare, Medicare spending per beneficiary would have to be cut to a rate maybe half of what the historic rate has been over the last 10 or 15 years. So there are a lot of questions raised about what the House did and the report is proving a lot of ammunition to Republican leaders to say you know what, the President and the Democrats are moving far too quickly on this very complicated, highly expensive plan. Let’s slow down and take a closer look at it and maybe rethink it.
JACKIE JUDD: And the Democrats are trying to discount what the report says by saying that the Bill wasn’t looked at in a full way, it didn’t consider revenue raising for example, that it wasn’t an apples to apples comparison.
ERIC PIANIN: I think that is true and you hear these debates back and forth over reports when the insurance industry came out with its study claiming that health care reform was going to drive up premiums and all that. The Democrats said well, wait a minute. You left out all sorts of important elements and mitigating circumstances, and I think the Democrats are doing the same with this CMS report, but the point is that the longer this process takes, the more time the opponents of health care reform have to husband their resources, you know, marshall their studies and reports. Apparently the Chamber of Commerce now is shopping around for an economist to do a study of the health care reform to reach the conclusion that it would kill jobs and hurt the economy.
JACKIE JUDD: And this is exactly the scenario that the administration has always been worried about and why the Obama White House wanted health care reform wrapped up this summer.
MARY AGNES CAREY: Right and they are still saying they want it done by the end of the year, but it looks like an incredibly heavy lift. The Senate, here we are almost at Thanksgiving, the Senate has not yet begun its debate on health reform.
JACKIE JUDD: And there is the abortion issue.
MARY AGNES CAREY: There is the abortion issue. The House adopted language that many abortion rights proponents want to get out of the Bill, it would say that if you receive a subsidy you couldn’t have a plan, a health insurance plan, in the exchange that would cover abortion services.
They feel this is incredibly restrictive, that it goes beyond current law, and in the Senate you have abortion rights proponents who say that they can stop this particular provision that it won’t get 60 votes, but this is going to be a battle point as Congress continues to look at health reform.
JACKIE JUDD: Okay, thank you both as always, Eric Pianin, Mary Agnes Carey. Thank you for joining us. I’m Jackie Judd.