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Transcript: Health On The Hill – A Big Week For The House

Over the weekend, White House officials urged the House of Representatives to vote on the Senate-passed health overhaul bill. Meanwhile, Rep. Nancy Pelosi is still working to assuage concerns from both sides of the ideological base on the issue of abortion. A vote is expected sometime this week. 

Watch the interview or listen to audio version (.mp3)


JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill. This looks to be shaping up as the climatic week in the Democrats’ efforts to overhaul the health care system. Here to bring us up to date, Mary Agnes Carey of Kaiser Health News and joining us for the first time today, Ed Epstein of Congressional Quarterly. Ed, welcome.


JACKIE JUDD: White House officials were very bullish over the weekend about whether the health care package would pass in the House. Are House leaders as bullish at this moment?

EDWARD EPSTEIN: Well they never will say publically whether they have the votes or not, although the majority did say on Sunday they are not there quite yet, but the Democratic caucus is very diverse and it’s like herding cats, really, you never know if they have the votes until you have the votes, and then suddenly you will see they will move to hold this vote, but a deadline might be in order to get the final deals made and force people to make up their minds.

JACKIE JUDD: Well, you’ve covered Nancy Pelosi in particular for many, many years. What can she say to wavering Democrats at this moment to get their vote that she has not said before?

EDWARD EPSTEIN: Well, there may be more deals made in this reconciliation package, which we have not seen all the language yet. But she is going to say to the liberals who want the public option or other more government involvement in health care that this is not the last Bill, this is just the beginning of health care reform. And to the anti-abortion people, she will say well, the Senate language, which cannot be changed under reconciliation, is that this is the best as we can do. You will fight another day. We are not funding abortion. So, she has to assure people on both sides of her ideological base.

JACKIE JUDD: Mary Agnes, as Ed suggested, this is a complicated process.


JACKIE JUDD: There is the Senate Bill that the House will be asked to vote on, presumably later this week. On a parallel track, is the package of fixes to that bill, the reconciliation package, what do we know about that at this time?

MARY AGNES CAREY: We know the President has certainly proposed a package of fixes to try to take for his feelings the best of the Senate and the House Bill. For example, he would keep this excise tax in the high cost plans but raise the threshold and push it out to 2018. As we know, a lot of unions did not like this so called “Cadillac Tax.” He would make adjustments there. He wanted more generous subsidies for middle income folks to help them afford health insurance and the health insurance exchanges.

The President would prefer that the reconciliation package have exchanges on a state basis versus a national basis, which was in the House Bill. And he also would have more funding for Medicaid to help with the Medicaid Expansion. But, as Ed mentioned, we have not seen the Bill. There could be more deal making done, and we will have to watch it very closely.

JACKIE JUDD: Now there was such a backlash to the last time deals were made, particularly for the Senators from Louisiana and Nebraska, and there seemed to be a hold on anymore deals, but now I am hearing you two say that deal making is back.

EDWARD EPSTEIN: Not for specific states, perhaps, but for groups, for Labor Unions or others that are key to the Democratic base, or if you have to get the votes, but Nebraska, the Cornhusker Deal just backfired on the Democrats big time because people around the country were infuriated that one state was getting this very special treatment of its Medicaid program.

MARY AGNES CAREY: Right and that is part of the deal as governors have said now wait a minute, you want to expand Medicaid, we states can’t help you do that, so you could see more funding in the reconciliation package for Medicaid expansion, or for states that have already moved ahead to expand Medicaid they may say, now wait a minute, we have gone ahead to cover childless adults for example, a population that is not often covered in Medicaid. If we have taken steps before the Federal Government, additional funding, we want that recognized. So I think if they can say it is equally applied, then you could see more funding.

JACKIE JUDD: Okay now walk us through what the rest of this week may look like. What happens first, then second, and then third? Who wants to go first?

EDWARD EPSTEIN: The House Budget Committee, well all the actions in the House this week is the House has to go first because it is a spending Bill. The House Budget Committee is meeting this afternoon and are going to come up with what you might call a placeholder bill, since they don’t have the final language and they don’t have the CBO final score, and Republicans will protest. And probably on Wednesday or Thursday, the House Rules Committee meets. That is the main event.

By then, if there is a Bill, if there is a reconciliation bill, we will see it and members can come in and offer amendments, Republican Amendments will all be voted down, and probably adopt what is called the closed rule for this, that means no amendments would be allowed on the floor.

More importantly from the House members’ point of view, one thing we haven’t touched on is the deep mistrust in the House of the Senate and its promises that it will pass a reconciliation bill, because the House does not like the underlying Senate Bill.

I hope you are following all of this. [Laughter] The House Members do not like the underlying Senate Bill, but they have to pass it because you cannot reconcile a piece of legislation that has not been signed. So, they are going to pass that and the reconciliation, but it will be in what is probably in what is called the self executing rule, saying that when the House votes on this rule for considering this package, the Senate Bill will be deemed passed, therefore the House members can say I never voted for that Senate Bill.

JACKIE JUDD: So there is a scenario where there would not be a specific vote by members on the Senate Bill itself?

MARY AGNES CAREY: There could be, right, it could be structured so they deem that it’s passed without actually taking the vote, but again you have to watch that rules committee meeting later this week to see how they structure the rules for the floor debate.

JACKIE JUDD: What would be the political strategy behind that approach?

EDWARD EPSTEIN: Republicans can’t use it against you in the fall. They can’t say you voted for this horrible Senate bill with this give away to Nebraska and this softer abortion language, for instance. They will say I never voted for that. I voted for a rule. It gets so complicated; the voters won’t understand or follow that.

JACKIE JUDD: They hope so anyway. The lawmakers hope so. Let me ask a final question before we close out and that is to talk for a moment about President Obama, who today, Monday, is on the road going to Ohio. What are his goals this week?

MARY AGNES CAREY: I think he wants to keep the drum beat up, the message that we have got to pass this bill now, we can’t wait. He has been talking about this all over the country. Last week he was in Philadelphia. He was in St. Louis. As you mentioned, he is in Ohio today. He has kind of got I think an outside game and an inside game. He has got to keep the public focused on it.

He wants them talking to their members, their House members, especially those who might be wavering saying pass this bill, and he is going to have a lot of work to do here back home as well. He has cancelled a trip he was going to take in midweek. He is pushing it off for a few days to stay here in town, to help Nancy Pelosi and the House Democratic Leaders push this Bill through.

JACKIE JUDD: Which raises the question in my mind, would the President really put his prestige on the line to the degree that he has for really the past 14 months, and then this week going out on the road, postponing a high profile trip, unless he was fairly certain this was going to happen?

EDWARD EPSTEIN: You cannot overstate the stakes for his Presidency of getting this passed, perhaps this week, this is it. This is his domestic initiative that will be his landmark legislation of his presidency. If they fail again, the Democrats, what are they going to say to their voters in the fall? We control the House and Senate by healthy margins. We have this popular young President. You still can’t get this done. Vote for us.

JACKIE JUDD: Okay, yet another interesting week in the health care debate. Thank you both very much, and thank you for joining us. This has been Health on the Hill and I’m Jackie Judd.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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