President Obama will visit Philadelphia and St. Louis this week to continue his push to have Congress pass health overhaul legislation this month. Abortion remains a major disagreement between the House and Senate, and the chambers’ measures also vary in other areas, such as cost control and financing.
JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill. The more than year long struggle by Democrats to enact health care reform legislation appears to be in its final phase, with President Obama hoping for House and Senate votes before the end of March. To bring us up to date, Mary Agnes Carey of Kaiser Health News, and Julie Rovner of National Public Radio. Welcome to you both. Tell us about what the President is doing this week.
MARY AGNES CAREY: He is out visiting Philadelphia and St. Louis this week to keep up the drumbeat on that Congress must pass health care reform. He will talk about how much policies are increasing, people are losing their coverage, small businesses need help, young adults need to be able to stay on their parents’ insurance policies because they cannot afford it in the individual market. He is basically going to keep the focus on this to try to help Congress back home, the Senate and the House to finish action on their health care package.
JACKIE JUDD: And what arguments can Nancy Pelosi be making now to persuade Democrats to vote yes, some of whom did not the first time in November and some of whom may be changing their minds?
JULIE ROVNER: Well, the main argument obviously is that it will be worse for them to have nothing than to have something. Clearly if you look at polls, and I am talking about polls for reelection, not polls on the bill, things are not looking good for the Democrats right now.
Most of the polls show that the Republicans are resurgent if you will, but clearly that is mostly because this has been something of a if not do nothing, a do not very much congress, and that is because congress has spent so much time working on this Health bill that has yet to come to fruition. So I think the best argument that Speaker Pelosi and Senate Majority Leader Reid can make to their members is we have got to push this over the finish line.
We have got to get something, and yes if you look at the polls on the bill, the bills themselves are not very popular, but when you look at the Polls on the individual elements of the bill, those individual elements are popular.
So there is an argument to be made that the Republicans have done a very good job demonizing the bill as a whole and the process by which it has come to be, but that if the bill passes and people come to understand what is in it, that they will like it better, so that if they go ahead and pass it and people see what it does, that they will A, get the credit for actually doing something that no congress has been able to do for the past 100 years, and B, that actually the elements that are in it are relatively popular.
JACKIE JUDD: What piece parts are most popular and with whom?
JULIE ROVNER: Well, the ban on preexisting conditions, not letting insurers discriminate against people with preexisting conditions, very, very popular, always has been, things like having exchanges, places where people can go, small businesses to get subsidies to buy insurance, that is very popular.
As Mary Agnes was saying, letting young people stay on their parents’ plans until they are either 26 or 27, that varies by the bill, that is very popular, even there was a Washington Post poll not too long ago that the individual mandate, which has been very controversial, requiring everyone to have insurance. There was a poll that said would you support that mandate if people who, with low incomes, got subsidies, which, of course, is part of both bills; 53-percent said yes, so even the individual mandate, depending on how you ask the question, gets majority support. So, there are many elements of these bills that are indeed quite popular.
JACKIE JUDD: A Democratic pollster was quoted in a Politico article over the weekend who said his focus groups of all kinds of voters show that many voters at this point are saying just get something done, and I guess that is the kind of sentiment that Obama will try to be tapping into during his road trips this week.
MARY AGNES CAREY: That is right. He is going to say how long can we afford to wait and how long do we want to wait? And that people need this help, and that Congress has been on the issue for so long, many members ran on this issue. The President ran on this issue, and that the time is now.
And, as Julie was saying and if they wait, the problems that exist now in health reform, of people losing coverage and high prices, are not going to get any better, of course there is great debate whether this bill will solve those problems, but from the President’s perspective and from any Democrats on the Hill, this bill is what has to happen now.
JACKIE JUDD: We were talking before we started to tape about how monumentally complicated it is, this vote, and that the situations for so many House members in particular have changed since November, what is the calculation on that side for those members?
MARY AGNES CAREY: I think they are looking at a variety of things, maybe looking if there was a gubernatorial race in their state where a Republican won, their Democrat and Republican campaigned against the Health Care bill, that would certainly be of interest to them.
If they think that in sentiment in their particular district is simply that this bill is too much of a government solution or as Julie was talking about if the polling numbers show that people are fearful, that it is perhaps a government takeover of health insurance, then they may be deciding to go back against the bill.
We have talked about the Blue Dogs last week, the Conservative Democrats in the House, they may be looking, if they were worried about the House bill not controlling costs, they may be taking a close look at the Senate bill, and they have to decide if that is a better cost controller. It really is an individual decision for so many of these people that they may not be as concerned about the greater Democratic party interest as perhaps Nancy Pelosi or Harry Reid or the President is.
JACKIE JUDD: One word I think that we have not yet spoken today is abortion, the great social issue of our time probably that just does not go away. What are the problems there that Nancy Pelosi is facing with this small block of Democrats?
JULIE ROVNER: Remember the first vote that the House members are going to have to take is on this Senate passed bill, and the Senate passed bill was a compromise on abortion primarily between Barbara Boxer and Ben Nelson. Barbara Boxer, very outspoken abortion rights supporting member; Ben Nelson, very conservative, pro-life member. But this language satisfied both of them, at least momentarily, but right now you have basically got the two sides saying black and white on this Senate language.
You have got abortion rights side saying we do not like this language, we think it is very much too pro-life, but you have got the pro-life side saying if you ever want to be seen as a pro-life member, you cannot vote for this. It is the biggest expansion of abortion rights since Roe v. Wade. That is literally what the National Right to Life Committee wrote last week, so you have got this huge dispute about what this language would do.
JACKIE JUDD: Well, let’s do a reality check for a moment. What does the Senate bill say about federal funding?
JULIE ROVNER: Well, it basically says that there will be no federal funding of abortion, at least that is what the language says. Now what the National Right to Life Committee says is that there are loopholes in that language that would allow for abortion funding in certain situations.
There are huge differences of opinion about whether that is true. Within the exchanges, about whether you could purchase abortion coverage, what it says is that you may purchase abortion coverage using your own money if you write a separate check every month.
JACKIE JUDD: And it would be put theoretically in a separate fund.
JULIE ROVNER: That is right. It would be walled off. Abortion rights groups are unhappy about that, because they say it would be so administratively complex that what would happen is that basically plans just would not bother to offer it.
JACKIE JUDD: And opponents of abortion are saying it is an impractical solution. Of course, there is going to be leakage in that wall.
JULIE ROVNER: That is right, so both sides actually dislike that part of it, but the pro-life groups say that within the rest of the bill there are loopholes and some of that money, an example there is $7 billion extra for community health centers, but because of the way it is written they say it would not be covered by the regular appropriation, which of course does have abortion banned through the Hyde Amendment which applies to the regular money.
There is a lot of dispute about whether it was inartfully written or whether that is sort of a ridiculous argument that of course it would be banned through the regular appropriation so there are disputes like that, but where you end up with is whether or not it is true, it is what do those 12 members believe? Will this vote be held against them by their constituents?
At some point it becomes irrelevant whether or not it is true, it becomes a matter of what the voters believe and what those members think that they can do, whether this vote will be held against them come election time by pro-life voters.
JACKIE JUDD: And given all of the complications that we have just talked about, is it practical for the President to get the timetable he is now asking for which is a House vote by March 18th before he leaves for an overseas trip reasonable?
MARY AGNES CAREY: Well, it seems like a heavy lift for a few reasons. We have not seen the actual legislative language or the scoring of the proposal the President put out which would go, this Budget Reconciliation Package that tries to bridge the differences between the House and the Senate.
That score has to be out there, the language has to be out there to really start to win those votes or not win them, as the case may be in the House and the Senate, so that is a little bit difficult. Of course, in the House things can move much more quickly than we are looking at in the Senate so we have got about ten days. We will have to see what happens, but it could be a pretty difficult thing to do.
JACKIE JUDD: We have not talked much yet about the Republicans, what are they doing this week?
JULIE ROVNER: They are very successful talking points, which is that this bill is the beginning of the end of the health care system as we know it, and that this would be a huge mistake. I mean, I think they have got two sort of sets of talking points.
One of them is aimed at the American public, saying that this is a bad bill, it is bad for the health care system, it is bad for the economy. And then there other set of talking points is aimed at the Democrats, saying this would be bad for you Democrats, we are going to make this a national referendum.
This is going to be in every race in the country come election time, so basically they are going after the concerns of some of the individual Democrats who will be asked to vote for his and they are continuing to sew the seeds of doubt in the American electorate, and so far up until now it has worked pretty well. Why should they change?
JACKIE JUDD: Okay, thank you both so much, will talk to you again next week. And thank you for watching. This has been Health on the Hill.