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Transcript: Health On The Hill – Obama’s Budget Proposal, Continuing Negotiations On Health Reform

President Obama’s budget request for fiscal 2011 would give states an additional $25 billion in Medicaid funding to help cover rising program costs. Meanwhile, House and Senate Democratic leaders continue negotiations on how to pass health care overhaul legislation this year, although lawmakers’ focus has shifted in part to finding ways to improve the economy and increase jobs.

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JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill. The President’s budget is unveiled and congressional Democrats are still discussing whether and how to move health care reform forward. Those are the two big headlines. Here to discuss the details, Mary Agnes Carey of Kaiser Health News. Good morning.

MARY AGNES CAREY: It’s great to be here.

JACKIE JUDD: What will the President’s budget say or do for health care?

MARY AGNES CAREY: One of the main items a lot of people will be focused on is additional Medicaid money for the states. The President’s budget will propose to add $25 billion for state budgets for Medicaid and this is important for a couple of reasons.

Number one, with the economic downturn, more people are losing their jobs. They are enrolling in Medicaid and as we know it’s a shared state federal program. States are feeling a lot of budget pressure. They had counted on additional Medicaid money as part of health care reform. That hasn’t happened yet, whether or not that happens is unclear.

And so to help states meet these short-term needs on Medicaid, they are going to add this additional funding. This would help states cope with Medicaid, as earlier in the year there was additional Medicaid money in the economic stimulus package. So when that will expire at the end of this year, this additional Medicaid money will help take care of all these folks that need help.

JACKIE JUDD: Mary Agnes, since the President’s State of the Union address last week, he clearly shifted the focus away from health care reform towards jobs and the economy, but in the background what’s been going on? What kind of discussions have been taking place among Democratic leaders and Republicans also about the future of this?

MARY AGNES CAREY: Right. I think the President and Democrats remain committed to health care reform. They know they need to move to jobs and they need to move the economy. That’s why the President focused so much of his State of the Union the first half hour or so on economy, on jobs, before he moved to health care, but negotiations are continuing on health care reform.

In the Senate and the House, Democratic leaders are trying to look at this strategy still of having the House pass the Senate Health Care Bill with a reconciliation package, but it is very difficult. They are trying to understand what can go in reconciliation and what cannot and there are some Senate moderates, Blanche Lincoln, Evan Bayh who are saying, they are Democrats, who might be a little nervous about this reconciliation approach.

JACKIE JUDD: So when you say negotiations are still going on, are they going on in terms of process at this point or policy or both?

MARY AGNES CAREY: Both. Reconciliation isn’t something they use every day and it has to deal with deficit financial issues, so they are trying to find out what provisions can be in both chambers, what might be acceptable, what reconciliation package could get those votes.

In the meantime, they are trying to, especially in the House, Speaker Pelosi is trying to figure out with her caucus the best way to go. She might double track it. She could continue negotiations on getting the larger Senate Bill passed, but she might also move to a piecemeal approach, doing a Bill specifically on the anti-trust exemption, lifting this federal anti-trust exemption for health insurers, or the medical loss ratio, which requires insurers to spend a specific amount of the health insurance dollar on medical care. She may try to move two tracks, but it is definitely I think both for policy and procedure.

JACKIE JUDD: As you well know, the health care reform debate has been all consuming on the Hill really for the past year. So, if there is this notion of doing a piecemeal approach, how distracting will that be to the larger issue?

MARY AGNES CAREY: I think it will certainly be taxing for all those involved. We have had staffers and members spend a good part of the last year or more on health reform specifically. If they need to change tracks, they certainly have a lot of background and can do that, but there is so much time and so many resources.

Let’s not forget we have got a midterm election in November. The longer this goes on, the tougher it’s going to be to get a comprehensive bill, so that’s definitely part of this equation.

JACKIE JUDD: And are Democrats in particular viewing the period we are in now as heaving some breathing room?

MARY AGNES CAREY: They are. They look at the Massachusetts election in the Senate, they have looked at that. They feel that that’s a message from voters that they are not happy with the approach on health care, how do they go to an approach on health care to help people that voters will accept, how do they deal with the economy, how do they deal with jobs?

There is a definite shift on the legislative priorities, but yet many Democrats are still very committed to health reform. Some think it can wait. Some probably would be very happy to walk away from it.

JACKIE JUDD: Barely a week has gone by when we have had these conversations that I’ve not asked a timetable question, is it too premature to ask the timetable question now, are they still just trying to work out the process questions first?

MARY AGNES CAREY: Well, I think that is exactly right. When you talk to Democratic leaders, and many Democrats rank in file, they say I don’t have to be wedded to any timetable. Harry Reid, the majority leader of the Senate, said we have got all year. Congress is a two year term for this Congress.

So, they are very reluctant now, after setting so many deadlines, missing some of them, making some of them, after all the pressure. Remember in the Senate, they passed their Health Care Reform Bill on the morning of Christmas Eve. They now realize they are regrouping, they have to refocus and they wan to slow that timetable conversation down and simply figure out how to get there.

JACKIE JUDD: Okay, thank you very much as always.


JACKIE JUDD: Mary Agnes Carey, thank you for joining us. This has been Health on the Hill and I’m Jackie Judd.

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