Health On The Hill Transcript – July 20, 2009

Today’s Health on the Hill conversation features Mary Agnes Carey and Eric Pianin, both of Kaiser Health News. Jackie Judd discussed health overhaul legislation and what is expected in the busy week ahead with them.

Jackie Judd: Eric, the action on the House side is going to be in the Energy and Commerce Committee chaired by Congressman Henry Waxman. Can you give us a preview?

Eric Pianin: Well, this is going to be a very important week, there’s no question about that. Last week, two other committees with jurisdiction over health care reform marked up and took action on the bill. Now the focus shifts to Waxman’s committee and there it could be very problematic. I think the other two committees moved the bill through rather expeditiously. Here they’re running into a lot of resistance within the Democratic party from Conservative ‘Blue Dogs’ who have very strong feelings about the legislation – feeling that it’s too costly, that it doesn’t do enough to slow the rate of growth of health care spending, and it doesn’t do enough for their rural areas. They are very concerned with protecting small businesses and hospitals there.

JJ: And as I mentioned, it’s chaired by Congressman Henry Waxman, one of the leading liberals in Congress, so where might both sides compromise?

EP: I think everybody is in agreement that there needs to be some legislation passed this year; it’s just how you achieve it. And I think that Nancy Pelosi, the Speaker of the House, and Henry Waxman have all signaled that there is room for compromise. Everybody is in agreement that a priority is slowing the rate of growth of health care spending over the next decade or so. It’s unsustainable growth, as the President constantly says. So, I think that there may be some amendments that they could work up between now and the time the bill gets to the House floor that addresses some of these fiscally conservative Democrats’ concerns. But there’s also an interesting dynamic here in that the Blue Dogs, on the one hand, are calling for fiscal restraint, deficit neutrality and all that, but still they want additional spending for their rural districts, especially in the way hospitals and doctors are reimbursed by Medicare for treating patients.

JJ: You spent some time interviewing one of the Blue Dogs, Congressman Mike Ross from Arkansas, for a profile you’re going to be writing. What’s his point of view on this?

EP: Well, he is someone with a lot of experience in health care issues. He’s a former state senator, his mother was a nurse; he has spent a lot of time on these issues over time, but he’s torn. On the one hand, he wants to uphold the Blue Dog principles of fiscal responsibility, except where it impacts on rural areas. And he feels very strongly that the bill as currently written would not address a lot of these problems in rural areas, would not take care of the problems that are leading to the vanishing of hospitals and health facilities in these rural areas. Decisions by doctors to go elsewhere where it’s more profitable. He’s from Prescott, Arkansas, a tiny town in southwest Arkansas, which over the last decade or so has seen the number of local doctors shrink from six to three. The only county hospital, which operated there for decades, closed in the late ’90s, so people have to drive long distances for health care. His concern is that they pass legislation that makes a difference for people in his district, that addresses some of these problems. Otherwise, he says, having a shiny, new insurance card is meaningless if you can’t get the care that you need with it.

JJ: Moving onto you, Mary Agnes, and moving onto the Senate. On the Senate side, it’s all about the Senate Finance Committee this week. Again, can you give us a preview?

Mary Agnes Carey: Max Baucus, who is chairman of the Finance Committee, continues to work with Democrats and Republicans on his panel. He very much wants to get a package that has bipartisan support. He has said, “We’ll mark up when we’re ready. We’ll let you know when we’re ready.” I think that this underscores all of the difficult things about health care reform: trying to get Republican votes, trying to control costs, as Eric is talking about, trying to protect members’ interests, whether they represent an urban area or a rural area. He (Max Baucus) wants to get a package to try to respond to these concerns and to control the growth of health care costs, because that’s just critical in this debate.

JJ: Mary Agnes, if you were to ask Senator Baucus at this point in the debate, what have your successes been so far, what would the answer be?

MAC: I think he would tell you that he’s kept Republicans at the table. Like Charles Grassley, his long time ally, when they talk about rural interests that represent their constituents. [Republican Senators] Olympia Snowe, Mike Enzi, Orrin Hatch. He’s really working hard to reach across the aisle and get a compromise with these folks. They’ve reached some agreement on controlling things in Medicare and Medicaid. There’s a lot of agreement in changing the way health care is reimbursed. Instead of paying by the service, they want to try to look at this more broadly and pay for the continuity of care. So I think he would tell you we have a lot of agreement on areas like prevention or reducing the growth of spending or a bunch of other issues where they’ve reached agreement. But he would tell you also it’s very hard, it’s very difficult and we need to keep working on these last few issues including the financing which is very tough.

JJ: Late last week, six moderate senators, including three Democrats, put out a statement basically saying ‘slow down.’ How significant is that in terms of what Baucus is trying to do and the timeline he’s trying to work on?

MAC: Well there’s a lot of pressure, of course. President Obama has wanted these bills to move on the floor before the August recess. Whether or not, I think that may be able to happen in the House, whether or not it’s going to happen in the Senate is an open question. There’s a lot of pressure, ‘we want to get health care done now.’ Everyone knows if you keep that out of the midterm election cycle they’ll be better off. But on the flip side is the counter pressure of the difficulties. So these members of Congress wrote this letter to say ‘wait a minute, slow down, you don’t have to give artificial deadlines, you don’t have to rush it. This is a very very big issue. If you need more time, let’s take more time.’

JJ: And President Obama has had a more public role in this debate in the past week or so than he has prior to that. Where is he at the moment, Eric, on the timeline issue?

EP: Well until recently there was a lot of pressure coming from the White House to get both the House and Senate to act on legislation by the end of July, early August. We’re hearing less and less of this timetable coming from the White House. Although I think the president is stressing the urgency of moving ahead as quickly as possible. He had a press availability last Friday. This week, the White House is planning a major rollout, where the president will have a press conference; he’ll go to Cleveland to make his case for expeditious movement on health care reform. They’ll be putting up ads on the Internet. It’s sort of a full blown campaign to try to coax the leaders, especially in the Senate, to move as quickly as possible.

JJ: And there was a poll released in the Washington Post today, that gives all the more reason for President Obama to try to rush this through, his poll approval rating.

EP: I think that’s true. I think the president still remains a popular president overall. But on specific areas, especially health care reform, his approval rating’s beginning to drop rather in an alarming way. And since April, public approval of his handling of health care reform has dropped from 57 percent to 49 percent. So I think they see the need to move as quickly as they can to take advantage of his popularity before the public begins to sour on the legislation as they find out more and more what’s in the bill.

JJ: Do you think there was a certain inevitability about all of this, Mary Agnes, in that his approval ratings would go down vis a vis health care, once the details became known?

MAC: Right well the devil’s always in the details. This is always when it gets hard. There’s been lots of agreement for months about when you do health reform, ‘we need to do it now, we need to focus more on prevention, we need to slow the growth of health care costs.’ But when you start talking about how you do it, with specificity, and people realize what it means to them personally, they begin to examine it and talk about it in far different terms. I think you’ll see a real shift in the debate now, in the months ahead. Much more of people coming out, criticizing certain previsions, members trying to figure out who they can align with who they won’t align with. And just I think this really shows the difficult in what’s ahead in the next few months.

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