Transcript: Health On The Hill Features Significant House, Senate Developments


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Jackie Judd: I’m Jackie Judd with Health On The Hill. Two potentially significant developments on Capitol Hill today regarding health care reform: one in the Senate, one in the House. Joining me from the Capitol is Eric Pianin of Kaiser Health News. Eric, let’s start in the House where the Blue Dog Democrats, the conservative Democrats, reached a compromise with the chairman of the Energy and Commerce Committee, Henry Waxman. 


Eric Pianin: Well, Jackie, after marathon negotiations, including House Speaker Nancy Pelosi and White House Chief of Staff Rahm Emanuel that went into late last night, members of the conservative Blue Dog Coalition agreed to a deal that will allow the health care legislation to move forward. The agreement, essentially, will postpone any vote by the House until after the August recess, but it will allow the Energy and Commerce Committee, which has jurisdiction over this, to begin a markup of the bill as early as this afternoon. And the plan is to get the bill to the House floor after the recess, after members have had a chance to study it and reach a decision.

JJ: Now, when Congressman Mike Ross,  the leader of the Blue Dogs, came out, he talked about a couple of items where he felt more comfortable having his coalition support this draft. One has to do with exempting more small businesses from a health care insurance mandate?

EP: That’s correct. I think that Mike Ross and six other Blue Dog Democrats who serve on the Energy and Commerce Committee have kept that health care legislation bottled up until they could negotiate their demands. I think it’s fair to say that their overarching concerns were the overall cost of the bill, which is somewhere in the neighborhood of a trillion dollars over 10 years.

But they also had some more regional concerns, and one of them was protecting small businesses in their congressional districts from what they view as onerous employer mandates. They didn’t want small businesses to have to pay penalties if they didn’t provide health insurance to their employees. And so the House Democratic leadership tried to satisfy them with an offer of exempting small businesses with payrolls as high as $250,000 a year. The Blue Dogs said, “No, no, no, that’s not enough. We want further exemptions.” And so the deal that they announced this morning would exempt small businesses with payrolls up to $500,000 a year and then a penalty would begin to kick in.

JJ: And there is another piece of this having to do with what providers will be allowed to do in terms of establishing payment rates with the government.

EP: Another big concern of the Blue Dogs, and I think these are concerns of lawmakers throughout the country, especially in rural areas, is a feeling that there is a regional disparity in Medicare payments. They say hospitals and doctors in rural areas are being short-changed in the payment structure. So, they have been pushing for an agreement that, in the future, doctors and hospitals that treat patients under this new public health care plan, would be paid something well in excess of the Medicare rates, which average about 20 percent below what private providers receive nationally.

JJ: So the deal was to call for the Secretary of Health and Human Services to negotiate with the providers to come up with more acceptable rates.

EP: That’s right. And (in the Senate) Max Baucus emerged from his office late this morning with the good news that he shared with reporters waiting outside, saying that last night they received a preliminary estimate from CBO, which is the nonpartisan agency overseeing federal budgets, saying they concluded that the pricetag for the draft proposal for the Senate Finance Committee would come in around $900 billion (over 10 years), which is substantially less than the trillion dollar pricetag that they had been discussing more recently. Or, if you go back a number of months, some proposals were up to 1.5 trillion.

JJ: And the other estimate that the CBO gave them was that in this draft, 95 percent of the currently uninsured would have some type of coverage?

EP: Correct. So taken together, Baucus felt that was enormously good news that he was sharing with the press and his colleagues on the Senate Finance committee. This has been a very tough slog for Baucus and the committee. It has been for Congress in general, trying to negotiate proposals in the House and the Senate, that could attract majority votes on the House and Senate floor. At one time, President Obama was very optimistic that both the House and the Senate could actually vote on proposals before the August recess and come back in the fall and try to reconcile the two and come up with a final deal. Well, reality has gotten in the way of all that.

JJ: But the reality at this moment looks better to the White House than it did just one week ago?

EP: I think so, because it wasn’t clear at all whether the House or the Senate could even act on these proposals in committee before the summer recess. Now it looks as if, on the House side, they will have committee action on a bill, which will be examined by members over the summer and then they’ll come back and vote on it. And the Senate has one more week of work before they break for the August recess so there’s still hope/expectation that Baucus’ finance committee could act as well. They still have a lot of tough work ahead of them.