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JACKIE JUDD: Good day. I’m Jackie Judd with Health on the Hill. Today a reporter roundtable to discuss health care reform, where legislative efforts stand in the house and the senate. Joining me today, Mary Agnes Carey of Kaiser Health News; we also welcome Eric Pianin, long time congressional reporter for the Washington Post and now with Kaiser Health News, and Ricardo Alonso-Zaldivar of the Associated Press. Welcome to you all.
Rick, I want to start with you. There was an expectation that the Democrats would release a draft of its bill on the house side late last week. Didn’t happen. What are the most contentious issues?

RICARDO ALONSO-ZALDIVAR: Well, there are a number of them, probably a long list, but what happened was that some of the conservatives and moderates expressed concern at the last minute that everything was kind of moving too fast and they wanted their say. Now, it appears to be that one of their main issues is basically the overall size, cost, scope of the bill, and in addition to that they have other concerns.
They have concerns about rural health care and they also, interestingly enough, had a concern about bipartisanship. The expectation was and still is that this is going to be a Democrats only bill in the House but they voiced a concern that the views of their Republican colleagues are not being sufficiently taken into account. So, all these things kind of like combined to cause a time-out, so to speak.

JACKIE JUDD: And Eric, the timeout was supposed to end as we speak early this week. There is still no firm word on when a draft bill will be released. The longer this goes on, what does that signal?

ERIC PIANIN: I think the longer it goes on, the more it signals that there is a real problem within the Democratic caucus in reaching agreement on the basic framework of the bill and the cost and I think that for weeks now we have been focusing a lot on the Senate side where Max Baucus and the Senate Finance Committee has been trying to figure out a way to reduce the overall cost. At one time, there were estimates of $1.6 trillion to $2 trillion over a 10 year period to pay for this thing.
Well, I think political reality set in, more and more concern about rising deficits. So I think in the senate in particular there has been a big emphasis on trying to bring that cost down and now they are talking in the neighborhood of $1 trillion, which seems like a lot of money to me, but still in trying to expand on a health care system in the United States, it is going to be a costly venture.
Now, over in the House where for a long time the liberal leadership has been sort of asserting that they would preserve their principles and develop a substantial program with a public option for providing insurance and protections for lower-income people in terms of subsidies and in other benefits, suddenly, as Rick was mentioning, these moderate and conservative Democrats, the Blue Dogs and the New Democrats, raised a big fuss late in the week to the point that Nancy Pelosi had to pull back the bill and basically go back to the drawing board.
And I think that is what we are seeing right now. How do you achieve all of your liberal goals but still stay within some kind of a spending framework that you can sell to the conservatives?

JACKIE JUDD: Do you think that the House leadership at this point knows the answer to that question?

ERIC PIANIN: Well, I don’t think so and I don’t think we are really going to have an answer until later this summer or early this fall when the House and the Senate negotiators actually sit down and try to draft the final bill. I mean, we are in kind of the early innings of this game and I know that there seems to be a lot of urgency to get stuff passed. But the reality is not until the conferees sit down this fall, with the administration, with the president very much engaged, are we really going to see the ultimate parameters of this.

JACKIE JUDD: Okay. Mary Agnes, turning to you, the Senate, as we all know, is very preoccupied this week with confirmation hearings that are beginning for the Supreme Court nominee, Sotomayor, does that take them off track from a focus on health care?

MARY AGNES CAREY: I don’t think so. I think for Max Baucus and the people he has been negotiating with they will continue to talk to try to get a deal on health care, probably takes a little pressure off them. But people will still be watching to see if they can get an agreement, can the committee move the bill before the August break? As we had all talked about before, the hope was that the bill would be off the senate floor by the August break, but that doesn’t seem to be the case now.

JACKIE JUDD: And in terms of where the key negotiators on the Senate side now stand with the big issues, is there consensus? Are they driving towards that?

MARY AGNES CAREY: Right. Now there is much concern among the Democratic colleagues and majority leader Harry Reid about taxing the employer provided health benefits. That was going to save about $320 billion over the next ten years and so now they need to look for other alternatives that could include taxes on higher income people, it could include looking at taxing much, fairly generous, employer-provided benefits like at the $25,000 level or higher. It could include other taxes. They have got some consensus on Medicare and Medicaid savings. They are trying to find that, and that is about $600 billion, trying to find that last chunk of financing is sort of where they are now and what they have to come down to.

JACKIE JUDD: Does the House Ways and Means idea that Charlie Rangel spoke about late last week, taxing the wealthiest among us, does that have legs in the Senate?

MARY AGNES CAREY: It’s always a much, much heavier lift in the Senate than it would be in the House, and so I think that they will look at it. They have got to keep the door open and examine everything, but they have to find consensus there and also on this issue of the public plan. The Senate is probably going to have a far less generous public plan, modeled on Medicare for example, it might be in the house. I don’t think we will see that first in the Senate, but they are trying to find consensus on those two key issues.

JACKIE JUDD: You know, in the past 72 hours, it seems to me that the anxiety level is rising a little bit in Congress about where things stand and one of the things that I have heard over and over again in the weekend is the president, it’s time for the president to step up, to take a stronger hand. Where is that coming from, Eric?

ERIC PIANIN: Well, it’s coming from a number of places, but I think particularly in the House now, among the Democratic liberal leadership, there is a sense that it’s time for the president to step up the plate. He has just returned from a lengthy overseas trip.
As we all know, he has taken a very different strategy than Bill and Hillary Clinton took in the 1990s when they tried to sell a major health care reform package to Congress where they basically arrived on the Hill with the plan. Sort of like a fait accompli, take it or leave it, and Congress decided to leave it. And I think this time the president perhaps very wisely decided to spell out the general parameters of a bill but leaving it to the House and the Senate to come up with specific legislative language and then try to negotiate it in the end.
I think particularly in the Senate now there is growing concern that the effort to create a truly bipartisan bill is not working. And that it’s harder and harder for Max Baucus to find common ground with Chuck Grassley and some of the moderate and conservative Republicans who have indicated a willingness to try to negotiate a deal. And there is added pressure from the liberal camp, noting that now that Al Franken is in the Senate the Democrats in the Senate have a 60 vote majority – a super majority, that would enable them to pass legislation on their own without any Republican support if they chose to do it, if they could keep everybody together.

JACKIE JUDD: Big, big “ifs.”

ERIC PIANIN: Big, big “ifs,” so I think the feeling now is it is time for Obama to speak out more, be more aggressive, and I think we will be seeing that. He is going to go out to Michigan to give a speech on health care reform. I think we will be seeing him more on the road and occasionally up on the Hill trying to coax all the parties to the table.

JACKIE JUDD: Rick, what are some of the risks that President Obama faces if he does do this?

RICARDO ALONSO-ZALDIVAR: Well, one of them is that there is no plan there right now. So it would be good if he had a plan to sell to the American people, but he doesn’t. You have competing ideas and not just two sets of ideas but maybe on every one of these big issues, three, four, five combinations.
He said it himself last Friday, I believe, at his press conference. He said it is not about Republican or Democrat, it’s about House and Senate and different committees and different perspectives.
So if he were to jump in right now, unless he is prepared to come out with specifics, there really isn’t much more that he can do than what he has been doing already, which is to sort of make the general case. And were he to decide to come out with specifics, there would be a risk there for him, too, because everything involving health care looks like it’s hard and people don’t like to hear about things that are hard.

ERIC PIANIN: I do think it’s interesting, though, that last week there was a big flap over an interview that Rahm Emanuel, the White House Chief of Staff, gave to the Wall Street Journal, indicating that there was some flexibility on the whole question of a public option, whether or not the White House would insist on the creation of a public governmental entity to provide health care insurance and compete with the private sector. And it was very interesting in that Emanuel indicated that there was some flexibility and might even consider putting off or delaying such an entity with a trigger that might put it into effect several years down the road if the insurance plan didn’t work.
And there was an amazing uproar on the Hill, especially among liberal Democrats in the house who felt that this was betrayal of promise or a pledge from the White House. And, in fact, it forced Emanuel to go up to the hill and reassure the Democrats that the White House was still very much in support of a public option. And then the president, from overseas, had to issue a statement, repeating his support for it.
And I think the Democrats seized on that and probably view that as an advantage now in the House in trying to preserve this very controversial option or provision which is probably one of the hottest issues in the debates in the House and the Senate.

JACKIE JUDD: But it also goes to Rick’s point which is the very delicate dance that the administration has to play when Congress is trying to reform one-sixth of the American economy.

MARY AGNES CAREY: We have heard several times from the Senate Budget Committee Chairman Kent Conrad, as we’re waiting out in the hallway after these meetings. He comes out and says this is really hard. This is a really hard thing to do and to Rick’s point, different members of the house have ideas, members of the senate have ideas, the president has ideas, and this is going to come in fits and starts. This is going to continue throughout the summer and to the fall.
And to Eric’s point, I think the real game is, we have to get to that part of the game of having a conference committee, of having two bills, but this is going to be a very, very difficult road for lawmakers and for the White House.

JACKIE JUDD: A final question, though, is there still a core belief among congressional leaders that this will still happen?

MARY AGNES CAREY: I would say yes, because I think that they know this is the time. You have got to get this as far away as possible from the midterm election. A lot of Democrats were elected on this. President Obama was elected on this. And they have learned the lessons of 1994, of the Clinton era. They don’t want to repeat them. They are running both the House and the Senate and the White House and they have got to do it now, and so I think it is still the core belief that they want to achieve it and that they can achieve it.

JACKIE JUDD: Is this what both of you sense as well?

RICARDO ALONSO-ZALDIVAR: Well I don’t know. A few weeks ago, before they encountered these difficulties, former Senator Tom Daschle, who would have been guiding this thing through Congress, he was asked what do you think? And he said I give it a 50/50 chance, and that was a few weeks ago, before we had this spate of troubles. Now, these troubles could be normal because as you said the dance of legislation, it goes through many, many phases, but I don’t think anything is clear at this point.
The one thing that seems interesting in kind of keeping the momentum going is that all the major interest groups that have a stake in this still say they want to see something big done, but I don’t think anything can be taken for granted.

JACKIE JUDD: Final word from you Eric.

ERIC PIANIN: One thing to always keep in mind, President Obama is a pragmatist in the end and I think that this is such an important part of his agenda that I can’t conceive of him walking away without at least something. And it may not be as ambitious a plan as he originally envisioned or that is being discussed now, but I’m pretty convinced that he is going to come away with something before the end of the year.

JACKIE JUDD: Okay thank you all very much for a really interesting conversation and thank all of you for joining us today. I’m Jackie Judd.