Already focusing on demonstrating tangible accomplishments before the mid-term elections in 2010, Congressional Democrats appear to believe that health care reform is the likeliest legislation to achieve sufficient bipartisan consensus. Two separate bills are being readied for movement to the Senate floor, one from Sen. Max Baucus’ Finance Committee, and the other from Sen. Kennedy’s Health, Education, Labor and Pensions Committee. It is generally expected that the two bills will be combined there. This is targeted for early summer according to aides from both committees.
Meanwhile, House Majority Leader, Steny Hoyer (D-Md.) invited three committee chairmen and other key players to a meeting to discuss health care strategy in the House. Working in cooperation with the White House Office of Health Reform led by Nancy-Ann DeParle, the party leaders are trying to fashion a legislative proposal for health care with input from the White House, key lawmakers, party factions, and outside stakeholders before they expose it to inevitable critics.
The three chairmen, Education and Labor Chairman George Miller (D-Calif.), Energy and Commerce Chairman Henry A. Waxman (D-Calif.), and Ways and Means Chairman Charles B. Rangel (D-NY), began meeting with one another after telling President Obama in a March 11 letter that the House would pursue a unified and "harmonizing approach" to devising a health care overhaul proposal.
The House strategy is an attempt to avoid party in-fighting which contributed to the collapse of the Clinton health care plan in 1994. Even on the other side of the aisle, House Minority Leader John A. Boehner (R-Ohio), who wants to see the focus on the economy, named Roy Blunt (R-Mo.) as the Republican point person on the issue, thus allowing health care to stay on the table for discussion. Blunt cautioned that his party would probably oppose any health care plan that includes a government-run insurance option, as Obama has proposed.
Blunt, a former minority whip, said it was too early to say whether Hoyer's efforts would be successful. "It helps sometimes when you go outside the process and get a small group of people involved," Blunt said. "But there are other times when you just need to be sure the committee process is working."
Bipartisan support for the passage of health overhaul legislation will require the White House to find a happy medium between Democrats and Republicans on the issue of what role a new "public plan" should play in covering the uninsured. President Obama and his supporters have favored a government-sponsored insurance plan as an alternative to private plans to enroll the uninsured. They contend that a government plan will help keep costs down and force private insurers into providing care that is more efficient to compete.
In an appearance April 15 at a forum sponsored by the Kaiser Family Foundation, White House Office of Health Reform Director Nancy-Ann DeParle fielded a number of questions about the public plan, which most Republicans and even relatively moderate members of the Democratic party view with suspicion. Charles E. Grassley (R-Iowa) and the ranking Republican on the Senate Finance committee warned at an April 9 forum in Mason City, Iowa, that Democrats should not include a public plan in their health overhaul proposals. Grassley said that if a public plan is offered, employers, especially small businesses, would end their coverage and tell employees to join a public plan. "Eventually such a plan would overtake the entire market. It would become de facto single payer," Grassley said.
But DeParle indicated she believed compromise was possible if lawmakers take a broad view of the public plan concept and its goals of lowering costs and keeping private plans on their toes.
She said that skepticism of the public plan idea among the members of Congress with whom she's met "aren't so clear about what it is," and that "when you actually start talking to them about what it might look like, you realize that you're talking about two different things. So I'm actually very hopeful that we'll be able to reach an agreement on that."
DeParle said, "Medicare is obviously a model of a public plan." But there are also, "state employee plans out there that some people would regard as public plans. They're sponsored by the government, but they have lower administrative costs and they tend to be less expensive, but they're often operated by private plans."
Kansas Gov. Kathleen Sebelius said "thirty plus states in the country, including Kansas, has a public plan side by side with private market plans" in their state employee program during her April 2 nomination hearing by the Senate Finance Committee. "They have an opportunity to take a look at which is best suited to themselves and their families. And there has been no destruction of the marketplace."
DeParle said her definition is "something that's sponsored by the government and therefore has very low, almost non-existent administrative costs compared to the others, it doesn't have the need to have brokers out selling, it wouldn't have the need to have a lot of costs and profits the way private plans do."
DeParle said the plan "could have payment rates that are the same as Medicare." But she noted that bothers some members of Congress because they say, "if the payment rates are Medicare rates it would shift costs to the private sector" because they think Medicare rates are too low. But "you don't have to use Medicare prices, you can use something else," she said.
Richard Curtis, president of the Institute for Health Policy Solutions, said in an interview Thursday that the public plan has become such a focus of the debate that "it's going to be important to find some middle ground here if reform is to succeed."
Other interest groups are concerned that Hoyer’s approach in the House may pre-empt committee action. "We need real hearings and real markups, with real questions. I worry that Congress is being made into an office of the White House," said Peter T. Flaherty, president of the National Legal and Policy Center, a conservative think tank.
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