Conservative Democrats threaten to block health bill

Kaiser Health NewsJuly 17, 2009 

WASHINGTON — Conservative Democrats in the House of Representatives seemingly have a new ally in the Congressional Budget Office as they attempt to make health care legislation less costly for the federal government.

Douglas Elmendorf, the director of the nonpartisan CBO, said Thursday that the bill now going through House committees and a similar Senate bill don't include adequate cost controls. His remarks sparked fresh criticism of the bills.

Early Friday morning, the House Ways and Means Committee, one of three House panels weighing amendments to the bill, approved the far-reaching legislation over the dissenting votes of three Democrats. It would guarantee insurance to the vast majority of Americans at a cost of about $1 trillion over 10 years. A combination of taxes on the wealthy and reductions in spending for Medicare and Medicaid would largely pay for expansion of insurance coverage.

A leader of the Blue Dog Coalition of conservative House Democrats said Thursday that he and six others in the group would vote together to block the bill in the Energy and Commerce Committee unless changes were made to slow the growth rate of federal health care spending and to ensure that rural hospitals are adequately reimbursed for treating new patients under the legislation.

"We simply are demanding a bill that contains costs so that health care can grow at the normal rate of inflation and that addresses many of the rural health care concerns that (hospitals be adequately reimbursed) and that we don't put small businesses out of business through an employer mandate," Rep. Mike Ross, D-Ark., said in an interview.

In response to the Blue Dogs' demands, House Speaker Nancy Pelosi, D-Calif., said that there would be opportunity for members to make additional "structural changes" to the bill to address cost concerns.

"Can there be more (savings)? I think so," she said. "And that is what the legislative process is about. You don't write the whole bill, introduce it, and then go to the floor. This is the time now for an open process of bipartisan review of the bill in the committees. So, I am hopeful and optimistic that there will be more savings."

Ross, chairman of the Blue Dogs' health care task force, said the six other Democrats who'd vote to block the bill are Reps. Zack Space of Ohio, Baron Hill of Indiana, Charlie Melancon of Louisiana, John Barrow of Georgia, Jim Matheson of Utah, and Bart Gordon of Tennessee. Ross said they would offer a series of amendments in committee to fix the problems they see.

The seven lawmakers outlined their goals in opening statements yesterday before the committee:

  • Find every penny of savings within current public programs and ensure we get more value for every health care dollar we spend.
  • Be more aggressive in implementing innovative delivery reforms to bend the cost curve;
  • Provide assistance for individuals, families and small businesses to help them purchase health care without bankrupting the federal government.

"If it's not amended, we cannot support the current bill, and it would only take seven Democrats to stop the bill in committee," Ross said.

The Blue Dogs also are concerned about requiring employers, especially small businesses in rural areas, to offer insurance or pay a penalty, he said. He added that they oppose a government-run insurance option to help extend coverage to more Americans if hospitals aren't paid far more than the rates allowed under Medicare, the federal program for the elderly and disabled.

The House bill would reimburse hospitals at Medicare rates and doctors at a slightly higher rate. Under the bill, businesses that don't offer health insurance would pay an 8 percent payroll tax to help subsidize coverage in a new insurance exchange. The bill was changed slightly to exempt the smallest employers from the requirement, but Ross said that isn't sufficient.

The House Democratic leadership has instructed the committees to complete work on the bill by next week.

Ross stressed that "we're not trying to stop health care reform. We just want to slow down and do it right. This is the biggest domestic reform that we'll undertake in my lifetime. Why do they want to rush it in a markup that's going to last two days this week and three days next week?"

(Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy-research organization that isn't affiliated with Kaiser Permanente.)

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