WASHINGTON — The health care package unveiled by House Democratic leaders Thursday appears a step in the right direction to the San Joaquin Valley moderates who may hold its fate in their hands.
While postponing politically volatile issues including abortion and illegal immigrant coverage, the latest health care reboot moved closer toward satisfying Valley members. In particular, the bill's modified government insurance option and lower overall price tag soothes some congressional concerns.
"There has been a significant improvement, that I helped fight for," said Rep. Dennis Cardoza, D-Merced, but "I still think it has a ways to go."
Cardoza specifically praised the revamped idea of letting doctors and hospitals negotiate rates with the government. Previous versions of the so-called "public option" would have been tied directly to Medicare reimbursement rates, which San Joaquin Valley hospital officials say shortchange them.
"The negotiated rate is a plus," agreed Rep. Jim Costa, D-Fresno, noting that "I was not prepared to vote for the previous bill."
Even so, Cardoza and Costa say they are still wading through the details of the revised 1,990-page package. Costa, moreover, made a point of stressing that "incremental progress is something that would be a lot better than attempting to do everything at once."
House Speaker Nancy Pelosi -- not a resoundingly popular figure in some San Joaquin Valley congressional districts -- convened a rally on the Capitol steps Thursday morning to trumpet the bill's release, the latest in a series of health care overhaul unveilings this year.
No House Republican is expected to vote for the health care package when it reaches the floor, sometime before Nov. 11.
"I oppose the bill because it takes choice away from Americans; it takes control away from patients and doctors; and it vastly expands government power and spending," Rep. Devin Nunes, R-Visalia, declared earlier this year.
Without GOP support, Pelosi can only afford to lose 38 Democrats and still get the 218 votes needed for House approval.
A number of the potential Democratic defections are likely to come from the House Blue Dog Coalition, to which both Cardoza and Costa belong. Many of the coalition's 55 members represent rural districts -- some carried by Republican presidential candidate John McCain last year -- and the Blue Dogs include the most conservative Democrats in Congress.
"There's no question that these kinds of bills are tougher (for Blue Dogs)" Cardoza acknowledged. "If you come from New York City, or you come from San Francisco, it's easier to decide."
Some Blue Dogs, including Rep. Jim Marshall of Georgia, have already told reporters they don't favor the ambitious health care bills now being debated in both the House and Senate.
An ambitious climate change bill approved earlier this year posed similar risks to Democratic lawmakers representing conservative-leaning districts. Costa, whose district includes oil-rich Kern County, voted against the global warming bill in July. Cardoza, who is a member of the Democratic leadership's House Rules Committee, voted for the climate bill.
The revised package released Thursday addresses some of the small-business and geographic priorities advocated by Blue Dogs. For instance, businesses with payrolls below $500,000 would be exempted from an employee insurance mandate. The original bill set a lower payroll threshold of $250,000.
"That's moving in the right direction," Costa said.
In another move potentially pleasing to Valley Democrats, the new bill calls for two studies on fixing the geographic disparities in Medicare reimbursement system that critics say harm regions like the Valley.