In This Issue
- New Draft of the House Tri-Committee Bill Delayed
- Senate Finance Committee Negotiations Are a Work in Progress
- Senate HELP Committee Mark-Up Continues
- Hospitals Strike a Deal
July 10, 2009
New Draft of the House Tri-Committee Bill Delayed
House Majority Whip Steny Hoyer (D-MD) announced yesterday that a revised version of the House Democrats' Tri-Committee health reform legislation expected to be released on today would likely be delayed due in large part to objections by the Blue Dog conservative Democrat coalition. The Blue Dog Coalition voiced serious concerns with the structure of the government-run public plan option and other components of the House Democratic bill in meetings with House leadership and the White House, and in a letter signed by 40 of its members this week. It's been reported that Blue Dog Health Committee chairman and Energy and Commerce Committee member Mike Ross (D-AR) Committee member Mike Ross (D-AR) said last night that the Blue Dogs would meet with the chairs of the three committees of jurisdiction today to discuss the changes the coalition feels need to be made to the bill. NAHU is working with members of the Blue Dog Coalition on proposed amendment ideas.
It is unclear what this potential delay will do to the House's previously announced schedule for the legislation. Each of the three committees of jurisdiction was scheduled to mark up the new draft early next week, with the Ways and Means and Education and Labor Committees planning two-day mark-ups and the Energy and Commerce Committee scheduling a three-day mark-up. Speaker Pelosi has publicly committed to a floor vote on the legislation in the last week of July.
Also in the House, the Ways and Means Committee Democrats spent a great deal of time this week negotiating pay-fors for their legislation, which is projected to cost at least $1.5 trillion over 10 years. Reportedly, an income tax surcharge of two percent or more on Americans with incomes over $250,000 is the current leading idea. Also under consideration are an excise tax on soft drinks and sugary beverages, a new payroll tax of 0.3 percent to be paid by employees and employers, and the elimination of the tax-referred status for Flexible Spending Accounts. Of these ideas, the only one NAHU supports is the excise tax on sugar-based drinks.
Senate Finance Committee Negotiations Are a Work in Progress
The Senate Finance Committee continues its closed-door work on its version of health reform legislation. Earlier in the week it seemed like a draft of the bill might be forthcoming today, with a mark-up tentatively scheduled to begin on Tuesday, July 14, but now that schedule seems to be unrealistic.
The committee has been in bipartisan discussions for weeks on its measure, but that process was temporarily waylaid when it was reported on Tuesday that Senate Majority Leader Harry Reid (D-NV) had instructed Finance Committee Chairman Max Baucus (D-MT) to cease bipartisan negotiations. However, following a meeting with Finance Committee Ranking Member Chuck Grassley (R-IA) and several other key GOP committee members, Reid appeared to relent on his demand. Bipartisan negotiations resumed again yesterday and lasted all day.
Key areas where the Finance Committee appears to be seeking compromise include the creation of a government-run public plan versus a nonprofit medical cooperative plan of some sort and the structure of a potential employer mandate or increased employer responsibility for coverage. They are also negotiating pay-fors for the legislation. A key area of revenue that now appears to be off the table due to Democratic objections is a cap on the tax exclusion for employer-sponsored health insurance coverage or the exclusion's outright elimination. This leaves the Committee short on revenue by several hundred billion, so they are currently discussing an income tax surcharge of up to five percent on high-income individuals, excise taxes on sugary drinks and other options.
Senate HELP Committee Mark-Up Continues
The Senate Health, Education, Labor and Pensions (HELP) Committee resumed its mark-up of the American Health Choices Act this week. A new mark-up of Title One of the bill has been released, which now includes the details of a government-run public plan and an employer mandate to provide coverage that would apply to businesses with 25 or more employees. The Committee has more than 400 proposed amendments to consider on Title One, many of which are supported and were suggested by NAHU.
Improvements have been made to the navigator section in the second draft as the new language specifies that navigators must be appropriately trained for the role they are playing. Their role has also been changed from providing enrollment assistance to facilitating enrollment, so that they would function more as a referral service and have no role in sales. However, there is still more work to be done and Senators Isakson and Coburn have offered amendments to strike the navigator provisions entirely and specifically require anyone selling insurance to be licensed.
Due to the delays in both this Committee and in Senate Finance, a combined bill passed on the Senate floor before the start of the recess on August 7 seems less and less likely.
Hospitals Strike a Deal
On Wednesday, the nation's hospital associations became the latest group to announce a deal with the Obama Administration and the Senate Finance Committee on cost-containment issues. Vice President Biden publicly announced that the nation's hospitals have agreed to forgo $155 billion in Medicare and Medicaid payments over the next 10 years because the hospitals believe comprehensive health reform efforts to improve health information technology and reduce the number of uninsured will "lift a financial burden on hospitals, allowing them to lower costs."
It's unclear though whether or not this deal will be binding as legislation works its way through the Congress. The administration and the Finance Committee brokered a similar deal with PhRMA and the AARP on prescription drug prices for seniors a few weeks ago. But, this week, the chairs of all three House Committee of jurisdiction announced that they do not consider their committees to be bound by the agreements in which they did not participate. However, the Blue Dog Democrats have opposed this stance too, sending the committee chairs a letter with more than 70 House Democratic signatures urging them to add the agreement terms into the draft health bill.
