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Congressional Activity On Comprehensive Health Reform Ramps Up

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Efforts to draft comprehensive health reform legislation are advancing in the Senate Health, Education, Labor and Pensions and Finance committees, according to several newspaper reports.

Senate HELP Committee Chair Edward Kennedy (D-Mass.) plans to lead a unified Democratic effort to develop and pass legislation based on President-elect Barack Obama's health care proposal to expand health coverage to more U.S. residents, committee spokesperson Michael Myers told reporters Thursday at a Families USA briefing, CQ HealthBeat reports. Kennedy began organizing discussions between his staff and health care industry stakeholders this summer. The roundtable talks have mostly involved Democratic lawmakers, but Myers said staffers expect to begin meeting with Republicans now that the election is over.

Myers said that the committee has not yet begun to draft legislative language and has not settled on the final aspects of an overhaul. However, he said that a "one-bill" approach is central to Kennedy's strategy to pass an overhaul. "There's a growing recognition that the best way, maybe the only way, [is] for Democrats to unite around one bill," Myers said (Nylen, CQ HealthBeat, 11/6). Myers also said that Kennedy would act on "cues from the Obama White House" on health care and expects that Congress will act on an overhaul measure during Obama's first term (Marcus, Bloomberg, 11/6).

A comprehensive health care bill could require Congress to make exceptions to pay-as-you-go budgeting rules, Myers said at the briefing. According to Myers, "Certainly, there's a strong inclination within large quarters of Congress that (health reform) has to be substantially paid for, but whether it's every penny, every dime -- those discussions still have to happen."

Obama's plan is estimated to cost about $60 billion, according to his campaign's estimates. Obama during his campaign said that he would pay for his proposal with a combination of not renewing tax cuts enacted by President Bush and with costs savings from some of the proposals within the overall plan. Myers said that the funding issue "isn't settled yet," adding, "Certainly, President Obama and his White House will have a lot to say about how we address this within the budget" (Young, The Hill, 11/6).

Myers added, "The question is no longer whether we will pursue health reform, but when and exactly in what form" (Bloomberg, 11/6). The New York Times reports that party leadership is considering "who will take the lead on the issue of national health care policy given the precarious state of [Kennedy], ... who has brain cancer" (Herszenhorn/Hulse, New York Times, 11/7).

Analysts at a forum sponsored by Congressional Quarterly and the Public Affairs Council "played down the likelihood" that the Obama administration and Congress would even attempt to pass a unified overhaul bill. Robert Laszewski, president of Health Policy and Strategy Associates, said crafting an all-encompassing bill would be contentious, even within the Democratic party, and the "$1 trillion budget deficit this year" would stand in the way. Laszewski added that the Obama administration should not attempt to go too far with health care reform. "Harry and Louise are alive and well," he said (Nylen, CQ HealthBeat, 11/6).


Senate Finance Committee Chair Max Baucus (D-Mont.) plans to release a white paper next week containing specific policy issues and proposals he sees as priorities for the newly elected Congress (Edney, CongressDaily, 11/6). In a letter sent on Thursday to Obama, Baucus wrote that the paper will "detail specific policy areas and proposals on which I believe the Congress must move forward to achieve successful health care reform -- from options for strengthening the employer-based system and reforming the delivery of health care for efficiency and quality to existing ideas on comparative effectiveness research and health information technology" (Carey, CQ HealthBeat, 11/6).

Baucus added, "Many of my reform objectives as Finance Committee Chairman will dovetail with your own health plan; in the places where our opinions and policy plan diverge, I am eager to work with you to achieve consensus." Finance Committee staffers currently are briefing Obama's transition team on the proposal, which is expected to contain insurance pooling arrangements to help businesses and consumers obtain affordable coverage; tax-code options designed to reduce inefficiencies and costs; a focus on preventive care; and Baucus' ideas about the roles to be played by individuals, employers and government in creating and funding an overhauled health care system, according to CongressDaily. Baucus has met with Kennedy to discuss the possibility of crafting a single health care overhaul bill (CongressDaily, 11/6).

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In related news, key Democratic members of committees responsible for SCHIP have been meeting with lobbyists for child advocacy groups in recent weeks and are expected to pass a large expansion of the program early in the next congressional session, CQ Today reports. House Speaker Nancy Pelosi (D-Calif.) on Wednesday in an interview with National Public Radio said SCHIP legislation "will probably be one of the first bills we would put on President Obama's desk." Advocates say it is important to keep SCHIP separate from a comprehensive health overhaul bill.

Gordon Whitman, spokesperson for PICO National Network, said, "I think there's a growing understanding ... that given the economy, you should do SCHIP quickly, and it actually builds momentum for broader reform and doesn't step on it."

Child advocates said they think the legislation will be similar to $35 billion expansion that President Bush vetoed in 2007, except with more funding -- potentially as much as $50 billion over five years -- to reflect inflation. The bill could include one "controversial tweak" that would lift a prohibition on legal immigrant women and children enrolling in Medicaid or SCHIP for their first five years in the U.S.

According to CQ Today, Democrats will face several challenges, including how to fund the expansion -- a previously-proposed increase in the tobacco tax intended to pay for the expansion would not be enough -- and a deadline to enact the legislation. New spending on SCHIP is authorized only through March (Wayne, CQ Today, 11/6).


Also in related news, Democrats are developing a $100 billion economic stimulus package that could be considered this month if Bush agrees to enter negotiations on the matter. The package is expected to include additional funds for state Medicaid programs. However, White House Press Secretary Dana Perino said, "We've long said that the package that they have put forward so far was not something we thought that we could support."

Another stimulus bill, to be drafted after Obama takes office in January, "could grow to well over $100 billion," the Washington Post reports (Montgomery/Marr, Washington Post, 11/7).

Opinion Piece

"If you believe what the pundits are saying, enacting universal health insurance in the next year won't be difficult: It will be impossible" because "it would cost too much money, antagonize too many interest groups" and "require too much raw political muscle," columnist Jonathan Cohn writes in The New Republic. He notes that while the Senate Finance, HELP and Budget committees have formed working groups to discuss reform legislation, "It's easy to see how the emerging consensus could break down as the congressional Democrats settle on details." Cohn continues, "But that's no reason for Obama to think small."

Cohn writes, "Obama and his allies also need to realize that delaying action on health care is a gamble of its own." Cohn writes, "The good news is that all the talk about health care has put Obama in a perfect position to push it," adding, "He can legitimately claim his election is a mandate for that change" (Cohn, The New Republic, 11/19).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.