Congressional Democrats Consider SCHIP Expansion
House Speaker Nancy Pelosi (D-Calif.) on Wednesday in a news conference said Congress would aim to pass measures related to health care that failed during the Bush administration, including an economic stimulus package with funding for state Medicaid programs, SCHIP expansion and federal funding for embryonic stem cell research, CongressDaily reports (McPike et al., CongressDaily, 11/5). In the Senate, Democrats and two independents who caucus with them will increase their majority from 51 seats to at least 56 seats, with four races still undecided as of Thursday morning. In the House, Democrats will increase their majority from 236 seats to at least 254 seats, with eight races still undecided (CNN.com, 11/6).
Pelosi suggested the current Senate take up the $61 billion economic stimulus package (HR 7110) approved by the House on Sept. 26. The bill includes money for state Medicaid programs, among other provisions, unlike the stimulus bill passed earlier this year. "If we can't get the [Bush] administration interested in doing more, ... the least we can do is the package that we have put forth," Pelosi said, adding that the new Congress could move forward with a new stimulus bill early next year. She said, "Depending on what the first package is we may need another one," and "it may be that we do one further down the road as we watch what is happening to our economy" (Clarke/Epstein, CQ Today, 11/5).
According to CongressDaily, the "first dilemma" the new Congress will face on health care is whether to move legislation that would renew and expand SCHIP as its own bill or as part of "a larger overhaul effort." Sources familiar with the matter say passing the expansion on its own could "give Democrats an early win by pointing to millions more children with health care coverage, a bonus if congressional stamina for an overhaul wears thin," according to CongressDaily. An SCHIP expansion likely would be funded by an increase in the tobacco tax, but other reforms -- such as expanding coverage to uninsured adults -- "will vie with other priorities for dollars," CongressDaily reports.
Pelosi also said that she would fight efforts "to destroy Social Security (and) unravel Medicare" and that Democrats would propose legislation to provide federal funding for embryonic stem cell research that was vetoed by President Bush. In addition, Congress could try to find a permanent fix for the Medicare physician reimbursement system next year, rather than providing a temporary delay of the planned cuts as it has done in recent years. Medicare Advantage payments likely would be cut to help fund a physician payment fix, as President-elect Barack Obama supports cutting MA rates.
CongressDaily reports that "some health overhauls might hitch a ride" on a Medicare payment fix bill, including comparative effectiveness research, pay-for-performance proposals and legislation addressing electronic health records -- if health information technology is not taken up in its own bill.
Senate Finance Committee Chair Max Baucus (D-Mont.) plans to release details of his own health care overhaul plan over the next few weeks and convene a meeting of relevant committee leaders during the lame-duck session to discuss how best to move forward with the bill. Baucus spokesperson Carol Guthrie said the meeting likely will center on how to achieve health care reform in the current economic climate (CongressDaily, 11/5).
Health reform efforts could be limited by declining tax revenues and an increasing federal deficit related to the recent economic downturn, the San Francisco Chronicle reports. Pelosi said, "I think it's important for the American people to know that many of our options have been diminished because of the downturn in the economy," adding, "We have a lot less money to draw upon" (Coile, San Francisco Chronicle, 11/6). According to CQ Today, stabilizing the economy and withdrawing from Iraq -- two priorities of Obama's -- could pull resources and attention away from other Democratic goals, including expanding health coverage.
In addition, even an increased Democratic majority in the Senate does not ensure easy passage of Democrats' priorities, according to CQ Today. Republicans could begin "digging in their heels," forcing Democrats to try to push their health care agenda, among other proposals, through the budget reconciliation process, which would allow passage by simple majority without the threat of filibuster. "The numbers can ... convey an impression of command and domination that doesn't stand scrutiny," Ross Baker, a political science professor at Rutgers University, said, but he added, "When actual legislation is presented, a lot of those numbers can evaporate pretty quickly" (Jansen, CQ Today, 11/5).
According to CongressDaily, Obama has sought advice on health care from former Senate Majority Leader Tom Daschle, who "learned firsthand what went wrong when the Clinton administration failed to push through universal health care in 1993," which was "seen as helping cause serious Democratic losses in the 1994 midterm elections" (CongressDaily, 11/5).
Former Democratic presidential candidate Sen. Hillary Rodham Clinton (D-N.Y.) said, "I hope that we're going to really make progress on health care right off the bat with a new Congress. There are a lot of different ways of doing that" (Earle, New York Post, 11/6). George Mason University public policy professor Mark Rozell said Democrats must find a balance between pushing their priorities and not alienating Republicans. He said, "If the Democrats push hard on health care reform, ... they're going to miss a unique opportunity to come out during a honeymoon period and really make a very big difference." Republican leaders "remained largely quiet Wednesday," according to USA Today (Fritze, USA Today, 11/6).
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