White House Backs Cost Panel to Clinch Bill in January; GOP Steps Up Opposition
With the Senate set to pass its health bill on Christmas Eve, President Barack Obama is planning to step up his involvement in the final health-care legislation, White House and congressional officials say.
At the same time, Republicans have ratcheted up their attacks on the legislation and begun approaching conservative Democrats to switch parties, in the wake of this week's unexpected defection of Democratic Rep. Parker Griffith of Alabama.
Administration officials want what they view as must-have pieces in the final bill to be hashed out in January by House and Senate negotiators. To help pay for expanded coverage, they favor the Senate's tax on high-cost plans over the tax on the wealthy the House approved . The White House is pushing for a strong independent panel to assess Medicare spending and recommend cuts to Congress, according to administration and congressional officials. That is in the Senate bill but not the House version. Mr. Obama "will be taking a more active role," said White House health official Nancy-Ann DeParle.
The Senate on Wednesday completed procedural motions needed to close debate and was scheduled to vote on the bill itself Thursday. The key motions passed with all 58 Democrats and two independents in favor and no Republican support.
The administration is sensitive to criticism the legislation does too little to trim growth of costs. White House Budget Director Peter Orszag says the 40% tax on high-cost, or "Cadillac," plans will encourage employers to look for more thrifty coverage and discourage unnecessary procedures. Cost is the reason for favoring this as well as the Medicare commission.
Mr. Obama said in an NPR interview Wednesday that Cadillac plans "don't make people healthier but just take more money out of their pockets because they're paying more for insurance than they need to."
Opponents of the tax on high-value plans say it will hit many middle-income workers and violate Mr. Obama's pledge not to raise taxes on the middle class. Rep. Tom Price (R., Ga.), head of the Republican Study Committee, called Thursday's planned vote a "Christmas Eve calamity."
Under the Senate bill, the new Independent Medicare Advisory Board would begin work in 2014. It would be made up of experts assigned to find new ways to reduce Medicare spending as well as private-sector health spending. The White House is pushing the Medicare commission over stiff opposition from doctors, who say it may unfairly target them for spending cuts. Some opponents also are concerned it would give away too much congressional authority.
While the commission could recommend changes in reimbursements, it couldn't judge the cost-effectiveness of drugs or procedures. Republicans have said the Democrats' plans could lead to the U.S. having a system like in Britain, where the National Institute for Health and Clinical Excellence rules against coverage for some treatments if cost relative to efficacy is judged too high. Democrats say the board would be prohibited from rationing care.
Mr. Obama has expressed concern that the House's stricter abortion language goes beyond the status quo of keeping taxpayer money away from abortion funding. Antiabortion groups say the House language needs to remain.
The Senate bill contains more of the cost-saving provisions favored by the White House, but the House bill goes further to expand insurance coverage, a central goal for the president. The House bill extends coverage to 96% of legal residents, compared with 94% in the Senate bill, because the House bill contains more-generous insurance subsidies as well as stiffer penalties for people who don't buy insurance and employers that don't offer affordable coverage.
Hospitals and insurance companies are pressing the White House to hit the higher coverage number. That could be difficult because the House's subsidies helped drive up the cost of its bill to $1.05 trillion over 10 years -- above the $900 billion limit the president set for the overhaul.
Although the House bill contains more-stringent insurance-market regulations, the Senate added a requirement at the last minute to prevent insurers from denying coverage to children with a pre-existing health condition; that is a provision the White House likes. Ms. DeParle stressed that the White House isn't focused on one particular bill and wants to include the best from each.
During the runup to the Senate vote, Mr. Obama personally wooed a handful of wavering lawmakers. Sen. Olympia Snowe, a Maine Republican, said she met him in person three times and received three calls from him, including two from Air Force One.
But Ms. Snowe said the president weighed in too late. She said that as far back as June, she told him a government-run insurance plan and abortion were going to be flash points. She said the White House should have tried to resolve those issues in a bipartisan fashion early on. They remain in limbo because the House and Senate bills treat them differently. "That's where the president could have asserted himself early," said Ms. Snowe, who opposes the Senate bill.
The president did help land the crucial 60th Senate vote, Democratic Sen. Ben Nelson of Nebraska. The president spoke with Mr. Nelson a half-dozen times in the past three weeks.
When White House ally Tom Daschle was Senate majority leader, he and Mr. Nelson had a "no surprises" pact to keep each other informed on legislative thinking, aides said. Mr. Daschle's former chief of staff, Pete Rouse, is now a White House official and used his contacts to help land Mr. Nelson's vote, aides said.
Critics say Mr. Nelson affirmed his support only after a last-minute change that would have the federal government permanently cover the costs of expanding Medicaid in Nebraska. The cost of that is estimated at somewhere below $100 million.
White House officials are confident enough about ultimate passage that they are moving to take some of the credit. "The role that the president and his team have played up to this point has gotten us to the point where, in all honesty, health care is not a matter of if -- health-care reform now is a matter of when," said White House spokesman Robert Gibbs.
In the wake of Democratic Rep. Griffith's defection, Republicans reached out to Democrats representing conservative districts, said Democratic campaign strategists. Sen. John McCain (R., Ariz.) approached Rep. Chris Carney (D., Pa.) about switching.
Rep. Carney said he would "continue to work closely with Democrats, Republicans and independents alike. I appreciate the Republican Party's outreach, but I have no plans to change parties."