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Ahead of Obama Speech, Health Reform Debate Renewed in Congress

September 8, 2009 at 12:00 AM EST
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New health care proposals were discussed Tuesday as Congress returned to Capitol Hill after its August recess. Betty Ann Bowser reports.
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JIM LEHRER: Congress went back to work today on health care reform. There were new proposals just 24 hours ahead of President Obama’s prime-time address.

NewsHour health correspondent Betty Ann Bowser begins our lead story report.

BETTY ANN BOWSER: With lawmakers back at the Capitol after their August break, and President Obama set to address Congress and the nation tomorrow night, Senate Finance Committee Chairman Max Baucus faced new pressure to show results from months of bipartisan talks.

After months of negotiations, it was widely reported over the weekend that Baucus circulated a framework for a bill to a select group of members of the committee, the so-called gang of six, three Republicans and three Democrats, who have been trying to reach agreement on a bipartisan measure.

Early details indicated the Baucus proposal would not include a government-run public insurance option to compete with private insurers. Instead, it would create nonprofit insurance cooperatives run by consumers.

The package would cost an estimated $900 billion over 10 years, and it would mandate most Americans have health insurance or face heavy fines. And to help defray the cost of covering the uninsured, it would impose fees on insurance companies for the most expensive health plans.

But, on the Senate floor, Republicans like John McCain of Arizona warned, their voices and their constituents are still not being heard in the health care debate.

SEN. JOHN MCCAIN, R-Ariz.: We do have legitimate, workable, doable, viable alternatives to the government option. And when the president of the United States stands up and says we don’t, he either is not paying attention to what we’re saying, which has been one of the big problems with this debate, or he willfully ignores the fact that there are solutions, that we can move forward and reduce health care costs in America and preserve the quality.

BETTY ANN BOWSER: Even so, Majority Leader Harry Reid said on the Senate floor he still wants a bipartisan bill this year. Later, he and House Speaker Nancy Pelosi met with President Obama at the White House, and they reaffirmed support for a public option plan in the final bill.

Continued push for bipartisanship

SEN. HARRY REID, D-Nev., Senate majority leader: We have a lot of work to do. We understand that. But we're still approaching this in the form of bipartisanship.

We still, after all these months, have a place at the table for the Republicans. And we're going to do everything we can to work with them. We want a bipartisan bill. We do not want to do reconciliation, unless we have no alternative.

QUESTION: What about public option at this point?

SEN. HARRY REID: I think that -- I personally am in favor of public option. There's -- in my mind -- there's no question that majority of -- I can't speak for the House caucus, but, if I were betting, I think the majority of them also believe in a public option. And we're going to do our very best to have a public option or something like a public option before we finish this work.

REP. NANCY PELOSI, D-Calif., Speaker of the House: As the president heard said -- and -- and I listened to him very carefully -- he believes that the public option is the best way to keep the insurance companies honest and to increase competition in order to lower costs, improve quality, retain choice -- if you like what you have, you can keep it -- and expand coverage in a fiscally sound way, that it saves money.

And that is why we -- but, he said, if you have a better idea, put it on the table. And, so, if somebody has a better idea of how to do that, put it on the table.

BETTY ANN BOWSER: But, back at the House, a leading moderate Democrat -- Mike Ross of Arkansas -- said he will oppose any bill that includes the public option. And House Republicans pointed to rising public opposition.

North Carolina Virginia Foxx:

REP. VIRGINIA FOXX, R-N.C.: Over the past month, I have heard from more people than I can count who have had enough of the explosion of Washington-style big government. And, of course, it was no comfort that, in the middle of August, the White House announced that they spent $9.1 trillion in new government debt over the next 10 years.

So, how is it that the American people are expected to stomach a new government-run health care proposal that is estimated to cost up to $1.6 trillion? Let's scrap the Democrat government-run health care proposal and return to the drawing board for a plan like ones that Republicans have offered that put patients, not government, first.

BETTY ANN BOWSER: President Obama gets his chance to shape the debate and provide more details of what he wants in his address tomorrow night.

JIM LEHRER: Gwen Ifill takes it from there.

GWEN IFILL: For more on the latest developments on the health care debate, we're joined by two reporters who have been following the story.

Karen Tumulty is national political correspondent for "TIME" magazine. And Shailagh Murray has been covering the story from Capitol for The Washington Post.

Shailagh, I want to start with you.

Maybe you can give us the latest on what this Baucus plan is and where -- what -- where it stands.

The Baucus plan

Shailagh Murray
The Washington Post
The most remarkable component of this plan is what is not in it, which is the public option.

SHAILAGH MURRAY: Well, about half-an-hour ago, the meeting in Senator Baucus' office that's been going on most of the afternoon with his gang of six -- three Republican and three Democratic negotiators -- they -- they left the senator's office and have until tomorrow at 10:00 a.m. to provide their comments on this very detailed plan that he circulated over the weekend and that we saw in greater detail today.

The most remarkable component of this plan is what is not in it, which is the public option. It has the cooperative approach that -- that we have already heard about. And that is an effort by Sen. Baucus and his fellow negotiators to find some common ground to -- to keep this proposal on track, wary of the deep concerns among moderate Democrats and then across the Republican caucus about this public option that has become the -- the center -- you know, the centerpiece of this debate in the last month or so.

GWEN IFILL: Karen, there are so many moving parts to this. Help us with the -- the areas in which there are some agreement. We know that the public option is not one of them. How about the areas in which there are.

KAREN TUMULTY: The basic architecture of all the bills that people are talking about on the Hill, in the House, the other bill that's come out of a Senate committee is pretty much the same.

It would require people who don't get coverage through their employers to go out and buy it. And it would set up these big new marketplaces called exchanges, like big shopping malls for health insurance, where a lot of the -- they could choose among a lot of different health care plans.

Another thing that all the plans would do is get rid of some of the most egregious practices that we have seen out of the insurance companies, you know, denying people coverage on the basis of the fact that they are sick.

And -- and, also, all of the plans aim to do some things -- not enough in the view of critics -- to bring down health care spending in the long run.

GWEN IFILL: Shailagh, bringing down health care spending, the -- the Baucus plan, for lack of a better way of describing it, is a little less expensive, less costly in its -- in the way it's been laid out than a lot of the other plans we have seen, about $900 billion, which is a lot of money, but not as expensive as the others. Why is that?

SHAILAGH MURRAY: Well, there's less coverage and fewer government initiatives in the bill.

There are also extensive Medicare changes that have not gotten the attention that they probably deserve, given the -- the flash point that Medicare has been over the years, but around $400 billion in changes and ultimately cuts to the Medicare program, an effort by Senator Baucus and a reflection of this -- of this broad consensus that -- that Karen spoke of on some of these other provisions to lower the cost of health care in the long run.

That is really the ultimate goal of this -- of this bill. It's the -- the public option has become a distraction to that goal, to -- much to the frustration of a lot of folks who want to really push this over the finish line.

So, the -- the more effective that President Obama and the House and Senate leaders can -- can move the discussion back towards a constructive -- the constructive changes that most people agree health care needs to undergo, so, that's the -- that's the underlying goal of the Finance Committee bill.

It expresses some of those initiatives more directly than some of the other bills we have seen. It sort of benefits from a simplicity. The -- what -- what circulated today was 20 pages, as opposed to 1,000 pages in the House. And I think it surprised people by how comprehensive it was.

Proposed insurance limits

Karen Tumulty
Time Magazine
One of the new features in this bill that Senator Baucus is talking about today would put sort of an excise tax on really fancy health care plans.

GWEN IFILL: Well, you -- when you say there may be cuts in -- savings in Medicare, depending on the word you like to use, but they're also talking about expanding Medicaid, the poor -- the program that covers the poor.

SHAILAGH MURRAY: Right.

Most -- most people agree -- and Republicans agree -- that Medicaid is the most effective way to cover poor people. It is not necessarily a cost-effective program in and of itself, but it's the most effective way to reach people below the poverty line.

This bill, the Finance bill, would increase coverage of Medicare to 133 percent of the federal poverty line. That's around $28,000 for a family of four in income, in household income, for a year. And that would -- that would be a huge expansion of the program. It would close some of the biggest gaps in the uninsured market, including uninsured -- or -- excuse me -- single adults, poor adults who don't have children, who completely fall through the cracks today.

Now, similar to the Medicare proposals, these Medicare expansions have not received much attention, again because the public option is sort of overshadowing everything. But a lot of governors are concerned about this, how they're going to step up and fill in some of the...

GWEN IFILL: Right.

SHAILAGH MURRAY: ... pay for -- you know, they pay -- the states pay a lot of the Medicare -- Medicaid costs themselves.

So, those are -- those are constructive, sort of well-intentioned efforts in this bill that are bound to hit some -- you know, some potholes as -- as this debate advances.

GWEN IFILL: Karen, there are also plans for new fees, for new taxes on insurance companies mostly.

KAREN TUMULTY: There are.

One of the new features in this bill that Senator Baucus is talking about today would put sort of an excise tax on really fancy health care plans, ones that basically cover pretty much anything you ask. They want to make these things so expensive that insurance companies quit offering them and people quit buying them.

GWEN IFILL: Don't a lot of union members, who are the Democrats' natural constituency, aren't they covered by plans like that?

KAREN TUMULTY: Exactly. We're not just talking about Goldman Sachs executives here.

GWEN IFILL: Yes.

KAREN TUMULTY: We're talking about firefighters. We're talking about teachers.

And, also, we're talking about people who live in parts of the country where health insurance is just more expensive, where health care is just more expensive than it is in other parts of the country. So, there is going to be a lot of pushback on this.

New momentum behind effort

Shailagh Murray
The Washington Post
So many Democrats are so reluctant to go it alone on this issue. It's just too contentious. It's too big. And it's too emotional.

GWEN IFILL: We have heard that -- we saw some of the initial reaction, Karen, as members began to come back to town. And some of it seemed like it had fallen into the old familiar ruts.

But is there any sense, especially now with the advent of a Baucus plan and 24 hours until the president gives his speech big speech tomorrow night, that there's movement?

KAREN TUMULTY: Oh, absolutely.

I think that this movement by Senator Baucus is a huge development, because, you know, as much as we in the media are all -- and the opponents and the proponents are all focusing on the problems with this bill, this bill has already -- a bill has already passed out of four different committees on Capitol Hill.

So, when the president goes in front of Congress tonight -- or tomorrow night...

GWEN IFILL: Tomorrow.

KAREN TUMULTY: ... it's going to be, you know, a -- on the verge of a lot more progress than we have seen in an issue that has defeated a lot of presidents.

GWEN IFILL: Shailagh, as the president goes to the Hill tomorrow, does it feel at all different from this time, say, two weeks ago? Does it feel like things are beginning to shift under your feet up there on the Hill?

SHAILAGH MURRAY: You know, it does. And I agree with Karen. I think there's more momentum behind this effort than is apparent maybe coming out of these -- this town hall meeting cycle that consumed so much energy and attention over the last month.

One thing we heard today was a shift in rhetoric from Republicans, who headed to the Senate floor and, one after another, you know, denounced the Democratic plans as inadequate, but conceded that they had heard repeatedly from their constituents that doing nothing is just not an option.

And that is -- that is definitely a shift in stance from what we saw earlier this summer, when Republicans were determined to sort of block this bill and slow it down. So...

GWEN IFILL: Does that mean bipartisanship is not dead after all?

SHAILAGH MURRAY: You know, I don't think it's dead. And I -- I don't think it's dead because I think that the -- the -- so many Democrats are so reluctant to go it alone on this issue. It's just too contentious. It's too big. And it's too emotional.

As we have -- as we have seen unfold in recent weeks, being out there on your own as a party on an issue that affects so many -- everybody's life so intimately, and -- and is at the basis of so many difficult decisions, that I just -- I think everybody would feel better if there was a consensus approach, and which we -- you know, we're seeing the seeds of that with this Finance proposal.

GWEN IFILL: Well, we have seen seeds before.

SHAILAGH MURRAY: Yes.

GWEN IFILL: And we will keep watching them to see if they grow this time.

Shailagh Murray, Karen Tumulty, thank you both very much.

SHAILAGH MURRAY: Thank you.

JIM LEHRER: You can use our online field guide to look up terms and sort through the jargon in the health care debate. It's at NewsHour.PBS.org.