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Despite Breakthrough in Congress, Wrangling Persists Over Health Reform

July 29, 2009 at 6:00 PM EST
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With Congress showing some progress Wednesday in the health care reform debate, journalists discuss the political hurdles that must be cleared to reach a final deal.
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GWEN IFILL: House Democrats scored a partial breakthrough today in the battle over health care reform. At the same time, senators reported their own progress toward compromise, as the president hit the road again to sell his plan.

NewsHour health correspondent Betty Ann Bowser has our lead story.

BETTY ANN BOWSER: They’d been at loggerheads for days with the leadership of their own party, but members of the Blue Dogs, the fiscally conservative House Democrats, worked out a deal today to move a bill forward in the Energy and Commerce Committee.

Arkansas Congressman Mike Ross said it would cut the cost of the House bill by $100 billion and still include a possible public option plan run by the government.

REP. MIKE ROSS, D-Ark.: We protected small businesses, and we ensured that the public option is on a level playing field, it’s optional for people, won’t be mandated on anybody, and that it’s done in a way by demanding that the public option compete with private plans by negotiating rates with providers instead of mandating Medicare rates on providers, saving a lot of rural hospitals across this country.

BETTY ANN BOWSER: Part of the agreement stipulates there will still be no vote by the full House until September, and Ross warned the deal does not guarantee passage.

There was also movement in the Senate, where members of the Finance Committee were told by the Congressional Budget Office that their health care reform proposals would come in at under a trillion dollars. That’s the number the senators have been trying to get to for weeks.

Committee Chairman Max Baucus said the CBO issued new figures last night.

SEN. MAX BAUCUS, D-Mont.: The report is encouraging. The current draft of the bill scores below $900 billion over 10 years, covers 95 percent of all Americans by 2015, and is fully offset.

BETTY ANN BOWSER: The Finance Committee has reportedly dropped a public option plan, in favor of non-profit cooperatives to compete with private insurers. But one negotiator, Democrat Kent Conrad, acknowledged obstacles remain.

SEN. KENT CONRAD, D- N.D.: If I had to describe the two or three things that I think are most challenging, one is the affordability question, for people who have insurance offered to them at their place of employment but it’s insurance they can’t afford, that is a significant concern.

Second would be Medicaid, and the expansion of Medicaid, and what the reaction of governors will be to additional state requirements.

Bill That Makes Sense

Ceci Connolly
The Washington Post
We've now learned that most of the negotiating had to do with this idea of a government-sponsored public insurance program that would compete with private insurance companies.

BETTY ANN BOWSER: One of three Republicans in the bipartisan talks, Maine's Olympia Snowe, said the committee wants to make sure it adopts a bill that will make sense to the average American.

SEN. OLYMPIA SNOWE, R-Maine: What's important for us is we, you know, proceed in a methodical basis every day on each and every piece of this overhaul is to ensure that these proposals will work and who they'll benefits and how they'll affect those who have health insurance, those who don't.

BETTY ANN BOWSER: At two events outside of Washington today, President Obama fine-tuned his pitch for reform, at a time when polls shows support for his ideas slipping. He spoke first at a town hall meeting in Raleigh, North Carolina.

U.S. PRESIDENT BARACK OBAMA: What we need and what we will have when we pass these reforms are health insurance consumer protections to make sure that those who have insurance are treated fairly and insurance companies are held accountable.

BETTY ANN BOWSER: The president unveiled an eight-point plan for achieving his goal.

Among the points, insurers would have to: comply with annual caps on what they charge for out-of-pocket expenses; fully cover routine tests to help prevent illness; and renew any policy, as long as the policyholder pays the premium in full.

Insurers would be barred from: refusing coverage because of pre-existing conditions; charging more for services based on gender; and placing caps on coverage.

Mr. Obama also said he does not expect Congress to vote on health care reform until September or October.

GWEN IFILL: Judy Woodruff picks up from there.

JUDY WOODRUFF: For more on today's developments and the larger factors at work, I'm joined by Amy Walter, editor-in-chief of the Hotline, National Journal's political daily, and Ceci Connolly of the Washington Post.

Thank you both for being with us. Ceci, to you first, what would you say are the most significant elements of what has come out of the House, this deal in the House today?

CECI CONNOLLY: Well, it's recognizing, Judy, that this continues to be a very fluid target. We haven't seen a lot of documentation yet, but interestingly we've now learned that most of the negotiating had to do with this idea of a government-sponsored public insurance program that would compete with private insurance companies.

Many of these conservative Blue Dog Democrats who were in the thick of those negotiations have some real issues around that. They were worried about Medicare paying enough in their rural districts. It looks like there's going to be some compromise around that, to pay enough to doctors and hospitals in rural areas.

It also looks as though there might be some options, so that a state could set up more of a cooperative approach. This is an idea that first came out over in the Senate from Senator Kent Conrad. It's a little bit less of a government approach, more of a nonprofit cooperative, similar to the way you see some utilities work out in the West.

Also, interestingly, it appears that the Blue Dogs have gotten some concessions that have to do with exemptions for small businesses to participate, kind of increasing the level so that the very smallest of businesses, mom-and-pop businesses, maybe would not be forced to provide coverage or contribute to health care costs of their workers.

Blue Dogs Worried About Cost

Amy Walter
The Hotline
These Blue Dogs, a lot of people think of them as southern Democrats, like the boll weevils of the '70s and '80s. These actually -- there's a bigger group than that, and they're more diverse than that.

JUDY WOODRUFF: So, Amy Walter, some changes in the look of the public plan, in the role that employers play in providing insurance. What does this say about the pressures on these members, and what that means they're more likely to want and to vote for?

AMY WALTER: Yes, that's exactly what we're talking about here, which is, you know, there's a famous saying about you go where the votes are in Congress, and the votes are with these moderate and conservative Democrats, not just on this committee, but in general.

If you look back at how Democrats took control of Congress in 2006 and continued to build on it in 2008, it is in these conservative districts Ceci talked about, and a lot of them are rural districts, so they have very specific concerns.

These Blue Dogs, a lot of people think of them as southern Democrats, like the boll weevils of the '70s and '80s. These actually -- there's a bigger group than that, and they're more diverse than that. They come from all parts of the country, but they have one thing in common, which they sit in either a swing district or a district that a Republican carried, presidential candidate carried.

And they see themselves as fiscal conservatives. They've campaigned as fiscal conservatives and that, to them, is the biggest issue.

You saw when they announced this plan one of the biggest things that Mike Ross, Democrat from Arkansas who sits on the committee, said is, This is saving us more money. We saved $100 billion from the original bill, and also talked about the fact that we are taking the hand of government and taking it off of this a little bit. So they do want to make sure that private insurance is able to compete against the government.

JUDY WOODRUFF: So, Ceci, these changes we're seeing in the House, coupled with what we're seeing changing in the Senate, again, dropping the public plan, which was something the president originally wanted, changes in employer mandate, less of that, that mandating that employers cover their employees' insurance. Does that mean the White House is less interested now in these aspects of health care reform?

CECI CONNOLLY: No. I think the White House continues to be very interested and is very encouraged by even these little baby steps of progress. Keep in mind, they're not meeting the timetable that the president had set out, House and Senate floor action before the August recess, but that was always meant to just kind of keep the pressure on. And it appears to have had some effect, in terms of getting at least some committee action here.

With respect to the Senate Finance Committee, which appears to be going in a more moderate, centrist kind of direction, that's something we always expected from that group. We know the makeup of the Senate is different than the House.

We know that Senator Max Baucus, the Finance Committee chairman, has said from the very beginning he wanted to pick up some Republican votes on this. So he's always kind of tacked a little bit more to the center. It's not clear that he has that deal signed, sealed and delivered yet, but we certainly keep hearing about bits and pieces of progress along the way.

Democrats on the Defensive

Ceci Connolly
The Washington Post
Of course, the downside of going into this August recess for those Democrats is that now that we have some specific things on paper, the other side will start picking those apart, and that becomes a target for opponents of reform.

JUDY WOODRUFF: Amy, when these members, both House and Senate, go home to their districts and their states for the August recess, what kinds of questions are they going to be hearing from their constituents?

AMY WALTER: Well, I think that's really the key here, because we know they go away for a month. And the fear among a lot of Democrats was, if Democrats are just on the defensive -- and we've seen President Obama now out on these town hall meetings, where it seems as if he's spending more time defending than he is promoting his plans -- they have to be able to give their constituents something that looks like they are addressing those concerns.

This idea that this is going to be socialism or that government is going to play too big of a role here or that it's going to cost too much money, these -- by getting a deal out of the Energy and Commerce Committee, by getting a deal out of Finance, again, that are both -- you know, that address the concerns of moderate and conservative Democrats and maybe some Republicans in the Senate, it gives this a new life, so to speak, where Democrats can start talking about this from a different perspective and to say, "This is where we are headed," rather than trying to defend a lot of the other stuff that's come out before.

JUDY WOODRUFF: And, Ceci, for people who are sitting at home right now trying to understand, trying to follow these changes, and they're reading what they see in the newspaper or what they're watching or hearing on television very closely, how similar, how much is what's going to be voted on in the fall going to look like what we're seeing emerge right now?

CECI CONNOLLY: Well, I think, in terms of the House floor vote and the Senate floor vote, we're getting a pretty good sense of that, and we will through tonight and the next several days.

But then what happens, the real work, and some of it will actually begin during the August recess here in Washington among the staffs. They go into something called a conference committee, where you hammer out those differences.

There are some big areas of agreement that they'll come together on, things like requiring almost every American to have health insurance, giving some discounts to lower-income workers who have trouble affording coverage, some of those insurance market reforms that President Obama talked about today out in his campaign swing. But there are also some big areas of disagreement.

I would also just mention, Judy, that, of course, the downside of going into this August recess for those Democrats is that now that we have some specific things on paper, the other side will start picking those apart, and that becomes a target for opponents of reform.

So it's really going to be a fascinating period outside of Washington to see what kinds of themes emerge.

JUDY WOODRUFF: Ceci Connolly, Amy Walter, thank you both.

CECI CONNOLLY: Thank you.