Healthcare debate now on for real

President Obama has issued his budget and held his health summit. Now the focus on health reform returns to more familiar terrain for K Street: Capitol Hill.

For months, senior lawmakers on health committees have been working behind closed doors on drafting legislation, building support among their colleagues and trying to assemble a winning coalition of outside interest groups to achieve the audacious goal of overhauling the U.S. healthcare system during Obama’s first year in office.

{mosads}This week, though, the work shifts into its public phase, with hearings in the House and Senate. For lobbyists representing the myriad interests with a stake in the outcome, that means the rubber is inching ever closer to the road.

Now is the beginning of “the actual legislative process,” as Mary Grealy, president of the Healthcare Leadership Council, put it.

“When you move from concept to legislation, obviously, that’s a key turning point,” Grealy said.

Lobbyists and executives from the healthcare industry, large and small employers, labor unions and activist groups have already spent plenty of time on Capitol Hill listening to lawmakers such as Sens. Max Baucus (D-Mont.) and Edward Kennedy (D-Mass.) make the case for health reform on their terms.

But Obama laid down a gauntlet of sorts, making a high-profile public push for his principles, and House and Senate Democrats laid out an ambitious timetable by targeting floor votes in each chamber before the August recess.

Though members of Congress have been building toward this moment for months, the president has used the bully pulpit to draw the public’s attention.

This week, engaged citizens will have plenty to chew on with a hearing schedule that includes meetings of Baucus’s Finance Committee, Sen. Kent Conrad’s (D-N.D.) Budget Committee, Rep. Charles Rangel’s (D-N.Y.) Ways and Means Committee, Rep. George Miller’s (D-Calif.) Education and Labor Committee, and Rep. Frank Pallone Jr.’s (D-N.J.) Health subcommittee under the Energy and Commerce Committee.

Baucus has said he wants a bill out of his committee by May and on the floor in June. His counterparts on other committees and Democratic leaders in both chambers have mulled similar timelines.

Meanwhile, Congress has to pass its budget, which will lay the foundation for how to finance health reform legislation and could draw some of the battle lines for the debate.

The budget will answer key questions such as how much money to set aside and where to find it, whether pay-as-you-go rules will apply to healthcare and whether Democrats will use the budget-reconciliation process to protect health reform from filibuster.

“So far, we’ve been dealing in broad themes and concepts and platitudes,” said one Democratic healthcare lobbyist.

“It’s getting much more high-intensity, much more specific. We’re moving way beyond principles,” one Republican healthcare lobbyist said.

That is the path that could lead to legislative success with many partners — but it’s the same path that could lead to crippling disagreement as special interests begin to ask themselves how it affects them.

“As the details get shaped and vetted, people are going to move from that broad reform perspective” and focus more on their narrower interests, the Democratic lobbyist said.

{mospagebreak}Congress, meanwhile, will also take a closer look at another issue central to Obama’s domestic policy agenda: climate change.

The House Energy and Commerce Committee looks at the future of coal in a carbon-constrained world. Coal-fired utilities account for about 40 percent of the carbon dioxide released into the atmosphere from human activity in the United States each year. But coal is a plentiful and relatively cheap fuel source that now accounts for just over 50 percent of the electricity used in this country.

What to do with coal is perhaps the critical question that supporters of climate change legislation face.

{mosads}“They have to fix the coal problem in order to move the bill through committee,” one lobbyist said. Although committee Chairman Henry Waxman (D-Calif.) has favored steep emissions cuts, several Democrats on his committee come from states that rely heavily on coal and may be less amenable to an aggressive climate change bill.

The stimulus package signed by the president would spend more than $3 billion to research and develop ways to remove carbon dioxide from coal plants before the emissions reach the atmosphere.

One approach is to sequester the carbon underground. Energy lobbyists want revenues from the cap-and-trade system to go to utilities to help them reduce their carbon footprint, although most of the money would be returned to consumers to help them offset higher electricity bills.

The Senate Energy and Natural Resources Committee takes up another issue critical to climate change efforts: expanding the network of power lines in order to increase the amount of renewable energy used to make electricity.

Transmission is critical, because the places with the best wind and solar resources are often far removed from the places where the power is most needed. New transmission lines are needed to join the two.

Rob Gramlick, policy director for American Wind Energy Association, said legislation needs to address the three P’s of transmission: planning, permitting and paying.

Legislation should create planning bodies large enough to assess the needs of whole regions rather than specific states. Federal regulators should have more power to decide where transmission lines are built, to speed projects and attract investors utilities say are now discouraged by the cumbersome nature of the permitting process.

The legislation should also determine specifically who pays for the new high-voltage network, Gramlick said. Utility customers in one state may be asked to pay a portion of a line even if the power bypasses them. That’s justified, Gramlick said, because all electricity customers will benefit because a larger, more efficient power grid means less wire congestion, which will reduce prices.