Rank-and-file aren’t waiting on leadership in healthcare debate

In the absence of draft healthcare reform legislation from the White House or key committees, rank-and-file members of Congress are stepping in, hoping to put their stamp on the thing that figures to dominate the political agenda this summer.

President Obama and the Democratic leaders in the House and Senate say they will have bills for lawmakers to consider next month, with an eye toward floor votes in July.

{mosads}But a growing number of Democrats and Republicans are showing they will not sit by and wait for bills they must either take or leave.

Members of Congress tend to feel strongly that they are capable of coming up with their own ideas.

Sen. Richard Burr (R-N.C.) is not content to line up behind whatever his leadership comes up with. “We’re here to, I guess, be the first to launch the specifics of healthcare reform,” he said at a news conference Wednesday. “I think what you will hear today is the boldest approach to healthcare in decades.”

Burr, Sen. Tom Coburn (R-Okla.) and GOP Reps. Paul Ryan (Wis.) and Devin Nunes (Calif.) introduced a measure that would replace the current tax exclusion for workplace health benefits with a universal tax credit and access to insurance through state-based insurance exchanges; emphasize prevention and disease management; and move Medicaid enrollees into private plans.

Ryan is part of the House Republican Conference’s working group on healthcare reform, led by Rep. Roy Blunt (Mo.), but he is branching out on his own by introducing this bill with Nunes, Burr and Coburn. Blunt plans to furnish members with a GOP proposal they can discuss back home with voters in their districts during the Memorial Day recess.

Sen. Lamar Alexander (R-Tenn.) offered a hint of leadership support for the bill. “I’m here today as chairman of the Senate Republican Conference to congratulate Sen. Burr, Sen. Coburn and Congressmen Ryan and Nunes on your vision to creating a healthcare plan that’s worthy of the party of Abraham Lincoln,” he said at the news conference.

But, Alexander later emphasized, “This is not the Republican alternative. … We can offer our ideas many different ways.”

These freelance efforts by rank-and-file Republican senators run counter to the strategy preferred by the party’s chief negotiator on healthcare, Senate Finance Committee ranking member Chuck Grassley (Iowa).

Grassley said recently that the GOP should hold off launching an alternative until Democrats trigger budget reconciliation, a procedure that enables Democrats to force a partisan majority vote to pass healthcare reform.

“I think some Republicans would like to have it released ahead of time, but I think that that draws a line in the sand and I wouldn’t draw a line in the sand until I know we’re going to have reconciliation,” Grassley told The Hill earlier this month.

Other Republicans clearly disagree. “We need to be out in front with some alternatives,” said Sen. Jim DeMint (R-S.C.). “We’ve got to have some alternatives out there, because most Democrats are intent on not working with us.”

On the House side, Republican Reps. Mark Kirk (Ill.), Charlie Dent (Pa.) and their centrist “Tuesday Group” colleagues offered up their own bill Wednesday that would prohibit the federal government from restricting what medical treatments physicians can prescribe.

These members are not the first to get in front of the leadership-sanctioned efforts taking place in the House and Senate.

In recent weeks, two groups of centrist House Democrats, the Blue Dogs and the New Democrats, have highlighted their concerns about proposals that would increase federal involvement and spending in the healthcare system. Likewise, the Progressive Caucus and allied groups of liberals in both chambers have insisted that their voices be heard.

Meanwhile, senior Democrats and Republicans continue to work on the “official” legislation that will form the basis of each chamber’s contribution to healthcare reform, while the White House publicly maintains a mostly hands-off approach on the details.

Senate Finance Chairman Max Baucus (D-Mont.) and Grassley have employed a process of public and private committee meetings accompanied by the release of documentation outlining the policies they are considering.

But hashing out a bipartisan deal — or failing to — will come down to Baucus and Grassley, following their longstanding practice.

The Senate Health, Education, Labor and Pensions (HELP) Committee has authority over a vast swath of healthcare reform, but the bill-writing process has not risen above the committee staff level, senators said, during the prolonged absence of ailing Chairman Edward Kennedy (D-Mass.), whom Democrats and some Republicans hope will return to Capitol Hill next month.

Burr, Coburn and Alexander sit on the HELP Committee, where senators have had fewer opportunities to shape the product heading toward a markup next month.

On the House side, the Energy and Commerce, Ways and Means and Education and Labor committees are operating in the top-down, majority-rules fashion customary to the lower chamber, causing some rank-and-file Democrats to grumble and Republicans to complain of being shut out. The Ways and Means Committee held a bipartisan, closed-door meeting on healthcare Wednesday.

Senate Republicans are meeting weekly to develop their principles on healthcare reform, Alexander said, even as Grassley and HELP Committee ranking member Mike Enzi (R-Wyo.) hold out hope for a bipartisan deal.