Congressional Democrats and the White House are scrambling to regain their footing after a series of setbacks has stalled political momentum to reform the nation’s healthcare system.
Despite having a popular president in the White House and comfortable majorities in Congress, the Democratic rollout on healthcare reform has encountered significant bumps in the road.
{mosads}A cost estimate hanging a $1 trillion price tag on an incomplete bill, salvos from powerful interest groups and great uncertainty among key Democrats on what will actually be in the legislation that moves through Congress have emboldened Republican critics.
The Senate Health, Education, Labor and Pensions (HELP) Committee postponed the markup of its healthcare reform bill by one day, to Wednesday. On the eve of that markup, the powerful U.S. Chamber of Commerce publicly ripped the bill.
Senate Finance Committee Chairman Max Baucus (D-Mont.) initially planned to release his bill Wednesday, but he has pushed back his timetable because of cost estimate concerns.
“Will we have something out tomorrow? Not sure,” Baucus said Tuesday. “Thursday or probably Friday,” he added.
Perhaps more importantly, the unity that Democrats touted earlier this year has cracked. As conservatives lambaste Democrats, liberal healthcare groups are not rushing to their defense because so many questions about the legislation have not been answered.
Senate Democrats continued to insist they would have their respective —some say competing — legislation out of both committees of jurisdiction by the end of next week.
The White House indicated Tuesday that it will be a long journey to enactment.
“I think this has many twists and turns to go,” White House press secretary Robert Gibbs said.
House and Senate leaders have vowed to have their chambers’ bills passed by the end of July. Obama wants a bill to sign by Oct. 15.
Health and Human Services Secretary Kathleen Sebelius on Tuesday sought to downplay the short-term expectations for healthcare reform, telling The Associated Press that the phase-in coverage plan of the legislation could spill into the next presidential term.
The longer the phase-in, the less the bill will cost. And cost is arguably the largest hurdle for Democrats to clear on passing healthcare reform.
Meanwhile, Republicans on both sides of the Capitol are ramping up their attacks. Senate Minority Leader Mitch McConnell (R-Ky.) said the healthcare debate is in a “chaotic state.” House Republicans announced they would have their alternative plan readied by Wednesday — before House Democrats have issued a bill of their own.
The cost of reform and how to pay for it dominated the discussion Tuesday as Democrats were forced to respond to an unfavorable Congressional Budget Office (CBO) analysis of one incomplete part of an incomplete bill.
The CBO looked at one portion of a draft bill written by the Senate HELP Committee and found, among other things, that it would cost more than $1 trillion while providing a net decrease in the number of uninsured people of 16 million.
The CBO also threw cold water on a promise by a coalition of healthcare industry groups to reduce healthcare spending by $2 trillion over 10 years. Obama announced their promise to much fanfare, but the CBO found that while a few of the cost-cutting measures would save money, others would cost money. In sum, they would not have a big impact on federal spending, the CBO concluded.
Baucus disputed speculation that his bill attracted a score of more than $1.5 trillion. “That reflects the policy of almost two weeks ago. It doesn’t reflect the savings that are also in the bill,” he said.
Asked how much his bill would really cost, Baucus was cagey: “More on the low side than on the high side.”
The White House and Senate Democrats tried to downplay the CBO finding. They also criticized the nonpartisan agency.
“The way CBO scores some things sometimes doesn’t make a whole lot of sense — I mean, real-life sense,” said Sen. Tom Harkin (D-Iowa.).
Senate Democrats have not agreed among themselves — let alone with Republicans — about how, or whether, to create a federal health insurance program to compete with private insurers or whether to establish “play or pay” rules for employers, under which they must either offer health benefits or pay into the government kitty.
Sen. Chris Dodd (D-Conn.), who is overseeing the HELP Committee in the absence of ailing Chairman Edward Kennedy (D-Mass.), indicated the panel would not have answers to those questions when it convenes Wednesday. Instead, the markup — which could go until the end of next week — will feature the more controversial issues later in the process.
Baucus suggested that he expects his committee to move ahead differently. “My goal is to, when we begin to mark up next Tuesday, that we’ll have a package that’s self-contained with the numbers and [that] will be deficit-neutral,” he said.
But Baucus and Dodd — not to mention Obama and a host of other Democrats — disagree on how to pay for it. Dodd has backed Obama’s plan to raise tax revenue by capping itemized deductions and rejected Baucus’s favored tax increase, a new tax on workplace health benefits. Baucus has similarly rejected the deductions cap and said his bill would only cut spending or raise taxes in health-related areas.
Off of Capitol Hill, the level of enthusiasm about the Democrats’ healthcare plans is difficult to gauge just six weeks before the House and Senate are due to vote on legislation.
Obama does enjoy the backing of some cheerleaders on the left such as MoveOn.org, but that group and others are targeting centrist Democrats to pressure them to support more liberal aspects of healthcare reform, such as the public plan option.
Other key Democratic constituencies are seeing things they do not like creeping up in the healthcare reform debate, which could hamper their ability to offer full-throated support.
Labor unions, for instance, have devoted millions of dollars to organizing and promoting reform, but oppose taxing health benefits.
Obama rankled the trial lawyers during his speech at the American Medical Association (AMA) on Monday, when he expressed openness to some form of medical malpractice reform.
The White House and lawmakers such as Baucus have gone to great lengths to keep business and healthcare interest groups at their side, but it has not yet translated into any endorsements. Indeed, trade groups have begun offering significant criticism of the legislation emerging from Capitol Hill.
The U.S. Chamber of Commerce, which has long been critical of major elements of Democratic healthcare reform plans, made it official by formally warning lawmakers Tuesday that it will oppose the HELP bill unless it is revamped.
“In the bill’s current configuration, the Chamber will oppose the ‘Affordable Health Choices Act’ unless several key provisions are significantly changed,” Bruce Josten, the Chamber’s executive vice president of government affairs, wrote in a letter Kennedy and HELP Committee ranking member Mike Enzi (R-Wyo.).
The influential hospital industry, while stopping far short of vowing to oppose any healthcare reform bill, firmly opposes proposed cuts to Medicare payments.
The White House last week proposed more than $300 billion in Medicare and Medicaid cuts to pay for healthcare reform — doubling cuts previously floated — much of which would fall on hospitals.
According to the American Hospital Association, the Obama administration’s proposed cuts to hospital funding would total $220 billion over 10 years. “Additional cuts of this magnitude could severely jeopardize hospitals’ ability to care for their patients and communities,” Rich Umbdenstock, the association’s president, said in a statement.
Hospitals are employing the same tack as the other healthcare sectors, however, by leaving the door open to supporting the bill eventually. The AMA, for instance, moved quickly last week to “clarify” its statements that it opposed the public plan, saying it only opposes a Medicare-like public plan.