What's New In The Baucus Health Care Pitch?

Health care topped the agenda Tuesday as lawmakers returned to Capitol Hill. The Senate Finance Committee, which failed to complete its bill before the summer recess, is trying to reach a bipartisan compromise on the divisive issue.

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From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.

NOAH ADAMS, host:

And I'm Noah Adams.

Lawmakers returned to work on Capitol Hill today with health care, of course, at the top of the agenda. President Obama met with the Senate majority leader, Harry Reid, and House Speaker Nancy Pelosi one day before his address to a joint session of Congress.

In the meantime, four congressional committees have completed work on health overhaul bills with only Democratic votes. The fifth and potentially most influential, the Senate Finance Committee, is the only one trying to reach a bipartisan compromise.

NPR's Julie Rovner joins us now from Capitol Hill to lay out the landscape. Hi, Julie.

JULIE ROVNER: Hey, Noah.

ADAMS: The Senate Finance Committee is also the only one, I understand, that has failed so far to complete its bill.

ROVNER: That's right, they are. And they are still trying to figure out if they can get something. They have this Gang of Six that's working at it. It's not the whole committee. It's three Democrats and three Republicans: Chairman Max Baucus of Montana, Kent Conrad of North Dakota, Jeff Bingaman of New Mexico are the Democrats. Then Chuck Grassley, the top Republican, Mike Enzi of Wyoming and Olympia Snowe of Maine are the Republicans.

They have been behind closed doors pretty much all summer, hoping to get a bill that can be embraced by the rest of the committee - hopefully, the rest of the Senate. And it's been anything but easy. The Democrats say that Baucus is going too far to please Grassley. Republicans don't want Grassley in particular to sign on to what they see as a Democrat's bill. They want to keep this a partisan exercise and hopefully an unsuccessful effort that they can use to win seats in next year's elections, much as they did back in 1994.

ADAMS: And so today we actually have an idea what they've been talking about - it's a proposal offered over the weekend by Senator Baucus. You've gotten a copy. Tell us a bit about it.

ROVNER: Well, we don't have the actual total numbers attached, but we've been told by staff that it would cost something under $900 billion over 10 years. That's a lot less than some of the other proposals we've seen in the House and the other Senate committee that's already acted.

Like the other bills, it would create something called a Health Insurance Exchange where small businesses and individuals who don't get insurance on their job could buy coverage. There'd be tax credits and subsidies for people with low incomes to help them purchase insurance, although these wouldn't be as generous as in some of the other bills.

And there's much more emphasis in this bill than in some of the other bills on changing the payment systems for doctors and other health care providers to weed out unnecessary care and to pay more for higher quality care. That's something that the members of the Finance Committee have really been talking about a lot over these past six or seven months.

ADAMS: Now, most of the controversy has surrounded not just how much the bills would cost, but how they would be paid for. I guess the same issue is true in this case.

ROVNER: Yes, that would be correct. This is the committee, remember, that had wanted to tax a high-end health insurance to help pay for it. That was something that then-candidate Obama campaigned against, and that got ruled out by Democratic leaders earlier this summer. It left a rather large hole for the committee to fill.

One aide described the search for ways to pay for the bill as turning over the sofa cushion and looking for quarters.

In the end, their proposal seems to be pretty egalitarian in the way it would be paid for; takes a little something from everyone including patients. Much has already been made in the last few days of a new fee that would be charged to insurance companies, and that is in there. Two fees, actually: one on those so-called Cadillac plans, another more broad-based fees on all health insurers.

But the proposal doesn't just single out the health insurance industry. There's also new fees that would be paid by drug makers, makers of medical devices, clinical laboratories and even non-profit hospitals would have to demonstrate they're actually serving their communities.

ADAMS: And the patients - how would the patients pay?

ROVNER: Well, wealthy seniors would pay more because the bills would raise their premiums for Medicare prescription drug coverage. The bill would also limit how much people could put away tax-free into those flexible spending accounts, and it would limit some of the things those accounts could be used to pay for. So, really, everybody would have to give a little bit of something in this bill.

ADAMS: And how's the reaction so far?

ROVNER: Well, so far I've only actually talked to Chairman Baucus. He said that the other senators have some changes that they want to make. He wants those suggestions on by paper by 10 o'clock tomorrow morning so the group can meet again tomorrow afternoon.

I think he wants to try to get a deal done before the president's speech tomorrow night. He's trying to use that as a wedge. But there have been lots of those deadlines that have come and gone. We'll have to see if this is just one more of those deadlines.

ADAMS: Thank you, Julie.

NPR's Julie Rovner from the Capitol.

ROVNER: Welcome.

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Congress Returns To Health Care, And Tight Deadline

House Speaker Nancy Pelosi stands next to Senate Majority Leader Harry Reid in April 2009 i i

House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid in April. Legislators this week return to Congress — and to the debate over remaking health care. But that focus may obliterate the rest of the Democrats' agenda, including items important to their restless base. Evan Vucci/AP hide caption

itoggle caption Evan Vucci/AP
House Speaker Nancy Pelosi stands next to Senate Majority Leader Harry Reid in April 2009

House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid in April. Legislators this week return to Congress — and to the debate over remaking health care. But that focus may obliterate the rest of the Democrats' agenda, including items important to their restless base.

Evan Vucci/AP

Legislators get back to business on Capitol Hill this week after a tumultuous summer break, and all eyes will be on President Obama Wednesday night, when he addresses a joint session of Congress.

He is expected to provide significant detail about what he wants out of his health care overhaul, refocusing a battle that will dominate congressional negotiations and debate well into the fall.

But returning legislators also face an array of other pressing issues, including budget appropriations and climate change; a financial regulation overhaul; and funding for the war in Afghanistan and for the president's plan to close the military prison at Guantanamo Bay, Cuba.

"The game is health reform," says Thomas Mann, a senior fellow in governance studies at the liberal Brookings Institution. "But in reality, there's a lot else cooking."

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President Obama is asking Congress to find a way to extend coverage to every American.

But with the House tentatively scheduled to recess for the year at the end of October, it remains an open question what Democratic congressional leaders can — or want to — squeeze into their short schedule.

Ambitious Agenda Meets Reality

Once, not so long ago, the White House dreamed of a health care deal before the August recess.

And even some Democratic leaders waxed hopeful about what other initiatives could be taken up before Congress finishes out the year.

"I laugh when I think back to three or four weeks ago, when [Senate Majority Leader] Harry Reid said that they're going to start on immigration this year," says Stuart Rothenberg, editor and publisher of the Rothenberg Political Report.

Rothenberg said his immediate thought was: "Are you kidding?"

The realities of scheduling, coupled with the Democrats' struggle to construct health care overhaul legislation that would attract even enough of their own members to ensure passage, have already as much as sidelined Senate action on a high-profile climate change bill.

And that's as it should be, say GOP leaders.

During a meeting last week with reporters, Sen. Lamar Alexander, a Tennessee Republican and chairman of the GOP conference, said that Democrats need to pick one big initiative to deal with this fall: health care, climate change or financial services regulation.

His comments came a day after Democratic Sens. Barbara Boxer of California and John Kerry of Massachusetts reported a delay in finishing the Senate climate bill they're writing. They said that the death of Massachusetts Sen. Edward Kennedy and Kerry's own August hip surgery made their promised early-September delivery impossible.

That has depleted the chances that a compromise bill could be negotiated with the House before the end of the year. The House passed its so-called cap-and-trade bill in June.

Other legislation already passed this year in the House and awaiting companion action in the Senate includes bills on clean water, corporate bonus taxes and expanded food safety. Congress also has to contemplate defense, intelligence and State Department reauthorization bills, as well as the massive, every-six-years surface-transportation spending plan, which expires at the end of September.

Must-Do Items And Dead-Enders

Other initiatives expected to be subsumed by health care and the calendar include financial regulation overhaul proposed earlier this year by the president, and legislation that would provide Obama the funds needed to fulfill his pledge to close the Guantanamo detention facility by Jan. 22.

"They are going to have to postpone that," Mann says of Guantanamo Bay, "and that will, as have other things, irritate liberals in Congress."

In May, the Senate voted to strip a supplemental war funding bill of money intended for the closing of the prison camp — a defeat for Obama. The president's proposal to incarcerate some of the prisoners on American soil proved unpalatable even to Reid.

"We don't want them around the United States," Reid said.

Action on proposed financial regulation changes is also likely to be delayed, especially if Sen. Christopher Dodd, a Connecticut Democrat, moves from chairman of the Senate Banking Committee to fill Kennedy's former seat on the Senate Committee on Health and Human Services. Democratic Sen. Tim Johnson of South Dakota is in line to replace Dodd as chairman on the banking panel.

Budget Deadline Looms

Legislators also face a slew of appropriations bills — and a fiscal year that ends Sept. 30.

"Obviously, they have to keep government open, right?" Rothenberg says.

The Senate so far has passed four appropriation bills, the House all of theirs — but none are in committee.

Staffers on Capitol Hill expect that with Congress so behind on appropriations action, it will pass a continuing resolution this month that will keep government funding at current or reduced rates going into the new fiscal year — and perhaps even into 2010.

Meanwhile, The Base Grows Restless

So while health care will remain the big deal of the fall — a referendum on Obama's ability to pass a big policy initiative, and on the Democratic leadership's ability to corral its members — there could be other surprises.

The war in Afghanistan is becoming a larger problem for the White House, with support sagging and the liberal base restive. It remains to be seen, however, whether anything will come to the floor on the issue.

Sen. Russ Feingold, a liberal Democrat from Wisconsin, has criticized Obama's strategy and called for a timetable for withdrawal.

"Feingold is probably unlikely to succeed in getting his bill to the floor of the Senate," Mann said, "but he could be difficult and add it to something else to get it rolling."

In the House, Mann says, it is "not out of the realm of possibility" that Speaker Nancy Pelosi could offer a vote on the war to keep the party's liberal wing happy.

"Health reform will define this session of Congress, and the president's start," Mann says. "But you've got to remember that Congress is a large, decentralized body."

And with a restive liberal base, and a health care overhaul that, despite Pelosi's insistence to the contrary, could be trimmed of elements most popular with that base (like a public insurance option), many legislators may be looking for other opportunities to make their mark before the 2010 midterm elections arrive.

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