Congress Moves Closer To Overhauling U.S. Health Care

Over the weekend the House of Representatives, narrowly passed sweeping legislation designed to overhaul the nation's health care system. Only one Republican crossed party lines to vote with the Democrats. The legislation now heads to the Senate, where additional changes and concessions are likely. House Majority Whip James Clyburn, a Democrat from South Carolina, and Sen. Bob Menendez, a Democrat from New Jersey who chairs the Democratic Senatorial Campaign Committee, discuss what's next in the push to overhaul U.S. health care.

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MICHEL MARTIN, host:

Im Michel Martin, and this is TELL ME MORE from NPR News.

Coming up, with the nations unemployment rate now topping 10 percent, is this a good time for older workers to think about opting out of work, retiring, instead of pounding the pavement. Well ask someone who has thought a lot about this later in the program. and a milestone for a cultural icon, Sesame Street turns 40. Well talk to one of its longest tenured human stars. The actor who plays Gordon is with us. Thats all coming up.

But first, a historic moment in Congress. On Saturday, the House of Representatives narrowly passed sweeping legislation designed to overhaul the nations health insurance system. But the celebration was tampered by some sobering political realities. Only one Republican crossed party lines to vote with the Democrats. Some 39 Democrats abandoned the bill and even some who supported it are now angrily protesting restrictions on abortion coverage. And now the legislation heads to the Senate, where some members are already calling it dead on arrival.

We wanted to find out more about how the vote came together in the House and whats likely to happen in the Senate. Joining us is a member of the House leadership, House Majority Whip James Clyburn and from the Senate, Bob Menendez. Congressman Clyburn represents South Carolinas Sixth District. Senator Menendez represents New Jersey. He also chairs the Democratic Senatorial Campaign Committee. I welcome you both. Thank you so much for joining us.

Representative JAMES CLYBURN (Democrat, South Carolina; House Majority Whip): Well, thanks for having me.

Senator BOB MENENDEZ (Democrat, New Jersey): Good to be with you, Michel.

MARTIN: Mr. Clyburn, I want to start with you. The highlights of the bill, it would guarantee coverage for 96 percent of Americans according to the non-partisan Congressional Budget Office. It would restrict the insurance companies from denying insurance for preexisting conditions, it includes a public option which is a government-sponsored alternative and federal subsidies for those who cant afford insurance. But now Senator Joe Lieberman of Connecticut, formerly a Democrat, now an independent who often votes for the Democratic Caucus says he will not allow a bill with a public option to come to a vote. So I wanted to ask whats your bottom line - will you support a bill without a public option going forward?

Rep. CLYBURN: I would rather not, but I certainly could. There are so many other things, you just enumerated some of them. There are about 15 different items, reforms that take place immediately upon the presidents signature that I think are great things in this program. And the fact that we are in this legislation removing the exemption that the insurance companies have enjoyed so long from anti-trust laws also contribute to the fact that we will be able keep the insurance companies under some kind of competitive standards. So, all of that would contribute to us having a much better system than we currently have. So, I do not have any kind of drop dead issues such as not voting (unintelligible) if it doesnt have a public option.

I am a product of the 60s, in that I was around when we were negotiating on the Civil Rights Act of 1964. When that act first started out, we had voting in there, we had other stuff in there. Housing, a very comprehensive bill. It became very clear to us that we were not going to get through the Senate with all of that in there, so voting was taken out, housing was taken out. We kept employment and a few other things. So, we passed the Civil Rights Act of 1964 and we came back a year later and got the Voting Rights Act of 65 and then three years later we got the Housing Law of 1968.

And we got 1972, we amended the 64 bill to do what a lot of us wanted to do and that is to bring state and local governments under it. So, I want us to get this process started. I can support a bill, though I do not want to, if it does not have a public option in it.

MARTIN: Senator Menendez, what about you, some of your colleagues in the Senate, as we mentioned Joe Lieberman says he wont let a bill with a public option come to a final vote. Lindsey Graham, the Senator from South Carolina, a Republican, said the bill is DOA, dead on arrival. Is that true?

Sen. MENENDEZ: Well, I dont know if thats the case. The reality is that the Majority Leader Senator Reid is awaiting the Congressional Budget Office scoring on the provisions that he sent to them. We hope to get that this week. I think that then the majority leader working with others, chairs of the Health and Finance Committee will put together a final bill that would come, I hope, next week before the Senate. And, you know, obviously, you know, the majority leader knows how to count votes.

And I think what well see is a robust package that does a lot of what we want to see in terms of insurance reforms, stopping insurance companies from discriminating against people based on their health status and preexisting conditions. On stopping, imposing annual caps or lifetime coverages, on improving our health care delivery system. On making sure that, in fact, we give small businesses tax credits to help them offer insurance to their employees. That we give low and middle income families assistance in purchasing insurance, and that we reach a goal on which our delivery system is based more on preventative health than a disease-based system.

And at the end of the day, do it in such a fashion that we will bend the cost curve because we cant continue to see double digit premium increases, not sustainable for the private sector, not sustainable for American families, not sustainable for the government under Medicare and Medicaid, and at the same time, make sure that we have these health insurance reforms so that insurance industry cant arbitrarily and capriciously deny people health care when they need it the most.

MARTIN: Mr. Clyburn says he doesnt have a drop dead issue per se. When you and I last spoke, you said you prefer that a bill have a public option. Can you support a bill without a public option?

Sen. MENENDEZ: Well, I join Jim Clyburn in the view that it will be the totality of the bill in which Ill cast my vote. I am a strong supporter of a public option. I believe that a public option actually is just that, one option among many in an exchange dominated largely by private insurance companies, but a public option giving them a competition to ensure that that premium growth that weve seen over the last decade doesnt continue to be the case and it can also drive innovation.

Now, if all of the other reforms that weve talked about and many more that we have not are in the bill and we reduce the cost of health care and create near universal access for all Americans and change our delivery system - that would be something very hard to vote against. So I would prefer to see a public option in it. I have not given up on that and I dont think that necessarily the statements of a few equals the views of many more.

MARTIN: If youre just joining us, youre listening to TELL ME MORE from NPR News. Im Michel Martin and Im speaking with House Majority Whip James Clyburn and New Jersey Senator Bob Menendez. Theyre both Democrats. Were talking about passage of health care legislation in the House. It passed over the weekend. It now heads to the Senate and were talking about its prospects there.

Mr. Clyburn, I wanted to ask about the issue of abortion, a very sensitive and emotional issue, of course. One of the members of your caucus, Diana DeGette, said that women are going to be outraged when they realize or women at least who are pro-choice - are going to be outraged when they realize that a Democratic-controlled House has passed legislation that would prohibit women paying for abortions with their own funds - were not going to let this into law. She says shes already collected 40 signatures from House Democrats vowing to oppose any final bill that includes the abortion language thats currently in the bill. What about that?

Mr. CLYBURN: Well, a lot of times we do things out of the House knowing fully well that when it gets to conference, cooler heads will probably prevail. What we had was a last minute effort on the part of about 12 to 14 members of our caucus who banded together and decided in conjunction with the Catholic bishops that they were not going to vote on a bill unless they had this language in it.

Now, this is the language that a lot of people (unintelligible) the so-called Hyde Amendment that is - has been with us for a long time now, and I do believe that when this issue gets to the conference, the House and Senate conferees will make sure that it doesnt go beyond what is the status quo, and that is the Hyde Amendment.

MARTIN: Which prohibits the use of federal funds to pay for abortions and the specific objections well, first of all, some members of the caucus dont agree with that, but in addition to that, their argument is that the insurance that if women are paying for insurance out of their own pockets, they ought to be able to have policies that include abortion coverage, and their understanding is the current amendment doesnt permit even that.

Mr. CLYBURN: Well, thats true, and the question is whether or not when you got more than 12 hours to start a debate on the bill that people will sit around the table and make sure that whatever the language is, that it does not violate what is status quo as it relates to the federal government paying for abortion.

MARTIN: Senator Menendez, can I hear from you on this question?

Sen. MENENDEZ: Yeah, I agree with President Obama that this is a health care bill, not a bill about the question of choice or abortion and that it should be abortion neutral, which is to say that this is not the place for huge shifts in abortion policy. It should retain the present law that no federal funds should go to abortions, but it still should allow a woman the opportunity to have a health insurance policy that can provide her those services should she seek to have them. And thats what the Senate bill basically did.

The Senate bill, you know, ensures that while private plans may chose to provide or not provide abortion services, each state must have at least one plan that covers those services, and at least one that does not. In this way people can choose their own personal conscience and go which ever way they want.

MARTIN: Senator, Im sorry to push, we really have about a minute left. I started with Mr. Clyburn. Id like to give you the final word. According to a Gallup poll published yesterday, Americans are now evenly split on this issue. According to Gallup, 41 percent say a new health care bill would make the U.S. health care system better in the long run, 40 percent say it would make things worse in the long run.

That poll was taken between Thursday of last week and this past Sunday. That sort of covers the period that the House was voting on the bill. What do you say about that? Does the political will still exist, the political consensus still exist to go forward? It sounds like Americans are split right down the middle.

Sen. MENENDEZ: Well, I think that the more people know about what we are trying to do in terms of this reform, the more likely that they will support it. Its our job to let them know that were going to bar insurance companies from discriminating against people based on health status, on pre-existing condition, on imposing annual caps, on arbitrarily and capriciously denying them health care when they need it the most.

Theyre going to know that in fact we are making sure, for example, that insurance companies cant charge women or people who have been sick more for their coverage. Were going to make sure that they understand that even members of Congress will buy their health insurance from the same

MARTIN: Okay.

Sen. MENENDEZ: exchanges that people in the states are. Were going to have them understand that were going to reduce cost, that were going to have insurance reforms.

MARTIN: Well have to

Sen. MENENDEZ: give people the opportunity to be covered. When they know that, I think there will be more people who support reform than not.

MARTIN: We have to leave it there for now. Senator Bob Menendez is a Democrat. He represents New Jersey. He was kind enough to join us from his office. We were also joined by House Majority Whip James Clyburn. He represents South Carolina. He is the number three leader in the House and he joined us from his home office in South Carolina. Gentlemen, thank you both so much for speaking with us.

Sen. MENENDEZ: Well, thank you for having us.

Mr. CLYBURN: Thank you.

MARTIN: This is TELL ME MORE from NPR News. Im Michel Martin. Please stay with us.

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