Author: Mike Lillis

The Republicans tonight had one last chance to put a wrench in the Democrats’ plans to tweak the Senate health bill via reconciliation. It came in the form of something called a motion to recommit, which effectively represented the one GOP amendment allowed under the rules set for the health care vote. And they chose a doozy: Their amendment was the same abortion language found in the original House-passed bill — language that was inserted upon the insistence of Michigan Rep. Bart Stupak, the anti-abortion Democrat who vowed to oppose the bill otherwise.

Republicans, of course, were hoping that the same coalition of anti-abortion Democrats who’d voted for that language the first time around would also support it tonight. Because many Senate Democrats oppose the Stupak provision, attaching it to the reconciliation bill would have threatened that proposal — which, of course, was why the Republicans chose it to begin with.

It didn’t happen.

Behind Stupak, Democrats rallied to defeat the motion to recommit by an easy vote of 232 to 199. Twenty-one Democrats joined every Republican in voting for the measure.

“This motion is really to politicize life,” Stupak said just before the vote, “not to protect life.”

With the last-minute support of anti-abortion colleagues, House Democrats on Sunday passed historic legislation to extend health coverage to tens of millions of uninsured Americans, protect patients from the most flagrant abuses of insurance companies, and curb runaway health care costs. All told, the $940 billion reforms represent the most sweeping overhaul of the nation’s health care system since the creation of Medicare more than four decades ago.

The tally was 219 to 212 in support of reforms passed by the Senate on Christmas Eve, with 34 Democrats joining every Republican in the lower chamber in opposition to the measure. An accompanying reconciliation proposal — which tweaks the Senate bill to address what House leaders considered to be inherent weaknesses — also passed, 220 to 211.

Democratic leaders were quick to place the reforms among the most significant in the nation’s history — legislation on par with that establishing Social Security, Medicare and new civil rights protections. “This is an American proposal that honors the traditions of our country,” House Speaker Nancy Pelosi (D-Calif.) said just before the votes. “We may not have chosen the time, but the time has chosen us.”

The Senate bill now moves to the White House, where President Obama will sign it shortly into law. The separate reconciliation bill then goes to the Senate, where Democrats are hoping to pass it before the Easter recess, which begins Friday. Reconciliation rules prevent upper-chamber Republicans from filibustering the proposal, meaning that Democrats need just 51 votes — not 60 — to pass it.

For House leaders, the victory didn’t come easy. Sunday’s vote capped a tension-filled week in which some Democrats who’d previously supported health care reform announced their opposition; others who’d formerly opposed reform announced their support; and party leaders were left with the delicate task of counting heads to ensure they had the numbers to pass the bill.

Quite aside from the unified GOP opposition, anti-abortion Democrats, led by Michigan Rep. Bart Stupak, had vowed to oppose the bill over language they feared would allow federal funds to subsidize abortion services — something that’s been prohibited for more than 30 years. And they had the numbers to kill the proposal. Breaking the impasse required the muscle of the White House, which stepped in Sunday to issue an eleventh-hour executive order stipulating that nothing in the reform bill would dilute the decades-old prohibition on the federal funding of abortion. The move — while blasted by abortion rights groups — caused the abortion opponents to throw their support behind the proposals.

“The real winner,” Stupak said Sunday at a press conference announcing the deal, “is really the American people.”

The rare weekend vote came after more than a year of rancorous debate over how Congress should approach health care reform. The saga first pitted Democrats against Republicans, but later — when it became clear that no Republicans would support the bill — saw liberal Democrats and their moderate colleagues doing battle over the most contentious provisions of the enormous bill. In the end, party leaders, behind Pelosi, convinced enough Democratic critics — both liberal and conservative — that the proposals would at least take steps toward fixing a health care system that all sides agree has grown dysfunctional.

“This is not the bill I wanted to support,” Rep. Dennis Kucinich (D-Ohio), the liberal single-payer supporter, said recently in announcing his reluctant support for the bill. “Hopefully” he added, it will take the country “in the direction of comprehensive health care reform.”

At the center of the reforms are a series of provisions reining in the most controversial practices of the health insurance industry. Under the reforms, for example, insurance companies could no longer deny coverage based on pre-existing conditions. They could no longer drop coverage when a patient gets sick. They could no longer hike premiums indiscriminately. And they could no longer put caps — either annual or lifetime — on coverage benefits.

Among the other major provisions, the reform bills will:

– Require most Americans to buy health insurance or face financial penalties.

– Take incremental steps to close the coverage gap in Medicare’s prescription drug benefit — the so-called doughnut hole — by 2020.

– Hike Medicaid rates on primary care services to equal those of Medicare.

– Extend funding for the Children’s Health Insurance Program through 2015.

To fund the changes, the proposals will:

– Cut more than $500 billion from the Medicare program, largely targeting the private insurance plans that receive huge subsidies to cover Medicare patients.

– Apply a 0.5 percent hike on Medicare’s payroll tax for individuals earning more than $200,000 and families earning more than $250,000.

– Tax the most expensive insurance plans, those costing more than $10,200 for individuals and $27,500 for family plans. (That tax will take effect in 2018.)

The Congressional Budget Office, which has estimated that the bill will expand coverage to roughly 32 million uninsured Americans, said Saturday that the changes will reduce federal deficits by $143 billion over the next decade, and by roughly $1 trillion in the 10 years to follow. The analysis at once convinced some Democratic budget hawks to support the bill, and took the wind from the sails of Republican critics who have said the reforms will bankrupt the nation.

Not that it prevented GOP leaders from attacking the reforms to the last. Rep. Marsha Balackburn (Tenn.), the first Republican to speak on the floor Sunday, set the tone early, blasting the Democrats for reforms that Republicans say will steal patient choice.

“Only they see the death of freedom … as a cause for celebration,” Blackburn said. “It is their children who will pay for their greed.”

Rep. Nathan Deal, the senior Republican on the Ways and Means health subpanel and candidate to become Georgia’s governor, echoed those criticisms. He vowed that, if elected to the governor’s office, he’ll focus on nullifying the reforms, particularly the Medicaid expansion, which many Republicans have called an unconstitutional mandate on states.

“The problem with socialism,” Deal said Sunday, “is that you ultimately run out of other people’s money.”

But in the end, Republicans — while effective in slowing the pace of the legislation — were helpless to prevent its passage.

The historic nature of the vote was not lost on Democratic leaders. Pelosi, who presided over the final vote, waved the same gavel that was used when Medicare passed the lower chamber more than six decades ago. And Rep. Louise Slaughter (D-N.Y.), the head of the Rules Committee who managed part of the day’s debate, was brandishing her own copy of a 1939 letter to Congress from Franklin Delano Roosevelt, a letter urging lawmakers to include a national health care system as part of the Social Security program.

“Good health,” FDR had written, “is essential to the security and progress of the Nation.”

Seventy-one years later, Democrats are hoping he was right.

The White House has announced that it will issue an executive order reiterating the 34-year old prohibition on the federal funding of abortion. The move was required to rally Rep. Bart Stupak (D-Mich.) and a handful of other anti-abortion Democrats behind the Senate-passed health reform bill that the House is hoping to pass this evening. The order will be officially issued after President Obama signs the bill.

Stupak and co. have claimed that the bill — which would allow exchange plans to offer abortion coverage, but require patients to write two checks to buy the abortion coverage separately — effectively subsidizes plans that offer abortion (a violation, they say, of the Hyde Amendment). They want a ban on subsidies to any plan that offers abortion coverage at all, forcing women to buy separate policies for those services. The executive order clarifies that the Democrats’ bill ”maintains current Hyde Amendment restrictions governing abortion policy and extends those restrictions to the newly-created health insurance exchanges.”

Stupak had also objected to the billions of dollars in the bill earmarked for community health centers and clinics. Abortion opponents fear that Planned Parenthood and other groups offering abortion services might benefit from that funding, even though current federal law already bans those groups from using the federal money for abortion services. Today’s executive order stipulates that “the Hyde language shall apply to the authorization and appropriations of funds for Community Health Centers.”

Below is the full text of the executive order:

ENSURING ENFORCEMENT AND IMPLEMENTATION OF ABORTION RESTRICTIONS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT

By the authority vested in me as President by the Constitution and the laws of the United States of America, including the “Patient Protection and Affordable Care Act” (approved March __, 2010), I hereby order as follows:

Section 1. Policy. 
Following the recent passage of the Patient Protection and Affordable Care Act (”the Act”), it is necessary to establish an adequate enforcement mechanism to ensure that Federal funds are not used for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered), consistent with a longstanding Federal statutory restriction that is commonly known as the Hyde Amendment. The purpose of this Executive Order is to establish a comprehensive, government-wide set of policies and procedures to achieve this goal and to make certain that all relevant actors–Federal officials, state officials (including insurance regulators) and health care providers–are aware of their responsibilities, new and old. 

The Act maintains current Hyde Amendment restrictions governing abortion policy and extends those restrictions to the newly-created health insurance exchanges. Under the Act, longstanding Federal laws to protect conscience (such as the Church Amendment, 42 U.S.C. §300a-7, and the Weldon Amendment, Pub. L. No. 111-8, §508(d)(1) (2009)) remain intact and new protections prohibit discrimination against health care facilities and health care providers because of an unwillingness to provide, pay for, provide coverage of, or refer for abortions.

Numerous executive agencies have a role in ensuring that these restrictions are enforced, including the Department of Health and Human Services (HHS), the Office of Management and Budget (OMB), and the Office of Personnel Management (OPM).

Section 2. Strict Compliance with Prohibitions on Abortion Funding in Health Insurance Exchanges. The Act specifically prohibits the use of tax credits and cost-sharing reduction payments to pay for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered) in the health insurance exchanges that will be operational in 2014. The Act also imposes strict payment and accounting requirements to ensure that Federal funds are not used for abortion services in exchange plans (except in cases of rape or incest, or when the life of the woman would be endangered) and requires state health insurance commissioners to ensure that exchange plan funds are segregated by insurance companies in accordance with generally accepted accounting principles, OMB funds management circulars, and accounting guidance provided by the Government Accountability Office.

I hereby direct the Director of OMB and the Secretary of HHS to develop, within 180 days of the date of this Executive Order, a model set of segregation guidelines for state health insurance commissioners to use when determining whether exchange plans are complying with the Act’s segregation requirements, established in Section 1303 of the Act, for enrollees receiving Federal financial assistance. The guidelines shall also offer technical information that states should follow to conduct independent regular audits of insurance companies that participate in the health insurance exchanges. In developing these model guidelines, the Director of OMB and the Secretary of HHS shall consult with executive agencies and offices that have relevant expertise in accounting principles, including, but not limited to, the Department of the Treasury, and with the Government Accountability Office. Upon completion of those model guidelines, the Secretary of HHS should promptly initiate a rulemaking to issue regulations, which will have the force of law, to interpret the Act’s segregation requirements, and shall provide guidance to state health insurance commissioners on how to comply with the model guidelines.

Section 3. Community Health Center Program.

The Act establishes a new Community Health Center (CHC) Fund within HHS, which provides additional Federal funds for the community health center program. Existing law prohibits these centers from using federal funds to provide abortion services (except in cases of rape or incest, or when the life of the woman would be endangered), as a result of both the Hyde Amendment and longstanding regulations containing the Hyde language. Under the Act, the Hyde language shall apply to the authorization and appropriations of funds for Community Health Centers under section 10503 and all other relevant provisions. I hereby direct the Secretary of HHS to ensure that program administrators and recipients of Federal funds are aware of and comply with the limitations on abortion services imposed on CHCs by existing law. Such actions should include, but are not limited to, updating Grant Policy Statements that accompany CHC grants and issuing new interpretive rules.

Section 4. General Provisions. 
(a) Nothing in this Executive Order shall be construed to impair or otherwise affect: (i) authority granted by law or presidential directive to an agency, or the head thereof; or (ii) functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.
(b) This Executive Order shall be implemented consistent with applicable law and subject to the availability of appropriations.

(c) This Executive Order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity against the United States, its departments, agencies, entities, officers, employees or agents, or any other person.

THE WHITE HOUSE

So reports MSNBC, without adding any details. The anti-abortion Michigan Democrat has threatened to kill the bill over concerns that the Senate language would open doors to federal subsidies for abortion coverage. Stupak had been in talks with the White House over an executive order reiterating the federal ban on abortion funding.

His switch to support the bill suggests that such an executive order is forthcoming.

Update: Via TPM, CNN is reporting that Stupak is still a no.

Later update: The New York Times is reporting that according to Stupak’s spokeswoman, he’s still a no.

Even later update: Stupak and the White House have reached a deal, Politico reports.

Under the agreement, President Barack Obama would sign an executive order ensuring that no federal funding will go to pay for abortion under the health reform plans. In addition, Stupak will get to state his concerns about abortion funding in the bill during a colloquy on the House floor during the debate.

In return, Stupak and a handful of other anti-abortion Democrats will sign on to the Senate-passed reform bill, Politico said.

Of the many reasons to oppose health care reform, this is probably the worst. From today’s Washington Post:

Former Republican House speaker Newt Gingrich said Obama and the Democrats will regret their decision to push for comprehensive reform. Calling the bill “the most radical social experiment . . . in modern times,” Gingrich said: “They will have destroyed their party much as Lyndon Johnson shattered the Democratic Party for 40 years” with the enactment of civil rights legislation in the 1960s.

So by Gingrich’s logic, lawmakers should really just shy away from the toughest issues of the day because changes in the status quo might haunt their political careers. And this guy wants to be president?

After a Saturday full of partisan bickering, presidential arm-twisting, rowdy protests, and naked racism, the House stands ready to vote today on a historic, $940 billion health care reform proposal that would leave 95 percent of the country’s population with health coverage within 10 years. Democratic leaders still don’t quite have the votes they need, but behind a lobbying push from President Obama (who visited the Capitol yesterday), they appear confident they can secure the necessary support by this afternoon. The highlights of Saturday’s events on Capitol Hill:

1) Faced with criticisms over their “deem and pass” strategy, House leaders dropped it. The deeming plan would have allowed the Democrats to pass the health care reconciliation bill — which tweaks the Senate-passed reform proposal — and “deem” the Senate bill passed without an actual vote on it. The new plan is to vote separately on both bills. Obama would then sign the Senate version, after which the Senate would take up the reconciliation bill.

2) The Rules Committee finalized the guidelines that will govern today’s events, setting formal debate time at two hours (split between the parties), and allowing the Democrats to postpone the vote if they fail to rally enough support to pass the bill.

3) Some Tea Partiers reportedly showed their racist stripes yesterday, allegedly showering several black lawmakers — including the civil rights hero Rep. John Lewis (D-Ga.) — with racial slurs as they walked from their offices to the Capitol. And the office of Rep. Emanuel Cleaver said that a protester spat on the Missouri Democrat, issuing this statement:

This afternoon, the Congressman was walking into the Capitol to vote, when one protester spat on him. The Congressman would like to thank the US Capitol Police officer who quickly escorted the other Members and him into the Capitol, and defused the tense situation with professionalism and care. After all the Members were safe, a full report was taken and the matter was handled by the US Capitol Police. The man who spat on the Congressman was arrested, but the Congressman has chosen not to press charges. He has left the matter with the Capitol Police.

Tea Party leaders are condemning the episode today, but it still hurts the image of a movement already seen to be dominated by bitter-class whites.

Meanwhile, those anti-abortion Democrats who continue to insist that the Senate reform bill would open doors to federal funding for abortions have been negotiating with the White House over whether the administration will issue an executive order reiterating the federal ban on abortion subsidies. Their beef is this: While the Senate bill bans federal subsidies of abortion services (requiring women to write a separate check for abortion coverage to ensure the funds are segregated), the anti-abortion folks want to ban subsidies for any plans that include abortion as part of their coverage package. The reason? They want those plans either to go out of business or to drop abortion coverage altogether.

What began as one of the most controversial issues of the months-long health care debate continues to be so: The public option — a government-backed insurance plan designed to compete with private companies — wasn’t included as part of the Democrats’ reconciliation bill, sending some liberals through the roof.

Yesterday, Senate Majority Leader Harry Reid (D-Nev.) attempted to appease some of the chamber’s most ardent public option supporters, vowing to hold a separate vote on the issue later this year, the Huffington Post reported today. In a letter to Sens. Jeff Merkley (D-Ore.) and Bernie Sanders (I-Vt.), Reid said he was “very disappointed” that the Democrats didn’t have the votes to keep the provision as part of the reform bills.

“I remain committed to pursuing the public option,” Reid wrote.

While I believe that the legislation we are considering does much to provide affordable coverage to millions of Americans and curb insurance company abuses, I also believe that the public option would provide additional competition to make insurance even more affordable. As we have discussed, I will work to ensure that we are able to vote on the public option in the coming months.

Unmentioned, of course, is the tiny inconvenience that, if Democrats didn’t have the votes to pass the public option by reconciliation (which requires just a simple majority), they certainly won’t have the votes to pass it later in the year, when the filibuster will be back requiring 60 votes to pass anything.

Republicans dismissing as inaccurate the Congressional Budget Office’s cost analysis of the Democrats’ health care reform bills seem to have forgotten history.

In 2004 — amid controversy over the Bush administration’s efforts to bury unflattering cost estimates of the Republican’s Medicare reforms — no less an authority than Sen. Charles Grassley (R-Iowa) deemed the CBO’s analysis the final word.

“The true cost estimate as far as Congress is concerned is that of the Congressional Budget Office,” Grassley, then the chairman of the Finance Committee, said in a July 2004 statement. “We’re required by law to abide by the cost estimates prepared by the Congressional Budget Office.”

The CBO yesterday released its cost estimate of the Democrats’ reform bills, finding that enactment of the Senate-passed bill and the reconciliation fixes would yield $138 billion in budget savings over the next 10 years. That hasn’t helped Republicans, who have warned for months that the reforms would bankrupt the nation.

A few weeks back, it was the House Oversight Committee’s domestic subpanel that examined the effectiveness of the White House programs designed to curb foreclosures. (They weren’t pleased.) Now, the full committee will have a crack.

Rep. Edolphus Towns (D-N.Y.), chairman of the Oversight panel, just announced a March 25 hearing to appraise Obama’s anti-foreclosure efforts, particularly the Home Affordable Modification Program. That initiative was sold as a way to help 3 to 4 million struggling homeowners by offering lenders financial incentives to modify mortgages voluntarily. As of last month, only 116,000 permanent mods had been finalized — a number that’s left lawmakers on both sides of the aisle unhappy with HAMP’s progress.

Next week, they’ll have even more data to scrutinize. Neil Barofsky, lead watchdog over the Troubled Asset Relief Program, is scheduled will release his report on HAMP management.

Other witnesses will include Herbert Allison, Jr., the Treasury’s assistant secretary for financial stability, and Gene Dodaro, who heads the U.S. Government Accountability Office.

The reasons behind the gathering are clear: While Wall Street is back to sipping champagne (literally), more than 308,000 homeowners suffered foreclosure last month alone, up 6 percent from the year before, according to RealtyTrac.

With a good number of reservations, the American Medical Association, the country’s largest doctors lobby, today put its significant weight behind the health reform bills the House will take up this weekend.

By extending health coverage to the vast majority of the uninsured, improving competition and choice in the insurance marketplace, promoting prevention and wellness, reducing administrative burdens, and promoting clinical comparative effectiveness research, this bill will help patients and their physicians.

This was never a sure thing. The doctors have complained for years about Congress’ failure to scrap the flawed formula that dictates their Medicare rates (a formula that would result in a 21 percent Medicare pay cut for doctors next month without congressional action). And while the House health reform bill scrapped that formula and provided the doctors with more realistic pay updates, the Senate bill did not. That means that Congress will have to return to the issue later this year, if only to kick the problem down the road with yet another short-term fix.

It’s not AMA’s only concern. The lobbying group also has reservations about a provision of the Senate bill that creates an independent commission that will suggest Medicare reforms — and could force Congress to vote on them. The doctors — indeed, almost everyone who’s part of the nation’s $2.3 trillion medical-industrial complex — have concerns that the panel would make suggestions that, as AMA said today, “could result in misguided payment cuts that undermine access to care and destabilize health care delivery.” That is, cuts that would reduce federal payments to them.

Meantime, though, AMA is supporting the bill, which the Democrats hope to pass in the House on Sunday.

The new poll, conducted by the non-partisan Kaiser Family Foundation, found that 46 percent of Americans support the health reform bills moving on Capitol Hill, while 42 percent oppose them. Furthermore:

Six in 10 Americans say they have heard little or nothing about budget reconciliation. And many people continue to struggle with health costs, with nearly one in five saying cost increases have caused them or their employer to switch to a less comprehensive health plan.

Like yesterday’s CBO score, the figures fly directly in the face of Republican talking points, which claim that the Democrats’ reform bills not only would add to deficits, but are grossly unpopular among Americans.

h/t: The Hill.

This morning, environmental activists erected two 20-foot teepees (for lack of a better term) in front of EPA headquarters in Washington to protest mountaintop coal mining. Ten hours later, they’re still there, and at least six of them have locked themselves to the teepees with a vow to remain until EPA Administrator Lisa Jackson agrees to fly over a mountaintop removal site . (The claim is that she’s never seen one.)

Via Twitter, Jackson acknowledged the protesters:

“People are here today expressing views on MTM, a critical issue to our country,” she said. “Theyre concerned abt human health & water quality & so am I.”

In the eyes of community activist Jeff Biggers, that ain’t enough. “Not one — count ‘em — of Jackson’s top officials in DC or herself have made any effort to actually visit a mountaintop removal site before making life-threatening decisions,” Biggers wrote today at the Huffington Post.

Considering what’s at stake, it’s difficult to argue that he doesn’t have a point.

Democratic leaders pushing health care reform this year like to argue that a vast majority of the proposals represent uncontroversial changes backed by most Capitol Hill lawmakers. And while that might be true, it hasn’t prevented some sharp disagreements between House and Senate Democrats over a handful of high-profile reform provisions.

Indeed, the House-passed reform bill strayed from the Senate proposal on a number of key issues, from children’s coverage to Medicaid payments to the creation of a public health insurance plan. Here’s how the reconciliation bill — which House leaders unveiled today to address what they considered weaknesses in the Senate legislation — would tweak (or not) some of the most contentious provisions in the upper chamber’s bill.

Paying the Freight

A central disagreement between House and Senate Democrats has been over how to pay the substantial costs associated with covering tens of millions of uninsured Americans. The House paid much of the tab with a 5.4 percent tax on the nation’s highest earners — individuals making more than $500,000 per year, and families pulling in more than $1 million. The Senate, meanwhile, passed a 0.5 percent hike on Medicare’s payroll tax for individuals earning more than $200,000 and families earning more than $250,000. But a larger chunk of funding under the Senate bill would come from an 40 percent excise tax on high-cost insurance plans — a provision that’s wildly unpopular among a key Democratic constituency: Organized labor.

The reconciliation bill alters both funding mechanisms. First, it scales back the insurance excise tax by increasing the dollar thresholds from $8,500 to $10,200 for single coverage, and from $23,000 to $27,500 for family coverage. It also delays the application of that tax until 2018. To make up the revenues lost by changes to the excise tax, the reconciliation bill also expands the Medicare tax to include net investment income (i.e. unearned income).

Kids’ Care

After years of promoting the virtues of the Children’s Health Insurance Program, House Democrats did a strange thing: They proposed to eliminate CHIP altogether, instead moving those kids into either Medicaid or private plans on newly created insurance marketplaces, dubbed exchanges. The Senate bill took a different tack, reauthorizing CHIP through 2019, while funding it through 2015. Despite a more recent White House proposal to provide an extra year of funding (through 2016), the reconciliation bill doesn’t touch the issue, leaving the original Senate provision intact (and kids welfare advocates happy).

Pharma Deal

A behind-the-scenes deal cut last year between Sen. Max Baucus (D-Mont.) and the pharmaceutical lobby drew a good deal of attention: The nation’s drug makers, under that agreement, would dedicate $80 billion toward health care reform over the next decade if Democrats would oppose further industry reforms — including a proposal allowing Americans to buy their prescriptions from abroad, and another empowering states to negotiate directly with companies on behalf of their lowest-income seniors.

While the White House endorsed the deal, House Democrats didn’t. Instead, Rep. Henry Waxman (D-Calif.), chairman of the House Energy and Commerce Committee, included the state negotiation provision as part of the House-passed bill. While the reconciliation bill does tap the drug makers for $28 billion over 10 years ($5 billion more than the original Senate bill), it doesn’t dabble with the other terms of the Pharma deal.

Abortion

Always the hot-button issue, abortion has emerged as the one topic that still really threatens House passage of health care reform. Late last year, Speaker Nancy Pelosi (D-Calif.) had negotiated a delicate compromise designed to satisfy a number of anti-abortion Democrats — notably Rep. Bart Stupak (Mich.) — who were concerned that the reform bill would allow taxpayer dollars to subsidize abortions. The so-called Stupak amendment would ban exchange plans from offering abortion coverage, forcing women to buy a separate policy covering abortion services. The Senate bill is a bit less strict, allowing abortion coverage on the exchange, but requiring women to write a separate check for those services to ensure that no federal funds go toward them. It’s the Senate provision that’s going to the floor of the House early next week, leaving Stupak and roughly a dozen other House Democrats vowing their opposition.

Anti-Trust Exemption

For 64 years, the health insurance industry has reaped the benefits of a rare exemption to federal anti-trust laws, which allows companies to share cost and coverage information without scrutiny from Washington. And for a number of years, Democrats have had their eyes on repealing it. The House bill would have done just that, but the provision didn’t make the cut in the Senate, due largely to the opposition of Sen. Ben Nelson (Neb.), the moderate Democrat whose close ties to the insurance industry include a stint as CEO of the Omaha-based Central National Insurance Group.

Like many other insurance reforms, this provision is one of those non-budget related items not eligible to move under the reconciliation process. The Democrats, though, are hoping to repeal the exemption later this year through separate legislation. Indeed, the House has already passed such a bill last month.

Medicaid Rates

The headlines today will likely focus on the plan to eliminate the sweetheart Medicaid deal that Senate leaders cut with Nebraska’s Nelson — a deal so unpopular that even Nelson himself claims now to oppose it. But much more significant for purposes of ensuring care is a provision of the reconciliation bill that hikes Medicaid rates to primary care physicians to at least the level of what Medicare pays for those same services. That provision was contained in the House bill, but not the Senate proposal.

The issue isn’t trivial. Medicaid rates are so low that many doctors refuse to see Medicaid patients. Only about 40 percent of physicians accept all new Medicaid patients, versus 58 percent for Medicare patients, according to a September study from the Center for Studying Health System Change, which randomly surveyed more than 4,700 physicians. And that number drops to about 31 percent among family doctors and general practitioners.

For dental care, the numbers are even worse. Only 27 percent of the nation’s dentists will treat Medicaid-insured patients, according to a 2007 survey by the American Dental Association survey. Those trends raise important questions about the value of an insurance program that nobody accepts — and led directly to the Democrats’ decision to hike Medicaid rates.

Closing the Doughnut Hole

Though seniors participating in Medicare’s prescription drug program are generally happy with their benefits, a painful thorn plagues the program: Seniors are forced to pay the full cost of drugs when annual expenses hit $2,700, and the subsidies don’t return until total costs hit $6,154 — a coverage gap known (not endearingly) as the doughnut hole. The Senate bills took steps to reduce the size of that gap, relying mostly on the pharmaceutical companies, who offered a 50 percent discount through the doughnut hole as part of their $80 billion deal with Democrats.

The reconciliation bill expands on that plan, offering seniors an additional $250 rebate in 2010, and closing the doughnut hole entirely by 2020.

Illegal Immigrants

While both the Senate and House bills would prohibit illegal immigrants from receiving federal subsidies on the exchanges, the Senate took the restriction a long step further by preventing those folks from buying insurance from the exchanges at all — even if they paid the full price of coverage using their own money. (The House bill would allow such unsubsidized purchases.) Although some members of the House Hispanic caucus have advocated for the House language in the reconciliation bill, it didn’t make its way in.

Public Option

The House bill included the creation of a government-backed insurance plan to compete with private companies on a national exchange, while the Senate bill contained no such thing. Despite a late push from liberal groups to include the House provision in the reconciliation bill, House Speaker Nancy Pelosi (D-Calif.) declined, citing a lack of support in the Senate.

House Majority Leader Steny Hoyer (D-Md.) said today that the lower chamber hopes to vote on the reconciliation bill Sunday afternoon.

House Democratic leaders just ended a much-anticipated press conference to unveil the details of their health care reform bill. Trouble was, the details were few and far between.

Rather than lending many specifics about the changes to the Senate bill, party leaders stuck with talking points about the general need for reform, as well as playing up the new CBO analysis, released today, estimating that the reform proposals would save $138 billion over the next decade and more than $1 trillion in the following decade.

That being said, House Speaker Nancy Pelosi (D-Calif.) did reveal a few things about the reconciliation bill. The notables:

1) The $940 billion cost of the bill will be offset largely by cutting costs within the current health care delivery system — the “waste, fraud and abuse” we hear so much about. CBO estimates that more than $500 billion will come from such cuts, most of which will target Medicare programs (particularly Medicare Advantage, under which private insurers tap generous federal subsidies to insure seniors.)

2) The other large offset provisions are (a) an excise tax on expensive health insurance plans — though that provision likely won’t go into effect for years to come — and (b) “a Medicare fee on unearned income,” something like the high-earner tax the House had passed last year.

3) The sweetheart Medicaid deal for Sen. Ben Nelson’s (D) Nebraska has been eliminated, though Pelosi ducked questions about whether other, similar state-based deals have also been scrapped.

4) Consistent with the original House bill (but not included in the Senate proposal), Medicaid payments to primary care physicians will increase under the reconciliation package, Pelosi said.

Pelosi also said vaguely that the reconciliation bill will offer more affordability for the middle class than the Senate bill did, while also taking further steps to reform the private insurance industry. Pushed for more details, Pelosi said, “Go to the Internet,” where a summary is expected to go up shortly.

Waiting now for those specifics.

By any objective measure, the $138 billion in deficit savings the Democrats’ health reform bill would rack up over the next 10 years (while extending coverage to 32 million uninsured Americans) is quite an accomplishment — particularly coming from a Congress not exactly known for paying all its bills.

But don’t try to convince the Republicans. After months of blasting the Democrats’ reform proposals for allegedly bankrupting the country with expensive new programs, Republicans now have a brand new message: The deficit savings aren’t enough to justify passing the bill. From The New York Times:

Republicans moved quickly to throw cold water on the claims, noting that government debt is piling up so fast that the health care legislation would barely make a dent. “Any projected savings over 10 years have already been wiped out five times over in just the first five months of the current fiscal year,” said Don Stewart, a spokesman for the Senate Republican leader, Mitch McConnell of Kentucky.

Mr. Stewart cited budget office data showing that the federal government had “incurred a budget deficit of $655 billion in just the first five months of fiscal year 2010.”

Mr. Stewart didn’t mention that their own multi-billion dollar health reform accomplishment of this decade — the creation of Medicare’s (unfunded) prescription drug benefit — has contributed no small amount to the nation’s budget crisis.

The Congressional Budget Office just posted its evaluation of the health reform reconciliation bill the Democrats hope to push through the House this week.

While pointing out that the analysis is preliminary, CBO estimates that enacting both the Senate-passed health reform bill and the reconciliation bill (which contains the fixes to the Senate proposal) would cut the federal deficit by $138 billion over the next decade.

Different week, different sales pitch from Democratic leaders about why heath care reform is worth supporting. The Washington Post’s Paul Kane reports:

House Majority Leader Steny Hoyer (D-Md.) told reporters Thursday that the legislation is “the largest deficit-reduction bill that members will have a chance to vote on” in most of their congressional careers — a key enticement for a bloc of undecided Democratic lawmakers who fear the legislation would run up the mounting federal deficit.

Though the Congressional Budget Office has yet to release the official score, Democratic leaders are saying today that the bill will cost $940 billion over the next decade, offset by a series of tax hikes and spending cuts that will reduce the deficit by $130 billion over the same span.

Their reason for emphasizing the deficit side of things is clear: There are more than 30 House Democrats considered to be on the fence about whether to support the bill, which will require 216 votes to pass the House. Most of those lawmakers represent conservative districts where criticisms of the nation’s $1.4 trillion deficit run high. But if they can go back home and say they supported reforms that expanded coverage to millions of uninsured folks (which most Americans support) and reduced the deficit by more than $100 billion, well, that might not be such a burden come November.

Democrats are expected to release the full details of the proposal today at noon.

Quietly, free of headlines and fanfare, the Obama White House is toning down the bellicose “war-on-drugs” position that’s defined the country’s narcotics policy for the last 25 years.

Appearing in Vienna last week for the 53rd annual United Nations meeting on global drug policy, administration officials shifted away from the decades-old approach of attacking drug use as a crime to be penalized. Instead they moved toward a strategy of tackling addiction as an illness to be treated, a number of health and human rights advocates who attended the event told TWI.

Drug reformers for years have promoted so-called “harm reduction” measures as a more effective and humane way to treat drug addiction and the diseases that often accompany it — an approach that runs counter to the punitive attitude epitomized by the Reagan administration’s “war on drugs.” And while the Obama White House — behind Gil Kerlikowske, the White House drug czar, and his deputy, Thomas McLellan — remains officially opposed to the hot-button harm reduction language, officials have also conceded that the current strategy isn’t working, advocates say. That sharp break from past administrations has left reformers hopeful that the Obama White House will mark a new era in the nation’s fight against drug abuse — one that prioritizes treatment and prevention above rap sheets and prison time.

“There was virtually no reference to a criminal justice approach,” Allan Clear, executive director of the Harm Reduction Coalition, an advocacy group, said of the U.S. delegation in Vienna. “I’m just so used to being appalled by their behavior … It was very encouraging.”

Deborah Peterson Small, executive director of Break the Chains, another group advocating for drug-policy reforms, agreed, noting a brand new willingness among White House officials to embrace certain elements of the harm reduction strategy. When she spoke about treatment reforms to U.S. drug officials in Vienna in 2008, Small said, the entire delegation walked out on her. “This year it was completely different,” she said. “We finally had a sense that they were listening.”

The comments mark quite a departure from those that drug reformers were making a year ago at the same U.N. event, where the Obama administration killed international efforts to include harm reduction language as part of a U.N. document that will guide the next decade’s global drug policy. Harm reduction refers to things like drug-substitute treatments and clean-needle exchanges — programs being tried (with promising results) in a number of countries to battle the spread of HIV/AIDS, Hepatitis C and other drug-related illnesses. The White House has argued that the broad harm reduction language is “ambiguous” and could include controversial programs the administration doesn’t support, including drug legalization, drug consumption rooms and heroin prescription initiatives.

But there are clear signs that the attitude is changing — and the policies are beginning to follow suit.

With Obama’s vocal support, for example, Congress last year repealed the 21-year-old ban on federal funding for needle exchange programs. And last week in Vienna, not only did the United States endorse a new U.N. resolution promoting access to controlled medicines for legitimate medical purposes (commonly considered to include drug dependency treatments, like methadone for heroin addiction), but it co-sponsored a separate declaration designed to tackle the treatment gap plaguing HIV patients. The latter resolution, while it doesn’t mention harm reduction specifically, references a U.N. technical guide promoting certain harm reduction measures, like needle exchange and opioid substitution therapy. Rebecca Schleifer, advocate for the health and human rights division at Human Rights Watch, said this week that the HIV document represents “the most vocal support” the White House has ever given for HIV-treatment efforts focusing on human rights.

Opponents of needle exchange and other harm reduction measures argue that the human rights groups have misinterpreted the signals coming from the White House in Vienna. “If you read Kerlikowske’s statement,” said Lana Beck, spokeswoman for the Drug Free America Foundation, “clearly there’s nothing there to indicate any change.”

That part is true. The remarks prepared for Kerlikowske — officially the director of the Office of National Drug Control Policy, or ONDCP — reiterated the administration’s opposition to the broader harm reduction language, arguing that the term “creates unnecessary confusion” and might be misused to “promote drug use.” Still, drug reformers were quick to point out that the drug czar declined to include those passages when he addressed the crowd in Vienna — more evidence, they say, that the U.S. is consciously toning down its traditional war-on-drugs rhetoric.

“Traditional advocates of harm reduction recognized that the United States was a different animal [this year],” Clear said.

The ONDCP did not return calls for comment.

For health and human rights advocates, there remains a long way to go. Like any number of emotionally charged issues, drug policy is often dictated more by entrenched ideology than evidence-based rationality. And on Capitol Hill, there remains a strong sense that drug users are criminals to be punished, not patients to be treated. For proof, look no further than the debate over needle exchange. Although a long list of public health organizations — including the National Institute of Medicine, the Centers for Disease Control and Prevention, the World Health Organization and the American Public Health Association — had endorsed needle exchange as an effective way to reduce HIV/AIDS without increasing drug abuse, the politics of Washington kept the ban in place for more than two decades prior to last year’s repeal.

Not that some lawmakers aren’t trying to reform the punitive mindset surrounding drug use. Sen. Jim Webb (D-Va.), for example, has long-criticized the criminal justice system for packing the nation’s prisons with non-violent drug users. A description of his reform proposal notes that the the war on drugs hasn’t diminished drug use, it hasn’t brought the multi-billion dollar drug industry under control, and it targets minority offenders disproportionately. The system, he says, is “broken, unfair, [and] locking up the wrong people.”

The Senate Judiciary Committee approved the Webb proposal in January, leaving supporters hopeful that Democratic leaders will bring the bill to the chamber floor later this year.

Meanwhile, health and human rights advocates have vowed to continue their push for health-centered drug reforms, encouraged by the tone of a White House that seems set to place a greater emphasis on treatment, health and human rights.

“That would put us on par with most other countries — like Iran,” Small quipped, “instead of being the leading jailer in the world.”

Arguing that access to health care is the right of everyone, not a privilege for the wealthy, Rep. Dennis Kucinich (D-Ohio) explains that while doesn’t really support the health reform bill the Democrats have proposed, he’ll hold his nose and vote for it anyway in hopes that it will move the country “in the direction of comprehensive health care reform.”

My criticisms of the legislation have been well reported.  I do not retract them. I incorporate them in this statement. They still stand as legitimate and cautionary.  I still have doubts about the bill. I do not think it is a first step toward anything I have supported in the past. This is not the bill I wanted to support, even as I continue efforts until the last minute to modify the bill.

The entire statement after the jump.

Each generation has had to take up the question of how to provide for the health of the people of our nation.  And each generation has grappled with difficult questions of how to meet the needs of our people.  I believe health care is a civil right.  Each time as a nation we have reached to expand our basic rights, we have witnessed a slow and painful unfolding of a democratic pageant of striving, of resistance, of breakthroughs, of opposition, of unrelenting efforts and of eventual triumph.

I have spent my life struggling for the rights of working class people and for health care.  I grew up understanding first hand what it meant for families who did not get access to needed care.  I lived in 21 different places by the time I was 17, including in a couple of cars.  I understand the connection between poverty and poor health care, the deeper meaning of what Native Americans have called “hole in the body, hole in the spirit”. I struggled with Crohn’s disease much of my adult life, to discover sixteen years ago a near-cure in alternative medicine and following a plant-based diet.  I have learned with difficulty the benefits of taking charge personally of my own health care.  On those few occasions when I have needed it, I have had access to the best allopathic practitioners.    As a result I have received the blessings of vitality and high energy.  Health and health care is personal for each one of us.  As a former surgical technician I know that there are many people who dedicate their lives to helping others improve theirs.  I also know their struggles with an insufficient health care system.

There are some who believe that health care is a privilege based on ability to pay.  This is the model President Obama is dealing with, attempting to open up health care to another 30 million people, within the context of the for-profit insurance system.  There are others who believe that health care is a basic right and ought to be provided through a not-for-profit plan.  This is what I have tirelessly advocated.

I have carried the banner of national health care in two presidential campaigns, in party platform meetings, and as co-author of HR676, Medicare for All.   I have worked to expand the health care debate beyond the current for-profit system, to include a public option and an amendment to free the states to pursue single payer.  The first version of the health care bill, while badly flawed, contained provisions which I believed made the bill worth supporting in committee.  The provisions were taken out of the bill after it passed committee.

I joined with the Progressive Caucus saying that I would not support the bill unless it had a strong public option and unless it protected the right of people to pursue single payer at a state level.  It did not.  I kept my pledge and voted against the bill.   I have continued to oppose it while trying to get the provisions back into the bill. Some have speculated I may be in a position of casting the deciding vote.   The President’s visit to my district on Monday underscored the urgency of this moment.

I have taken this fight farther than many in Congress cared to carry it because I know what my constituents experience on a daily basis.  Come to my district in Cleveland and you will understand.

The people of Ohio’s 10^th district have been hard hit by an economy where wealth has accelerated upwards through plant closings, massive unemployment, small business failings, lack of access to credit, foreclosures and the high cost of health care and limited access to care.  I take my responsibilities to the people of my district personally.  The focus of my district office is constituent service, which more often then not involves social work to help people survive economic perils.  It also involves intervening with insurance companies.

In the past week it has become clear that the vote on the final health care bill will be very close. I take this vote with the utmost seriousness.  I am quite aware of the historic fight that has lasted the better part of the last century to bring America in line with other modern democracies in providing single payer health care.    I have seen the political pressure and the financial pressure being asserted to prevent a minimal recognition of this right, even within the context of a system dominated by private insurance companies.

I know I have to make a decision, not on the bill as I would like to see it, but the bill as it is.   My criticisms of the legislation have been well reported.  I do not retract them. I incorporate them in this statement. They still stand as legitimate and cautionary.  I still have doubts about the bill. I do not think it is a first step toward anything I have supported in the past. This is not the bill I wanted to support, even as I continue efforts until the last minute to modify the bill.

However after careful discussions with the President Obama, Speaker Pelosi, Elizabeth my wife and close friends, I have decided to cast a vote in favor of the legislation.   If my vote is to be counted, let it now count for passage of the bill, hopefully in the direction of comprehensive health care reform.  We must include coverage for those excluded from this bill.  We must free the states.  We must have control over private insurance companies and the cost their very existence imposes on American families. We must strive to provide a significant place for alternative and complementary medicine, religious health science practice, and the personal responsibility aspects of health care which include diet, nutrition, and exercise.

The health care debate has been severely hampered by fear, myths, and by hyper-partisanship.  The President clearly does not advocate socialism or a government takeover of health care.  The fear that this legislation has engendered has deep roots, not in foreign ideology but in a lack of confidence, a timidity, mistrust and fear which post 911 America has been unable to shake.

This fear has so infected our politics, our economics and our international relations that as a nation we are losing sight of the expanded vision, the electrifying potential we caught a glimpse of with the election of Barack Obama.  The transformational potential of his presidency, and of ourselves, can still be courageously summoned in ways that will reconnect America to our hopes for expanded opportunities for jobs, housing, education, peace, and yes, health care.

I want to thank those who have supported me personally and politically as I have struggled with this decision.  I ask for your continued support in our ongoing efforts to bring about meaningful change.  As this bill passes I will renew my efforts to help those state organizations which are aimed at stirring a single payer movement which eliminates the predatory role of private insurers who make money not providing health care.   I have taken a detour through supporting this bill, but I know the destination I will continue to lead, for as long as it takes, whatever it takes to an America where health care will be firmly established as a civil right.

So says Fox News, pointing out that the Ohio liberal — who voted against the House health care reform bill last year because it didn’t include a public insurance plan — has been under intense pressure from Democratic leaders to change his tune this time around.

Looks like Obama’s visit to Ohio earlier this week paid dividends.