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Week In Review: Honing Political Strategy On Health Reform; Facing Down A Medicare Deadline

Confusion from the primary elections this week punctuated the Obama administration’s progress on implementing the new health law. 

The Obama administration continued its strategy, which Politico described as front-loaded “consumer-friendly, insurance industry reforms and other fixes” designed to “generate support for the new law in the run-up to the pivotal midterm elections”  (Haberkorn, 5/17). 

On Monday, the White House released guidelines explaining how a new small business tax credit will help employers extend health coverage to their employees. According to CongressDaily, the details became available “just days after a national small-business organization joined legal challenges to the law” (McCarthy, 5/17). The Washington Post offered some of the plan’s specifics: “not all of the firms will be eligible for the credits immediately, because not all of them currently offer insurance. … But all were sent government postcards alerting them to the availability of the credit — which covers up to 35 percent of their health-care costs — in hopes of spurring more to offer coverage” (Montgomery, 5/17).

The Associated Press
 noted some limitations of the program: “The full benefit goes to companies that have 10 or fewer workers with average salaries of $25,000 or less. They can get Uncle Sam to pick up 35 percent of their premiums. But sole proprietors aren’t eligible. And neither are firms with 25 or more employees, or average wages of $50,000 and above.” But “John Arensmeyer, head of the advocacy group Small Business Majority, said business owners have expressed strong interest in learning more about the credit” (Alonso-Zaldivar, 5/17).

, in a separate story, emphasized that even as Democrats try to “shore up public support” and provide cover to Democratic candidates facing challenges in the mid-term elections, a new survey, released Friday by the Kaiser Family Foundation (KHN is a program of KFF), “suggests the accelerated implementation schedule has failed to sway a skeptical public-or even kept health reform’s most ardent supporters on board” (Haberkorn and Kliff, 5/21). The Hill, while noting the absence of the public opinion bounce Democrats had hoped for, also reported that support for the Republican strategy to repeal “has eroded as more voters become aware of specific provisions they support” (Pecquet, 5/18).

KHN’s May 17 Morning Edition provides more detailed coverage of the administration’s implementation strategy and more details regarding the small business tax credit can be found in the May 18 Morning Edition.  

Meanwhile, observers were watching the results from the week’s primary elections to try to gain early insights into how the difficult health care battle might play out among voters. No clear answers seemed to emerge.

Sen. Blanche Lincoln, D-Ark., for instance, is considered to be among the Senate’s most vulnerable Democratic incumbents, partially because of her moderate stance on health care, according to The New York Times.  During her primary campaign, conservative Democrats and Republicans “excoriated” her for supporting the bill while liberals “hammered her for opposing a government-run insurance option” (McKinley, 5/16). Labor unions mobilized for Lincoln’s more liberal primary opponent, Lt. Gov. Bill Halter, partly because of her vote on health care. And, as The Washington Post reports, their “effort was fruitful: Lincoln and Halter are heading to a June 8 runoff” (Slevin, 5/19).

The Washington Post also reported that an anti-incumbent mood may have been more crucial in the defeat of Pennsylvania’s Republican-turned-Democrat Sen. Arlen Specter than his vote for health care, although he “provided the [Democratic] party with a critical vote needed to break GOP filibusters against health-care legislation” (Balz and Cillizza, 5/19). Meanwhile, The Wall Street Journal reported that “for Democrats, Tuesday’s results revealed a possible toolkit for navigating the year’s challenging political climate. In a closely watched Pennsylvania congressional race to replace the late Democratic Rep. John Murtha, the Democratic candidate, Mark Critz, successfully wooed conservative voters in his party by opposing Mr. Obama’s health-care law, and by opposing abortion rights and gun control.” Mr. Critz defeated a Republican in a district that supported John McCain in the 2008 presidential race (Wallsten and Bendavid, 5/19).

The May 19 Morning Edition has more details about these races.

Meanwhile, on Capitol Hill lawmakers faced a legislative deadline. A 21 percent reduction in Medicare reimbursements is slated to take effect June 1, unless Congress intervenes. CNNMoney reported that “[i]f the proposed cuts go through, physicians are worried their practices will be so strapped that they’ll have to drop some of the 43 million Americans who are covered under Medicare” (Pepitone, 5/17).

Lawmakers’ anxiety about deficit spending is adding a new level of tension to the “doc fix” vote.

CongressDaily reported that “Congress has been under pressure from interest groups and the White House to pass a permanent Medicare physician fix” (Cohn, 5/19). For instance, according to The Hill, the American Medical Association has argued that short-term fixes don’t address the program’s solvency issues and instead calls for “a permanent repeal of the sustainable growth rate which would cost about $250 billion – most of which would have to be paid for under House ‘pay-go’ rules (Pecquet, 5/18).

Early in the week, House Democrats appeared to favor a plan that included a five-year Medicare pay fix in a tax “extenders” package moving through Congress. But on Thursday, a three-year approach was unveiled by Democratic leaders of the House Ways and Means Committee and the Senate Finance Committee. According to Politico, under this idea, “[P]hysicians would get a 1.3 percent raise this year and an additional 1 percent raise in 2011. In 2012 and 2013, primary care and preventive services doctors would get” a higher raise than other physicians. “It’s the first time payments have been split up by practice. The move is designed to encourage doctors to go into primary and preventive care services (Haberkorn, 5/20). The House is expected to vote on the overall tax extender bill early next week.

The May 19 and  May 21 Morning Editions detail the dynamics of pending pay fix proposals.  

Meanwhile, in addition to the pay fix provision, the tax extenders bill also contains an extension of the COBRA subsidy that helps unemployed people continue health coverage through their previous employers. Kaiser Health News reports that it would be the fifth time Congress has extended the subsidy since February 2009.

For more details regarding the COBRA extension, read the May 21 Morning Edition.