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Transcript: Health On The Hill – November 2, 2009

House Democrats are expected to begin floor debate this week on their health care overhaul plan and House Republicans are expected to unveil an alternative measure. View the HOTH video or listen to the audio version (mp3).


JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill, a conversation about efforts to pass health care reform legislation. Joining me, as always, Mary Agnes Carey of Kaiser Health News and Eric Pianin, also of Kaiser Health News. Good morning to you both. Let’s talk about this week first. In the House, the debate begins on the bill that the Democrats unveiled last week. What is the expectation?

MARY AGNES CAREY: Well I think that they will have a lengthy debate. The House Democratic leaders are very confident that they will have the votes to pass their measure. We will have to see if that happens. Republicans in the House are expected to have their alternative which would be far, far different from what Democrats have offered.

For example, the Republican House, Republican alternative, would not have an individual mandate, is not going to have an employer mandate, is going to have some medical malpractice caps which is not part of the Democrats’ plan. So, they will try to offer that and get votes for it, but again the House Democratic leaders are confident that they will have enough votes to pass their bill possibly.

ERIC PIANIN: And for sure there are a few outstanding issues including abortion, immigration that have to be resolved. It is not a slam dunk.

JACKIE JUDD: Go into detail if you can for a moment about the abortion issue.

ERIC PIANIN: Well, Congressman Stupak from Michigan is leading the effort of the anti-abortion forces to make sure that the legislation makes it clear that no federal money could be used for abortion counseling or for abortions and the leadership has got to figure out a way around this because it’s a very contentious issue.

JACKIE JUDD: Does the leadership fear that this could peel away some of the 218 votes?

ERIC PIANIN: That’s a possibility and I think they are looking at a number of possibilities. Congresswoman Capps of California has a proposal that would try to preserve the option for abortion services and yet also make it clear that no federal money would be used for those purposes so they have got to work this out.

JACKIE JUDD: Soon after the Democratic leadership unveiled its bill last week, late last week the Congressional Budget Office came out with an analysis of the public option which, as we all know, has been getting so much sustained attention over the past few months with some surprising, I think, for people across the country, surprising results. What are they?

MARY AGNES CAREY: Of the 30 million people who would purchase health care through the health care exchange as part of the bill by 2019, just 6 million of those folks would be enrolled in the public option, so that was a big surprise, exactly to your point. It has gotten all this conversation, all this attention, yet the amount of folks who would enroll is quite small.

JACKIE JUDD: And so I guess the obvious question is why has it become such a big issue? It seems that the Republicans use it almost as emblematic of the Democrats trying to turn this into a government run program.

ERIC PIANIN: I think that is it. I mean, I think for the critics it would be tantamount to the camel’s nose under the tent. Yes, it is a small beginning but it could metastasize into, from their standpoint, government control of more and more of the health care industry, and so there has been very strong opposition to any kind of government public option.

But it is pretty remarkable when you look at the numbers, for all the debate and angst over this issue, it’s a miniscule percentage of people who would actually be taking advantage of it, and depending on how the program works out the insurance premiums under the public option might not be any less expensive than other forms of insurance. In fact, in some cases, it could even be more expensive.

JACKIE JUDD: So does the CBO report ironically help the Democrats argue this is not the nose under the tent?

MARY AGNES CAREY: I think they can make the argument, continue to make the argument they have made all along, this is just a choice. It is an option. You don’t have to enroll. Not everyone is expected to enroll, it will have nowhere near the massive sweeping change on the health care system that Republicans say that it will.

JACKIE JUDD: Let’s move over to the Senate side for a moment, what’s happening there this week?

MARY AGNES CAREY: Well, you’ve got the combination of the, we are expected to see a combination of the Senate Finance Committee and the HELP, or the Health, Education, Labor and Pensions Committee. Senator Reid, who is the majority leader, has sent some options to the Congressional Budget Office (CBO) for scoring and we are awaiting that product to come back and to see how things go from there.

JACKIE JUDD: Moving down to 1600 Pennsylvania Avenue, there was reporting over the weekend how the Administration really has been playing a very significant behind the scenes role, it may not always have been obvious, what is your take?

ERIC PIANIN: Well, I think that there has been this ongoing debate about how involved should the President get in the nitty-gritty negotiations.

JACKIE JUDD: There have been fits and starts.

ERIC PIANIN: Fits and starts and of course after the August recess when the proposal seemed to be on a respirator because of all the opposition to it and the critical comments at all these public meetings around the country, a lot of people were saying where is the President? He has got to get more involved. He has got to roll up his sleeves and come up to the Hill and knock heads and make stuff happen.

Well, the reality is that some of his top lieutenants, you know, Rahm Emanuel, Nancy Ann DeParle and others who have been focusing on this issue, have been spending lots of time up on the Hill and are key players in the negotiations. The President prefers to step in at critical moments or enunciate his views on the campaign trail, if you will, and that is pretty much what he has been doing up until now.

We will just have to see. I mean, this thing goes in fits and starts. Right now, things look really good for the Administration. It looks as if something will pass. There will be something on the President’s desk to sign, but something could blow up. We know the history of these negotiations so while things look pretty good for the White House now, there is no telling exactly how this is going to all play out.

JACKIE JUDD: Okay, thank you both very much. I appreciate it. And thank you for joining us. I’m Jackie Judd.

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