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Transcript: Health On The Hill – Debating Next Steps For Health Reform

Congressional Democrats continue to debate their next step on health care overhaul legislation, with some urging that Congress move quickly on a scaled-back approach. President Obama and administration officials have stressed that they do not want Congress to abandon the issue and the president is expected to discuss health care during his State of the Union address.

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JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill. It’s been a week since the election of Republican Scott Brown of Massachusetts to the Senate, ending the Democrats’ filibuster proof majority, and placing in jeopardy passage of the overhaul of the nation’s health care system. Here to discuss what’s ahead, Mary Agnes Carey of Kaiser Health News, and Julie Rovner of National Public Radio. Thank you both for joining me today.

Administration officials were fanned out across the Sunday talk shows. Was there a singular message that they were delivering about what’s the future of health care; Julie?

JULIE ROVNER: Well yes and now I think their message was that you cannot let this health overhaul die; that something has to happen. I think the problem with the Administration’s message is that it hasn’t been very clear. The President started out last Wednesday in an interview with George Stephanopoulos and said; well maybe Congress should just take out the most popular and agreed upon elements of this Bill.

Almost immediately the Administration started walking that back, saying well no, maybe we really need to go ahead with something approaching the Bill that was in the process of being negotiated. Now how procedurally you could do that is still difficult with the-

JACKIE JUDD: The Senate passed Bill you’re talking about.

JULIE ROVNER: The Senate passed Bill; now Speaker Pelosi’s saying there aren’t the votes for the Senate-passed Bill, but remember they were negotiating the House and the Senate passed Bill. House Speaker Nancy Pelosi’s saying, well we can’t pass the Senate-passed Bill.

The President on Friday went to Ohio and went back and said, we really have to push full speed ahead. Meaning you need something really robust; sort of talking about the big Bill again. And then over the weekend we saw these administration officials looking like they were talking about maybe a smaller Bill again.

So we’ve really had this back and forth, the Administration looking like it’s arguing with itself. Saying yes, there needs to be something, but exactly what that should be is not all that clear, coming from the administration.

JACKIE JUDD: Safe to say then that the Democrats, to some degree, are still reeling from this political upset in Massachusetts, even a week later?

JULIE ROVNER: Oh yeah, absolutely.

JACKIE JUDD: And Mary Agnes, what are you hearing on the Hill about what Valarie Jarett called determining the art of the possible?

MARY AGNES CAREY: Well that’s really going to be in the eye of the beholder. I mean some members think you could do a much smaller package; you could focus on the insurance market reforms. But then again, if we go that route and here we’re talking about not discriminating based on a pre-existing medical condition; or not cancelling health insurance when someone gets sick, that brings up this difficult issue of the individual mandate, which some members have a problem with, and some members and the public have a problem with this idea of requiring people to buy health insurance.

A smaller package could include – there were provisions in both Bills to allow young adults to age 26 or 27 to stay on their parent’s health insurance policies; the idea of expanding Medicaid, or subsidies to small business, or to individuals. The question is whether or not you can scale that back into a package.

The Massachusetts Senate race scared a lot of folks on the Hill. Some of them think this means we shouldn’t touch health care at all. Some think we should move quickly to do a scale-back package; move on to economy and jobs. Those were also issues, not only Massachusetts, but all over the country. So I think that consensus is being developed, along with the White House with their thoughts and we’ll have to see where it all plays out.

JACKIE JUDD: And do you both believe from what you’re hearing, that the notion of having the House simply vote on the Senate Bill, and then fixing some of the issues in it, and reconciliation later with the 51 vote majority in the Senate, is that absolutely dead or are there still conversations?

MARY AGNES CAREY: Well Speaker Pelosi said that there are not the votes for it at this time; that qualifier was thrown in and I think it leaves the door open. But there’s a lot of discomfort in the House with the Senate Bill. And there’s also a discomfort whether or not you could put fixes into a budget reconciliation package. Would the Senate in fact pass that if the House took the first step to do it? So this is all a part of the ongoing negotiation.

JACKIE JUDD: On Wednesday night the President goes to Capitol Hill to deliver his State of the Union address. What are you hearing, Julie, about what to expect in terms of the messages he will be delivering about health care reform?

JULIE ROVNER: Well certainly jobs and the economy will be the primary message of this State of the Union. The administration was always planning on turning to jobs and the economy as the main message of this State of the Union. But I think now, given what happened in Massachusetts, health care is going to have to be an important part of that.

I would think that what we saw in Ohio on Friday; which is that Congress must do health care, that this has been the President’s message all along; you cannot fix the economy without fixing health care, will be an important part of the speech. It will not be the central part of the speech, but it will have to be in there, and one would think that by then the White House will have, you know, decided which way it really wants to go on health care.

JACKIE JUDD: And most likely, given the nature of State of the Union, it will be about the lofty goals; the view from the 10,000 foot level. It’s not going to be the nitty-gritty.

JULIE ROVNER: No, of course not, and it never is. But certainly this is important. I think at this point, Congress needs to be led on this issue. Congress, you know, they really are sort of running around trying to figure out which way to turn on this, and how to do it procedurally.

So really, they need the President to lead them at this point; to bring the public back on board in terms of health care so they can decide how best to proceed. Because right now you’ve got Democrats, as Mary Agnes said, scattering in lots of directions.

Does this mean they should do something smaller? Does this mean they should do nothing at all? Does this mean they should proceed full-speed ahead? It’s not entirely clear, and you’ve got lots of disagreements just within the Democrats in Congress about how to proceed on health care.

JACKIE JUDD: Mary Agnes?

MARY AGNES CAREY: Well I think that that’s exactly right, that in the State of the Union it’s going to be a very general message, but I think the President will keep the heat on to get health care reform passed. I think that’s definitely what he wants to happen this year.

JACKIE JUDD: Let’s talk about Republicans for a moment. They also were on the Sunday talk shows; what kind of signals are they giving about what they would like to do in the near future with health care reform?

MARY AGNES CAREY: Well they’ve said that the current-the Bill that currently exists for Democrats are absolutely non-starters. You got to get rid of it; you got to start over. Now they say that they would like to find consensus and they put out markers that are important to them; medical malpractice reform, for example o equalizing the tax treatment between individuals who purchase health insurance, and then people who get it at work, to give them the same kind of tax break an employer can receive.

They want to sell health insurance across state lines. They may want to do that in a different way than the Democrats want to do it. They say they’re open, but there have been signs all year that Republicans have been extremely resistant to what Democrats want on health reform, and the way the Democrats want to proceed.

Speaker Pelosi was very skeptical last week during a news conference that Republicans would want to work with them at all on health reform. So it does seem like it’s still-I don’t know what Julie thinks, but I think a pretty strong dividing line between the parties on what they want to attain on this.

JULIE ROVNER: Remember Max Baucus spent three months trying to deal with Republicans; trying to get a deal with Senator Chuck Grassley-

JACKIE JUDD: Trying to get a single vote-

JULIE ROVNER: Trying to get a single Republican vote; well, he ultimately did get Olympia Snow at the committee, but really he sat in that room with Senator Grassley and Senator Enzi, and for a while Senator Hatch. You have to remember that a lot of the things that Republicans are talking about is consensus issues, medical malpractice, selling insurance across state lines; when the Republicans were in the majority, they never got a majority vote for medical malpractice.

They never got 50 votes in the Senate when they had the majority. The selling across state lines, the Speaker of the House, the Republican Speaker of the House never brought that to the House floor. He was afraid he couldn’t get a majority for that when the Republicans were in the majority. These are not wide-spread, popular agreed upon things; these are very controversial items.

So these are not exactly consensus-building issues of their own. So let us not fool ourselves that these are things that everybody could agree on. These are things that don’t necessarily have consensus agreement within the Republican Party; they are not exactly going to be things that they can just throw in and suddenly get broad agreement.

JACKIE JUDD: Okay, thank you both, another interesting week. Thank you for joining us. I’m Jackie Judd, and this has been Health on the Hill.