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Transcript: KHN’s Health On The Hill

Jackie Judd: Good day. I’m Jackie Judd.with Health on the Hill. Today, a reporter roundtable to discuss health care reform as Congress returns from its July 4th recess.

Joining me todayas always, Mary Agnes Carey of Kaiser Health Newswe also welcome Carrie Budoff Brown of Politico and Jeffrey Young of The Hill. Welcome to you all.

Mary Agnes, the first question goes to you. The Senate HELP committee is coming back from recess with a new estimate of what its bill would cost from the Congressional Budget Office. What are the new estimates and why was it important?

Mary Agnes Carey: It was important to them because the number of the new estimate was far lower than the number of the previous estimate. The estimate released late last week put the Senate Health, Education, Labor and Pensions Committee bill at about $600 billion over the next decade. That would include a public plan option, an employer mandate and it would cover about 21 million Americans who currently do not have health insurance. The previous estimate, a few weeks ago, had a much higher price tag at about a trillion dollars, picking up about 16 million of the uninsured.

Now, members of the HELP committee said on Friday that their hope is: once what they’ve done is combined with what the Senate Finance Committee is expected to do, that you’ll have health insurance covering about 97 percent of Americans who currently don’t have insurance. The problem is that they’re assuming that you could have a Medicaid expansion to as high as 150% of the federal poverty level. It doesn’t look, at this point, that Senate Finance is going to go that high. So we’ll have to see how this plays out in the next few weeks.

JJ: Jeff, when those first numbers came out from the CBO, it was disastrous. The impression was enormous sums of money would be spent and, at the end of the day, not that many more people would have insurance who don’t now. So what’s the political spin here – why was it important to get that new estimate?

Jeffrey Young: You’re right. If you take a trillion or so dollars and divide it by 16 million people, it’s a pretty hefty price tag per person, and it makes it look like a terrible bill. So, right away you have the perception of ‘now, we’ve made this thing cheaper and, look, we’ve managed to cover all these new people, not even counting what they might do with Medicaid in the Finance Committee.’ So, right away, that looks better.

And it’s also important to point out, on the policy side, why this could look good for them, at least one part of it. By writing in this employer mandate, it locks people in who already have coverage at work and would require almost all companies – if you have more than 25 workers – to provide it. It would preserve the coverage that middle-class workers already have, which they say in every poll that most people are very satisfied with, which would give some real weight to what President Obama says when he tells people if they like what they have, they can keep it. In the case of this bill, the employers wouldn’t have a choice but to let them keep what they already have. So that could go a long way to reassuring middle-class voters that this bill is not going to up-end what they already use.

JJ: Carrie, during the congressional recess, lawmakers from both houses heard from constituents about health care reform. You spoke last week with Sen. Charles Grassley, from Iowa, who is the leading Republican on Senate Finance. What did he have to say about what he’s hearing and where he thinks things stand at the moment?

Carrie Budoff Brown: He had numerous town halls across Iowa. This is traditionally what he does when he goes home for the breaks. In almost every town hall, he heard a lot about health care and he said it ran the spectrum of people who are concerned and really want something passed, concerns about a bipartisan bill, concerns about power grabs of the government, about government messing up what they have. So he really heard a broad spectrum of concerns.

I tried to press him a little bit to see if there was something specific, or overwhelming, that he heard that would change his strategy or give him pause about what’s going on in Washington. He really didn’t let on much about that. I think that what he heard last week will inform him coming into this week, because he’s a key member of the Senate Finance Committee. Everybody is looking to him to see which way he moves in the next two, three weeks, five weeks, really. A lot of speculation that, as the highest ranking Republican still involved in the process, it’s going to be become increasingly more difficult for him to stay at the table as Democrats continue to exert what they want more over the next few weeks and months.

JJ: He’s part of this group that Senator Baucus, the chair of the committee, called “the coalition of the willing.” Is that still a focal point of negotiations between Democrats and Republicans?

CBB: It is in the Finance Committee, which is the last place where Democrats and Republicans are sitting at the table together, for the most part. They will be back this week, they’re the core of the working group (in the Finance Committee) trying to come up with a bill. Of course, all those members are going to have to go back to their respective parties and their caucuses to try to get sign-off. But a lot of the writing of the bill right now is concentrated with these seven senators.

JJ: Jeff, you heard Vice-President Biden give an interview over the weekend about his view about how this could play out, politically. What was it that caught your ear?

JY: Well, while we’re all rightly paying attention to the process that’s taking place in Congress right now – the House will start marking up its bills, the HELP committee will finish its markup at some point and the Finance committee some time soon had better come out with a bill – from the White House’s perspective (and I think a lot of people on the left are counting on this too), what Vice-President Biden said was that the President is not going to get personally involved in the negotiations over individual policy points in the bill, such as whether to have a public plan as part of the health insurance exchange, until after the House and Senate pass their original versions and then go into the conference committee to hash out the final product.

This is something that everyone sort-of, maybe figured, but it was telling that the Vice-President came out and said as much. And it matches the strategy that the President has used on other bills, as well, such as the stimulus. From the liberal perspective, and I’ve heard little hints at this from people especially those in the Senate, who support the public plan, who support some of the more liberal policies in there – they may be concerned about what’s coming out of the Finance committee. What they can look at now is, ‘well, the House will have a public plan, the House will have a Medicaid expansion, the Senate HELP committee will have a public plan’ and some other things that they like to see, the President keeps saying he supports those things. So even if what comes out of the Finance committee, or indeed even the Senate itself, doesn’t include some of those provisions, I think they feel pretty confident that they’ll win out in the end, provided they can get through the next five weeks and actually get to that point where the House and Senate have passed bills, especially once President Obama steps in and tells members of Congress, members of his own party, that ‘this is what I want, I’m standing here.”

JJ: He hasn’t done that yet.

JY: I think what the Vice-President made clear is that he plans to, and now we know when. I think that also sends a signal to liberals in the Senate, in particular, “the President is with you” and I think it sends a signal to Republicans in the Senate, in particular, that there will come a point at which the President is going to assert himself.

I should also add that if you are a centrist Democrat, whether you’re in the House or Senate, you probably knew this already, but now you know that the President is going to come to you at some point, if the House and Senate pass their bills, and say: ‘I know there may be things about this that you’re not comfortable with. Are you with me or not?’ I think it’s going to be hard for – even though centrist Democrats have said ‘we don’t like a public plan, we don’t like these other things – to tell the President ‘no’ in his first year in office, his first major domestic initiative.

CBB: On the flip side, for the progressive end of the party, too, they’re going to have to – if this comes to a point where the shape of the bill doesn’t satisfy them the President will have to exert himself on the progressives and say ‘you may not be getting everything you want, but do you want to scuttle this whole thing if you don’t get the strongest public plan that you envisioned?’ So we’re all kind of looking for when the President will do that. And I think that’s why those comments were telling.

JJ: You know, in these conversations we always talk about or allude to the timeline – the timing of all of this. Why is that so important to this debate and how it eventually will resolve itself?

MAC: Because it’s always so difficult to pull these things together. Senate Finance as we know has not produced their bill. We’re talking about probably 2 weeks of floor time on the Senate floor to get this done. If they’re going to have a bill, members of that committee, in particular the Republicans want to see a full score from the Congressional Budget Office before they mark up that package. All these things take time, so if you look at the calendar, we’ve got about 4 to 5 weeks, the Senate then a week longer, they’re in the first week of August, the House is not the Senate has got to start moving things if they want the bill done before the August recess. The House is likely to pass its first version before the August recess. And then you have to have time for this thing called the conference committee when they come back, when members of the House and Senate get together.

JJ: And the conventional wisdom again sticking with this timeline discussion is that the longer it goes on, the more you risk the Christmas tree syndrome — people adding more and more ornaments, more and more things to help them and their constituents. And also the President doesn’t want it to go on too long because who knows what will happen to his honeymoon period, how long that will last.

CBB: Yes, and even just looking to November, after the first week of November, you sort of shift into pretty hardcore, midterm election politicking. And then that complicates things severely, so we hear about October 15th as when the President wants this bill and that’s for a reason. It gives him enough time ahead of when people really start campaigning and shifting towards the 2010 election that will complicate everything. And you’re right, the longer this drags out for the President, it’s harder, it becomes easier for the opposition to build and sharpen their message and the Democrats have specifically not put out too much detail on their bills. The Finance committee didn’t put out the full scope of what they’re looking at before the July recess for that very reason, which is the more you get out there, the easier it’s going to be to develop opposition messages and attack it and weaken it.

JY: From the President’s perspective, he also needs a thing to actually sell. This is such an enormous issue, and as people always point out, unlike you know, you could look at other big issues like energy and climate change and stuff like that. This affects every single person basically every day. So it has to be a presidential initiative. And if Congress goes into recess in August, and there’s three weeks of silence here in Washington on this stuff, and the President doesn’t have a narrower set of things to try to sell the public.

Into September and October, he needs a bill to tell people “this is what it does, this is why it’s good.” So if this lingers around too long with all this uncertainty, the President has to continue to be somewhat vague What a lot of members of Congress have said to me, and I’ve seen it reported everywhere on the Democratic side, is: ‘this needs to be the President’s bill not ours.’ And until there’s a bill, it can’t be.

JJ: And Carrie, you wrote an interesting article that was posted today about a memo from a centrist organization about how to shape the debate that Jeff was talking about. Are we going to start hearing health care reform described in a slightly different way?

CBB: I think, what their way they argued in this memo, they did a large poll. Obama’s pollster did the polling. And they step back a little bit. President Obama has talked about cost, quality, affordability; those are kind of his three principles. And the memo argued that you need to actually be a little more visceral and sort-of draw a more emotional response from people. Those are very computational words. You know, Mister Spock words for a Doctor Spock debate was there, was what they said about it.

So they argue that you need to build this argument around the idea of stability, creating stability for the middle class. And in addition to talking about, it should be the umbrella over the debate in terms of trying to get buy-in from the middle class, who are concerned that whatever happens will help somebody else, not them. They generally support reform when it comes to wanting it. The case isn’t being made that they will personally benefit. And their way argues that you need to sell them on the idea of stability. That we are going to keep the costs low, that you won’t have to worry about losing your job.

And [the memo] argues that the lawmakers and the President should provide that more emotional argument for people so they move from just saying generally they like it, to actually buying in and believing that this package will provide something for them and just not covering 47 million uninsured people, which generally has been the focus of the President and lawmakers. But they sort of need to reshape the debate, and already the House Democratic Caucus has incorporated this into their talking points. They did that ahead of the recess.

JJ: One final question to you, Mary Agnes. Apart from what’s going on Capitol Hill, the White House is negotiating with the hospital industry to come up with a cost savings plan. Describe where things stand with that and how that tracks with what is happening on the Hill.

MAC: The negotiations are ongoing. Both sides appear very close to an agreement that would reduce government payments through Medicare and Medicaid to hospitals by about $160 billion over the next decade. The key thing here under discussion is the phase in of the cuts. Hospitals get this thing called disproportional share or dish payments to help cover the care they provide to the uninsured people and as more and more Americans get health insurance, the thought is that that’s how those dish payments could slide down and be reduced over time.

So it’s a very interesting thing to watch, because you do have everything going on on Capitol Hill, all the committees with come up with their own jurisdiction of what they call ‘pay fors.’ They’ll want certain things of the hospital industry, they’ll want certain things out of the health insurers, out of the drug industry. But separately, those industries have been negotiating with the White House to come up with their own list of savings cuts that are out there and that can help pay for health reform. Because as we all know, the message has been, with Democrats and President Obama, not only do we want to expand coverage, we want to make sure that we pay for it as well.

JJ: OK that’s the final word for today. Thank you each and every one of you. We appreciate it. And thank you very much for watching. I’m Jackie Judd.

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