Congress has left the building.
Four out of five committees of jurisdiction have completed work on an overhaul of the US healthcare system -- three in the House, one in the Senate. And members are back in their states and districts defending -- to sometimes-raucous town meetings -- a health plan that does not yet exist.
But the endgame for healthcare reform still turns on six bipartisan negotiators on the Senate Finance Committee -- and the army of interest groups invited in or out of the cone of silence.
Their clout is the number 60. That’s the number of votes it takes to break a filibuster in the Senate, and with members absent for health reasons, Democrats need GOP votes to get to 60. The only panel with a claim to a bipartisan strategy is Senate Finance.
The Gang of 6 has missed self-imposed deadlines since March, but is running up against a mid-September deadline that may signal the limit of how long the White House and congressional Democratic leaders are prepared to wait for the last panel to get it done.
The six include Sens. Max Baucus (D) of Montana (committee chairman), Kent Conrad (D) of North Dakota, and Jeff Bingaman (D) of New Mexico, who rank No. 3 and 4 in seniority on the Democratic side. The three Republicans are Sens. Charles Grassley of Iowa (the ranking member), Olympia Snowe of Maine, and Michael Enzi of Wyoming.
Emerging elements of the Senate Finance draft include: No public health insurance plan, no employer mandate and no denial of coverage for preexisting conditions; a likely individual mandate and subsidies to help buy insurance; a network of nonprofit, member-owned cooperatives and state-based health insurance exchanges to expand access; taxes on high-end insurance policies; and a price tag of around $900 billion over 10 years.
For lawmakers not privy to these closed Senate Finance deliberations, it’s a frustrating process.
“Obviously it would seem to me that it would be better if we were all participating, but [Chairman Baucus] obviously wants to get the 60 votes, and so all the attention has gone to these three [Republicans],” said Sen. John Rockefeller (D) of West Virginia, in a briefing with reporters on Thursday.
“You just watch as the bill diminishes in its scope and in its coverage and in its ferocity to try to attack the problem. And I don’t know where it will come out,” he added.
So, how do the other 529 members of Congress get to have a say in these closed yet critical deliberations? The same way they influence legislation -- by working through outside interest groups with clout in the Congress to influence other members.
That’s how Senator Rockefeller, ranked by seniority the No. 2 Democrat on the Senate Finance panel, but not one of the six, went public with his concerns about the Gang of 6 this week -- and mobilized interest groups to raise concerns about how proposed reforms would affect children.
At issue is whether poor children will lose benefits they now claim under the State Children’s Health Insurance Program (SCHIP) once they are moved into proposed state-based insurance exchanges.
“I sat with Grassley and Baucus from 5 p.m. to 7 p.m. every day for weeks to get SCHIP passed,” Rockefeller told reporters on Wednesday. “SCHIP is very big on dental and mental, but that will all disappear when they go into the exchange.”
At the same time, children’s advocacy groups active in the drive for SCHIP, writing to senators and members of Congress under the umbrella of the advocacy group First Focus, picked up the theme this week.
“Movement of children out of the Children’s Health Insurance Program and into the Health Insurance Exchange could potentially leave 9 million children worse off by providing fewer benefits and higher cost sharing than they currently have through CHIP,” said First Focus, in an Aug. 5 letter signed by 153 national and state groups.
“Before moving children out of these successful programs, Congress should ensure that children will receive comparable or better benefits, cost-sharing protections, and access to care under any new program,” they wrote.
First Focus President Bruce Lesley notes that the impetus for mobilizing outside groups came from Rockefeller. “Senator Rockefeller said that he’s feeling that the Finance Committee is moving toward a solution that would eliminate SCHIP and move them into the exchange and leave them less well off,” he said in an interview.
By end of week, as Congress prepared to leave for August recess, Chairman Baucus was briefing colleagues and fielding questions on the issue.
“I was one of the proponents of SCHIP,” he said. “We’re going to do all we can to make sure that SCHIP is not damaged. We’re very sensitive to that.”
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