Senate Democrats scrambling to pass a sweeping health care reform bill before Christmas begin this critical week facing a host of nettlesome problems that threaten to derail the Democrats’ fast-track timetable.
Democrats must work out compromises on long-standing problems like the public option and abortion while dealing with more recent intraparty spats, like whether to allow consumers to buy Food and Drug Administration-approved drugs from other countries, an issue that stalled last week and remains stuck on the Senate floor.
Most insiders agree that Democrats have until Thursday to work out their differences if they want to pass a bill by Dec. 23. It will take at least five or six days after Democrats move to end debate before they can vote on the bill. Democrats expect to begin the endgame early this week and still sound optimistic that they can get it done.
“We’re struggling to come together on the most difficult issue America has ever faced, and we’re really getting close to the finish line. We’ve had our disagreements, but it hasn’t been poisonous in any way,” said Sen. Chuck Schumer (D-N.Y.).
The first disagreement Democrats have to bridge is over the public option. Senate Majority Leader Harry Reid last week declared a broad agreement had been reached on this thorny issue, only to have his own party members walk back his pronouncement. In reality, Democratic liberals and moderates had only agreed to ask the Congressional Budget Office to provide cost estimates on a number of possible solutions — now expected to be finished as early as Monday.
One of the compromises is to jettison a government-run health insurance plan in favor of creating new national nonprofit health plans provided by private insurers and expanding Medicare to allow people 55 to 64 years old to buy coverage. It’s a solution that has great appeal among liberals but has met resistance from moderates like Sens. Ben Nelson (D-Neb.), Olympia Snowe (R-Maine) and Joe Lieberman (I-Conn.)
On Sunday, Lieberman said on CBS’s “Face the Nation” that the Senate could pass a bill this week if Democrats agreed to take “a few things out of the bill,” including the Medicare expansion and public option.
“It doesn’t take much more than that,” he said. Lieberman’s road map to success entails giving in to almost all the moderates’ demands — a scenario that would infuriate liberals.
And it’s not just moderates who have problems with the Medicare buy-in. On Friday, a group of 10 Democratic senators, including Wisconsin’s Russ Feingold and Vermont’s Patrick Leahy, wrote to Reid, worried that expanding the program without changing the rates Medicare pays to doctors would curtail seniors’ access to care. The letter came a day after a report by the Centers for Medicare and Medicaid Services found that the bill’s Medicare savings “may be unrealistic.”
Another finding by the CMS actuary — that the bill will increase national health expenditures by $234 billion, or 0.7 percent, over the next decade — could have particular resonance this week as Republicans use the finding to buttress their argument that the bill does nothing to control costs.
In fact, Senate Republicans reminded reporters of the $234 billion increase Sunday, minutes after Missouri Democratic Sen. Claire McCaskill said on “Fox News Sunday” that she’d “absolutely” vote against the Senate health care compromise if it increases costs and the deficit.
Another issue that may grow more troublesome for Democrats is a provision in the bill that allows insurers to place annual dollar limits on coverage as long as they’re not “unreasonable,” which backtracks on a Democratic promise to abolish such caps.
Reid spokesman Jim Manley said “banning all annual limits, regardless of whether services are voluntary, could lead to higher premiums.” Democrats, he said, are working to ban arbitrary limits while keeping premiums in check.
When Democrats return to debate the bill Monday, they also will have to resolve an internal flare-up over an amendment that threatens to break an $80 billion deal between the White House and the pharmaceutical industry.
The amendment to allow consumers to buy FDA-approved drugs from other countries stalled on the Senate floor last week as Democrats tried to figure out how to give North Dakota Democratic Sen. Byron Dorgan a vote on his amendment without busting the carefully crafted deal between drug companies and the White House. Some Democrats worry that a broken agreement with PhRMA could send health reform completely off the rails. When the deal was struck, there was an understanding that the drug industry would not face further cuts. Dorgan estimates reimportation could save $100 billion.
Dorgan, who thinks he has the 60 votes needed to pass the amendment, said his colleagues are delaying because “they’re probably worried that it’s going to pass.”
Iowa Republican Sen. Chuck Grassley supports the provision and said it’s being held up “because of the PhRMA agreement with the White House. ... They don’t want egg on their face with PhRMA.”
Some Republicans were downright gleeful about the Democratic turmoil. “They’re all wrapped around the axle here. It’s amusing,” laughed Arizona Sen. John McCain, who supports Dorgan’s amendment.
In fact, some Republican lawmakers raised the prospect that their GOP colleagues who oppose the amendment may vote in favor of it just to further complicate the bill.
Democratic leaders blame Republicans for holding up the amendment. They say that their offers to vote on the bill were rejected by the GOP. Republicans say they rejected an offer late last week because it would have allowed a vote on three Democratic amendments and only one Republican proposal, which was not fair.
New Jersey Democratic Sen. Frank Lautenberg has drafted an alternative to Dorgan’s amendment that he says ensures that imported drugs will be safe; it will be voted on with Dorgan’s amendment. He rejected the notion that he’s offering the amendment to protect the PhRMA deal.
It’s also an argument that the drug industry is making.
“There are a number of members who agree that we should have importation only if the FDA can say definitely ... that it’s safe,” a drug lobbyist said.
Dorgan said Lautenberg’s amendment is “designed to kill our effort to allow the reimportation of drugs and put the brakes on skyrocketing drug prices.” He called the safety argument “completely bogus.”
The drug industry is fighting Dorgan’s amendment, but a White House official knocked down as false a report that the administration is working against it.
“The president supports reimportation of safe and effective drugs. He made that clear in his fiscal year 2010 budget, which included $5 million to enable the FDA to begin developing policy options,” said spokesman Reid Cherlin. “The Food and Drug Administration has raised safety concerns about the current proposal and will continue exploring policy options to create a pathway to importing safe and effective drugs.”
If Democrats can overcome the looming hurdles and pass a Senate bill, they still face the difficulties of reconciling their legislation with the more liberal House bill. In a meeting last week, House Democratic leaders dismissed suggestions that they’d be willing to simply accept whatever the Senate passes, people present said. Majority Leader Steny Hoyer (D-Md.) told the group that he wanted to make sure the House would not just rubber-stamp the Senate bill simply to avoid another round of contentious, time-consuming negotiations.