Government Executive - Authors - Anna Edney

It's really over this time; chambers finish health care overhaul

Anna Edney — Fri, 26 Mar 2010 00:00:00 -0400

After more than a year of debate, the House and Senate put the final touches on the healthcare overhaul Thursday, passing changes to the new law that locks up President Obama's signature domestic policy issue.

The House passed the technical changes, contained in a reconciliation package, 220-207, after a short debate Thursday evening. The House already passed the initial reconciliation bill Sunday night when it approved the main overhaul bill.

The Senate, which passed the reconciliation bill 56-43 earlier Thursday, had to make tweaks after the first House passage based on a parliamentarian ruling that two student loan provisions violated the Byrd Rule. The Byrd Rule requires every piece of a reconciliation bill to directly affect the budget.

The reconciliation bill makes changes to the overhaul legislation Obama signed Tuesday. Democrats added student loan language to make the deficit reduction numbers required by reconciliation add up.

Republicans attempted to drag out the final House debate Thursday night.

In a floor statement kicking off debate on the fixes, Rules Chairwoman Louise Slaughter called the roadblocks a "surprise."

"Does it really make sense to anyone that the other side is demonizing a bill that's already been approved by both the House and Senate and signed into law?" she asked.

Rules ranking member David Dreier explained that Republicans were critical of the handling of the fixes, because, he said, the Rules Committee had just met and the measure was rushed to the floor under what's called a "martial law rule." While Democrats did call the Rules meeting at the last minute, the changes to the reconciliation bill amounted to 20 words.

The Senate endured 12 hours of "vote-a-rama" on more than 40 Republican amendments beginning Wednesday evening, with a break in between until the final vote Thursday afternoon. Democrats turned back each amendment.

Democratic Sens. Ben Nelson of Nebraska and Blanche Lincoln and Mark Pryor of Arkansas voted against the reconciliation bill during the Senate vote. Sen. Johnny Isakson, R-Ga., did not vote. He was released from a Georgia hospital Thursday after suffering a bacterial infection.

Nelson objected to the student loan language, and Lincoln did not support using reconciliation. Pryor objected to the substance, mainly, he said, that Arkansas' Medicaid costs for enrolling users will double, wealthy Americans will be taxed for unearned income, and employers who do not offer health insurance will face significantly larger fees.

"As more and more details of the package were released, I spent considerable time weighing the benefits and drawbacks to Arkansas," said Pryor, who voted for the main overhaul bill. "In the end, I believe this legislation is a step we don't need to take."

The reconciliation bill increases federal subsidies to help those without employer-sponsored insurance purchase coverage; closes the Medicare Part D doughnut hole; increases Medicaid funding for most states; and pushes back implementation of a tax on high-cost health plans until 2018 while raising the threshold for plans eligible for the tax.

In a comedic bit of déjà vu, Senate Majority Leader Harry Reid once again voted "no" at first, immediately switching his vote to "yes," just as he did Christmas Eve when the Senate passed the main overhaul measure. Just as he did that December morning, Reid looked down laughing before he gave the "yes" nod.

Billy House contributed to this report.

]]>

Senate sends fixes bill back to House

Anna Edney — Thu, 25 Mar 2010 00:00:00 -0400

The Senate on Thursday voted 56-43 to approve changes to the healthcare overhaul and send it back to the House for a re-vote on two tweaks that the Senate was forced to make to ensure the bill complied with reconciliation rules.

The House expects to vote Thursday evening, Majority Leader Steny Hoyer, D-Md., said, wrapping up a debate that has lasted more than a year on President Obama's signature issue.

The adjustments the Senate made to the reconciliation bill, which contains changes to the overhaul Obama signed into law Tuesday, are minor. Speaker Nancy Pelosi, D-Calif., characterized them as "technical." The Democrats voting no were Sens. Ben Nelson of Nebraska and Blanche Lincoln and Mark Pryor of Arkansas. Sen. Johnny Isakson, R-Ga., did not vote because he is hospitalized.

Both tweaks apply to the student loan section added to make the deficit reduction numbers add up to meet reconciliation requirements. The Senate parliamentarian ruled the provisions out of order because they do not have an impact on the budget.

One provision would have protected Pell Grants from shrinking if their appropriations decrease. The provision would not have affected the grant program until 2013, and Democrats are confident they can address the issue before then.

Senate Budget ranking member Judd Gregg, R-N.H., raised the points of order against the two provisions. His office said the provision would not affect Pell Grant spending in the bill.

"While that provision might mean something in a future Congress, it has no effect on the level of mandatory spending on Pell Grants in this bill," according to a statement from Gregg's office. "And even though the provision is struck from the bill, mandatory Pell spending in this bill remains unchanged."

The other provision would have eliminated obsolete language.

The reconciliation bill increases federal subsidies to help those without employer-sponsored insurance purchase coverage; closes the Medicare Part D doughnut hole; increases Medicaid funding for states; and pushes back implementation of a tax on high-cost health plans until 2018 while raising the threshold for plans eligible for the tax.

Savoring his big healthcare win on the first lap of a victory tour, Obama today dared Republicans to "go for it" and try to repeal the signature legislative accomplishment of his presidency. GOP leaders have promised to fight to repeal the new law.

Returning to Iowa City, Iowa, where he first promised to overhaul health care during his campaign for office, the president joked that "some folks in Washington are still hollering" about the bill he signed into law on Tuesday.

"Now that it's passed, they're already promising to repeal it. They're actually going to run on a platform of repeal in November," he said.

"Well, I say go for it. If these congressmen in Washington want to come here to Iowa and tell small-business owners that they plan to take away their tax credits and essentially raise their taxes, be my guest."

Noting that opponents will have to tell individual Americans to give up the new rights given them in the legislation, he said, "They can run on that platform. If they want to have that fight, I welcome that fight. Because I don't believe the American people are going to put the insurance industry back in the driver's seat."

George E. Condon Jr. contributed to this story.

]]>

House approves Senate health care bill

Billy House and Anna Edney — Mon, 22 Mar 2010 00:00:00 -0400

The House took a historic vote late Sunday night to approve an overhaul of the nation's healthcare system after more than a year of debate, a few near-deaths for the measure and an intense final week marked by loud and angry protests outside the Capitol.

The House voted 219-212 to send an overhaul measure the Senate passed in December to the president's desk. It also voted 220-211 to approve a package of fixes to the Senate bill. The Senate bill passed amid opposition from every Republican and 34 Democrats. The corrections bill passed with opposition from every Republican and 33 Democrats.

For many House Democrats, the passage represented an historic landmark legislative achievement for President Obama and themselves -- alongside Franklin Roosevelt's signing the Social Security Act and Lyndon Johnson's enactment of Medicare and Medicaid.

"We'll be joining those who established Social Security, Medicare and now tonight health care for all," Speaker Nancy Pelosi, D-Calif., told members just before the vote.

Minority Leader John Boehner, R-Ohio, begged to differ: "This institution is broken and, as a result, this bill is not what the American people need or what our constituents want."

Speaking late Sunday night from the White House, Obama praised the passage of his signature domestic priority, saying, it was "a victory for the American people" that, while it might not "solve every problem" in the healthcare system, "moves us in the right direction."

The Senate will take up the corrections bill that reflects changes to the Senate measure as early as Tuesday. Senate Democrats have 52 votes to pass the fixes, a Democratic aide said. Vice President Joe Biden would break a tie, but with 52 votes it does not appear his vote will be needed. Senate Majority Leader Harry Reid, D-Nev., sent Pelosi a letter promising he has the votes to pass the fixes, but did not publicly release how many votes exactly.

Boehner attempted to cast doubt on the assurance, calling up the one provision in the fixes the GOP feels strongly it can trip up Senate Democrats on. The provision is one that pushes back a tax on high-cost health plans until 2018 under a deal with unions at the White House's request. Republicans argue reconciliation cannot alter Social Security law, which they say the tax would do.

"The bill does not increase Social Security taxes or make any changes in the Social Security Act," the office of House Majority Leader Steny Hoyer, D-Md., argued in a statement. "In fact, the increased Social Security revenues are an indirect result of the health insurance reforms in the legislation."

If the Senate parliamentarian rules the provision is challengeable, the point of order would require 60 votes to overcome -- votes the Democrats do not likely have.

House Democratic leaders worked throughout the week to bring on fence-sitting members, altering language to provide for more equity in Medicare reimbursements in rural areas and, lastly, reaching an agreement with anti-abortion Democrats on Sunday afternoon. Rep. Bart Stupak, D-Mich., and a handful of other anti-abortion Democrats negotiated an executive order that would clarify a ban on federal funding of abortion.

The agreement on the executive order put Democrats over the 216 votes they needed to pass the bill. "I do believe they had the votes even before," Stupak said when he announced the deal around 4 p.m. on Sunday.

"What do you have -- nothing or the executive order, which has the force of law?" he asked. "I'll take the executive order."

Boehner argued any president can change an executive order at any time. "Make no mistake, a 'yes' vote on the Democrats' health care bill is a vote for taxpayer-funded abortions," he said.

Stupak disagreed. "All due respect to Leader Boehner, it's not true," he said.

In a bit of high drama on the House floor, Stupak took to the microphone to challenge a Republican motion to recommit, saying the motion was not an anti-abortion measure as depicted by its sponsors. The GOP brought up a motion to recommit in between the vote on the Senate bill and one on the corrections bill that they argued reflected the abortion language Stupak included in the House bill in November no longer under consideration.

Rather, Stupak told his House colleagues the Republican motion was "an opportunity to continue to deny to 32 million Americans an opportunity for health care."

As Stupak was speaking, someone from the Republican side of the chamber yelled out "baby killer."

Republican at first denied it came from their ranks, suggesting it came from the visitor's gallery above.

But Rep. John Campbell, R-Calif., told reporters asking him about the shout that he heard it, and it came from someone sitting behind him and to his left, and sounded like "a Southern accent."

Campbell went back into the chamber, then returned back outside to a group of reporters to add that he was told a group of Texans were sitting in that area, and that "people who know won't give it up."

The $940 billion overhaul will extend insurance coverage to 32 million people, in part by requiring people to have insurance, offering tax credits to help them buy coverage and extending Medicaid to those earning up to 133 percent of the federal poverty level. The legislation will create a new marketplace, or exchanges, where people can shop for insurance and will prohibit insurance companies from denying coverage based on preexisting conditions. CBO estimates the bill will reduce the deficit $138 billion over 10 years.

The bill is offset in part by a Medicare payroll tax on unearned income and a tax on high-cost plans. Pharmaceutical companies, medical devicemakers and insurance companies also are taxed to help fund the overhaul. The bill making the fixes fully closes the Medicare Part D coverage gap known as the doughnut hole by the end of the decade.

The Rev. Jesse Jackson, proudly holding court outside of the House chamber as his son, Rep. Jesse Jackson Jr., D-Ill., presided inside over a portion of the day's debate, described the healthcare vote as the latest push-and-pull of what has been an historic "tug of war between hope and fear" in America. Pointing to such historic legislation as the Voting Rights Act, Jackson said, "All of these significant changes come with resistance and great fear."

He also indicated this is only the beginning, saying it changes the "frame" of the healthcare system. Comparing it to the Voting Rights Act, he said, "Once the frame changed, other battles were relatively small."

Some Democrats who voted against the overhaul are already feeling the heat from unions. AFL-CIO President Richard Trumka was on Capitol Hill throughout Sunday. AFL-CIO and the Service Employees International Union let Rep. Jason Altmire, D-Pa., know they were unhappy with him in a joint letter Sunday morning informing him they intend to hold him accountable.

"We find it pretty outrageous that he's talking about not supporting healthcare reform," SEIU Secretary-Treasurer Anna Burger said before the vote.

Altmire, who did vote "no," ran on healthcare reform, Burger said, and unions rallied behind him with support and resources. Burger said they will begin searching for a Democrat to challenge him.

As the lawmakers debated on the floor, and eventually voted, thousands of demonstrators surrounded the Capitol. They hoisted banners, and chanted, "Kill the bill! Kill the bill!" and "no, no, no," or "Freedom! Freedom!"

More than once, House Republicans walked out onto a balcony adjoining the speaker's lobby outside the chamber, waving and joining -- or inciting -- them in their chants.

To underscore a bit of solidarity, Pelosi in the early afternoon joined arm-and-arm with other House Democrats, including Rep. John Lewis, D-Ga., in a walk across the street from the Cannon House Office Building to the Capitol.

The walk was a symbolic ode to Lewis' having led voting-rights marchers onto the Edmund Pettus Bridge outside Selma, Ala., where they were tear-gassed by state troopers on what became known as Bloody Sunday. It came on the heels of some lawmakers on Saturday having become targets of anti-gay and racist language by demonstrators outside the Capitol. This time, as the demonstrators shouted and jeered, Pelosi and her entourage were tightly guarded by Capitol Police.

]]>

Congress has light load for State of the Union week

Humberto Sanchez and Anna Edney — Mon, 25 Jan 2010 00:00:00 -0500

Congress has a fairly light legislative schedule this week as lawmakers prepare to receive President Obama's State of the Union and continue mulling what to do about healthcare legislation.

Democrats do not appear in any rush to decide how to proceed with a healthcare overhaul. They are likely to maintain that they need to take a breather to determine the best path forward and will be able to use cover from the State of the Union to turn more heavily toward a jobs agenda.

Many House Democrats favor slicing up the overhaul effort so they can work only on proposals that prove popular with the electorate and could gain bipartisan support in the Senate.

Last week, many rejected the idea of simply passing the Senate bill and making changes to it through the reconciliation process, though senators hoped House Democratic leaders could convince their Caucus otherwise.

Rep. Bill Pascrell, D-N.J., is working on a handful of bills that would include popular proposals like ending discrimination against pre-existing conditions, providing tax credits for coverage and allowing young adults to stay on their parents' insurance longer. He said he could begin rolling out the measures as early as this week and could have GOP support.

Any final decisions on how to proceed are unlikely in the next few days.

House Speaker Nancy Pelosi, D-Calif., has indicated she did not want to hurry a decision and Sen. Christopher Dodd, D-Conn., suggested Democrats take a month to think about a path forward.

Senate Democrats this week are looking to finish work on legislation that would boost the statutory debt limit by $1.9 trillion to $14.294 trillion.

They will first vote on a handful of amendments, including a proposal to create a deficit-reduction commission whose recommendations Congress would have to take up.

Budget Committee Chairman Kent Conrad, D-N.D., who sponsored the commission amendment with ranking member Judd Gregg, R-N.H., argues that a special process is needed to make decisions to cut spending and raise revenue that committees of jurisdiction have failed to make.

It is unclear if the amendment will win the 60 votes needed to pass. Finance Committee Chairman Max Baucus, D-Mont., and an array of progressive and conservative groups, would prefer the committees of jurisdiction take on the deficit in regular order.

Baucus has offered an amendment to protect Social Security from the commission. "Sens. Conrad and Gregg have painted a big, red target on Social Security and Medicare," Baucus said. "That's what this commission is all about. It's a big roll of the dice for Social Security and Medicare."

Conrad is working with Democratic leaders on a fallback plan under which President Obama would create a similar commission by executive order. Under a tentative agreement, House and Senate Democratic leaders would pledge to put the presidential panel's proposals to a vote. Without the pledge, the commission's recommendations would not have to be voted on by Congress.

Republicans are critical of the presidential commission, saying it would be toothless. "Without the statutory structure to guarantee an up-or-down vote, nothing can be accomplished," Gregg said.

The agreement is needed to ensure passage of the debt ceiling increase bill by bringing along about 14 Senate Democrats, led by Conrad, who have said they would oppose the boost unless Congress establishes a process to reduce the deficit.

As part of the tentative deal, the Senate would pass pay/go legislation to require that increases in mandatory spending and tax cuts would have to be offset. Senate Majority Leader Harry Reid, D-Nev., is expected to offer the pay/go amendment.

Making pay/go a law has been a priority for House Democratic leaders, who pushed a pay/go bill through the House in July. That measure exempted four policy items: cutting middle class taxes; reducing the estate tax; patching the alternative minimum tax; and providing higher Medicare payments to physicians.

Conrad has opposed the House pay/go bill, taking exception to the exemptions, even though the Senate typically has not offset them in recent years.

The compromise under discussion would have the Senate pass a pay/go bill that limits the exemptions. The AMT and estate taxes exemptions would be limited to two years, and physicians' payments would be exempted for five years. But the Bush-era tax cuts for the middle class would be exempted without a time limit.

Expected action on the debt ceiling comes as the CBO is scheduled to release its outlook for fiscal 2011.

Other possible amendments include a proposal from Sen. Jeff Sessions, R-Ala., to seek cap discretionary spending to no more than a 2 percent increase a year for five years. Sessions said he plans to offer the proposal this week.

* The Senate meets Monday at 2 p.m. for morning business, then resumes consideration of debt ceiling legislation.

* The House is not in session Monday. The House meets Tuesday at 12:30 p.m. for morning hour and 2 p.m. for legislative business. Votes will be postponed until 6:30 p.m. On Wednesday the chamber meets at 10 a.m. for legislative business and will recess at 5 p.m. for a security sweep. At 8:35 p.m., the House will meet in a joint session with the Senate for the State of the Union. No votes are expected Thursday and Friday.

DEFENSE

The Senate Armed Services Committee will meet behind closed doors on Wednesday for a Pentagon briefing on cybersecurity, an issue that is expected to take on increased importance in the Defense Department's fiscal 2011 budget request and the accompanying Quadrennial Defense Review of military requirements and capabilities.

A draft Pentagon budget document obtained by CongressDaily states the upcoming QDR will list operations in cyberspace as one of six missions critical to achieving U.S. strategic objectives. The security environment, according to the "pre-decisional" document, demands better capabilities designed to counter threats in cyberspace.

Marine Corps Gen. James Cartwright, vice chairman of the Joint Chiefs of Staff, and James Miller, principal undersecretary of Defense for policy, are scheduled to brief the panel.

ENVIRONMENT

The success of efforts by Democratic leaders this year to get broad climate and energy legislation passed will largely hinge on whether they can convince moderates in both parties that it would create jobs.

The Senate Environment and Public Works Committee will hold another in a series of hearings this week to try to further that argument.

Thursday's hearing stars Interior Secretary Ken Salazar and focuses on jobs that could be created through expanding the use of solar energy.

Democratic leaders have a tough climb toward reaching 60 votes for a bill similar to the one passed in the committee last year that calls for an economywide cap-and-trade program. It is unclear also how persuasive Thursday's hearing will be to the overall debate in a panel that -- other than Baucus -- does not have a strong representation of moderates in either party.

At the same time, Senate Energy and Natural Resources Committee ranking member Lisa Murkowski, R-Alaska, and Senate Agriculture Committee Chairwoman Blanche Lincoln, D-Ark., are leading an effort to try to pass a resolution blocking EPA from regulating greenhouse gases. There is some fear this effort could undermine the attempt to pass broad climate legislation by this spring, as both Murkowski and Lincoln have cautioned that that timeline may be too quick to do a bill that has a deep impact on the economy.

HOMELAND SECURITY

Lawmakers will continue a series of hearings this week into government failures associated with an attempt to blow up Northwest Flight 253 over Detroit on Christmas, with an eye toward crafting legislation to improve counterterrorism programs.

The Senate Homeland Security and Governmental Affairs Committee plans a hearing Tuesday to examine whether more reforms to intelligence agencies and operations are needed.

The hearing will feature testimony from former Rep. Lee Hamilton, D-Ind., and former New Jersey Republican Gov. Thomas Kean, who led the 9/11 Commission.

The House Homeland Security Committee plans a hearing Wednesday to examine the failed plot.

Also on Tuesday, former Sens. Bob Graham, D-Fla., and Jim Talent, R-Mo., will release a report card on the government's efforts to counter the proliferation of weapons of mass destruction.

"The report card assesses U.S. government progress in such areas as the biological threat, nuclear weapons proliferation, government reform and citizen participation," according to an announcement.

Graham and Talent chair the congressionally chartered Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism.

HOUSE LEADERSHIP

Buoyed by the victory last week of Sen.-elect Scott Brown, R-Mass., House Republicans will finish up the week with their members' issues retreat, Thursday through Saturday in Baltimore.

Obama has agreed to speak at the event on Friday, setting up a quirky circumstance of a Democratic president headlining a GOP conference with the theme of "Winning Back America."

Republicans say they chose Baltimore for their conference because it is a working-class city struggling with high unemployment. They say they will be working on solutions to fix what they describe as failed Democratic policies enacted over the last year.

Newly inaugurated Virginia GOP Gov. Bob McDonnell, former House Speaker Newt Gingrich, R-Ga., and former House Majority Leader Dick Armey, R-Texas, are expected to address lawmakers.

POLITICS

Tuesday is the filing deadline for House and Senate races in Kentucky, but the roster of candidates for the headline race to replace GOP Sen. Jim Bunning has been set for months.

Lt. Gov. Dan Mongiardo and state Attorney General Jack Conway are the top two contenders for the Democratic nomination, while Secretary of State Trey Grayson and eye surgeon Rand Paul are the big names on the GOP candidate list. No Bluegrass State House members are retiring but some might face primary challenges.

Saturday is the filing deadline in West Virginia, where there is no Senate race and all three House members are running for re-election.

TELECOMMUNICATIONS

Comcast Chairman and CEO Brian Roberts delivers a Wednesday morning keynote at the annual State of the Net conference that's certain to attract plenty of attention, given the company's pending merger with NBC Universal.

Also speaking that morning will be House Energy and Commerce Communications Subcommittee Chairman Rick Boucher, D-Va., who heads one of the four congressional panels that will hold hearings on the deal. The event kicks off on Tuesday with a "pre-conference" featuring remarks by FCC regulators Michael Copps and Meredith Baker.

On Thursday, the Senate Commerce-Justice-Science Appropriations Subcommittee, headed by Sen. Barbara Mikulski, D-Md., holds an oversight hearing on the Commerce Department's role in the $7.2 billion broadband stimulus program. Commerce Secretary Gary Locke and Larry Strickling, administrator of the National Telecommunications and Information Administration, are scheduled to testify. The witnesses are expected to discuss changes that Commerce and the Agriculture Department have made to the program in response to congressional concerns about red tape.

Billy House, Megan Scully, Darren Goode, Chris Strohm, Erin McPike and David Hatch contributed to this report.

]]>

Markup set to seek information on health bill deals

Anna Edney — Mon, 25 Jan 2010 00:00:00 -0500

The House Energy and Commerce Committee will mark up a Republican resolution Wednesday that would force the White House to bring to light information on backroom deals it made with certain healthcare industries to gain support for the overhaul bill.

The markup comes just hours before President Obama heads to the Capitol to deliver his State of the Union address.

The resolution, proposed by Rep. Michael Burgess, R-Texas, in December, calls on Obama and the Health and Human Services Department to hand over any documents and communications based on the deals as well as offer up the dates of meetings and lists of those in attendance.

The resolution does not have any co-sponsors, but Energy and Commerce Committee Chairman Henry Waxman, D-Calif., has particularly criticized a White House and Senate Finance Committee deal with the Pharmaceutical Research and Manufacturers of America. Waxman's office did not respond to a request for comment.

PhRMA agreed to an $80 billion plan to help fund the overhaul and close a gap in Medicare prescription drug coverage and in exchange was protected from other cost-cutting attempts throughout Senate consideration of health reform.

The hospital industry cut a $155 billion deal, and unions worked with the White House to soften an excise tax on high-cost health plans.

The resolution singles out the earliest attempt at a deal when groups, including PhRMA, America's Health Insurance Plans, the American Hospital Association and the Service Employees International Union agreed to find $2 trillion in cost-cutting measures to help fund the overhaul. The number never materialized.

Burgess originally wrote Obama asking for more information about the deals in September. The letter points to the Finance Committee markup during the same month when certain amendments, even Democratic ones, were shot down because they disrupted industry deals.

Waxman included in the House overhaul bill a provision that would provide Medicaid discounts on prescription drugs for low-income Medicare beneficiaries. The Finance Committee rejected a similar provision on account of the PhRMA deal.

]]>

Dems aim to send health bill to CBO Friday

Peter Cohn and Anna Edney — Thu, 14 Jan 2010 00:00:00 -0500

Healthcare overhaul negotiators have set a Friday goal to send a completed package to CBO, although they said deal-making could stretch into Saturday.

While lawmakers must iron out several issues, the White House and labor officials shored up a tentative agreement today to bring unions on board with an excise tax on high-cost insurance plans.

Sources said the tentative agreement calls for the high-cost plan tax thresholds to be raised to around $9,000 for individual coverage and $24,000 for a family plan. That is slightly more generous than the Senate version, which began to apply the tax at $8,500 and $23,000, respectively.

Collectively-bargained plans are exempt from the tax until 2017, sources said. Dental and vision coverage are also removed from the calculation of the cost of the plan.

But one key negotiating objective of labor -- increasing the annual indexing threshold so that it exceeds the core rate of inflation plus 1 percent -- was not accepted. That means more and more health plans could be hit by the tax each year and passed down to middle-class workers.

"That's still an issue," Rep. Joe Courtney, D-Conn., said. He also said he heard that "this is something the White House is sticking to, but then there's at least going to be some opportunity in 2013 to revisit that."

The White House believes this is the only way to contain costs.

Officials cautioned there was no final agreement yet and that they were working on selling it to union membership and House Democrats. House Speaker Nancy Pelosi, D-Calif., was entering a meeting with labor officials this afternoon to discuss the deal.

One labor official predicted that because the indexing rate is still unchanged from the Senate version, that provision in particular could be a bitter pill for many unions to swallow.

Rep. Earl Blumenauer, D-Ore., said unions at the negotiating table were split over whether they could support the deal.

There was "acknowledgement of progress but there was some split amongst them," he said. He added they are concerned about getting a deal when non-union workers will be hit right away with the tax.

Rep. Sander Levin, D-Mich., a vocal opponent of the tax who sits on the Ways and Means Committee and is tight with unions, appeared pleased with what he had heard of the deal, although he had not seen anything on paper yet.

He said the tax was "substantially transformed."

House members have blasted the excise tax for hitting middle-income workers, particularly those in unions, who accept lower wages in exchange for more expensive health insurance.

"I'm not about to agree to taxing middle-income healthcare plans," Rep. Shelley Berkley, D-Nev., said Wednesday. "That's just the bottom line for me."

Meanwhile, House Ways and Means Chairman Charles Rangel, D-N.Y., said negotiations are nearly complete on other revenue raisers for the overhaul. "We're close," he said Thursday.

Other outstanding areas include whether a final measure will include a national exchange in the House bill or state-based ones in the Senate version; an implementation date of 2013 like the House bill or 2014 in the Senate measure; and how much federal help people will receive to purchase insurance. Negotiators have yet to discuss federal funding of abortions or immigration issues, Rangel said.

Leaders and committee chairmen on both sides of the Capitol hope to wrap up talks Friday or Saturday. CBO would take several days, possibly a week or longer, to produce a cost estimate necessary before a vote.

Rep. Chris Van Hollen, D-Md., assistant to the speaker, said negotiators have sent scorekeepers pieces of what they have been discussing "to calibrate some of the ideas that are out there and know what the costs are."

Pelosi denied Democrats have their eye on the next day or two to complete talks because of the threat of a loss of a Democratic Senate seat in Massachusetts, where Democrat Martha Coakley and Republican Scott Brown are in a close race in Tuesday's special election.

"The fact that CBO takes so much time is more the issue," Pelosi said.

House leaders and chairmen huddled this morning to discuss overnight work following a marathon meeting Wednesday with President Obama and Senate negotiators.

Leaders will head back to the White House Thursday afternoon, and Obama is set to address House Democrats Thursday during their annual issues conference and persuade them to move ahead with the bill even if they are not pleased with the entire package.

House rank and file also have issues with other provisions in the Senate bill, particularly a commission meant to make decisions on Medicare cuts and a greater financial responsibility for a Medicaid expansion.

Berkley said Wednesday the Medicare commission "is a serious power grab" for the administration. House members do not want to give up such a large chunk of decision making, while senators feel such a move is necessary because Congress rarely makes tough decisions needed to decrease spending.

On the Medicaid expansion, Rep. Eliot Engel, D-N.Y., said Wednesday his home state receives $4 billion in the House bill, while it is forced to shell out $1 billion above its current obligation in the Senate version.

"So I would want to make sure that at least when monies are given to states, New York is treated more like the House version than the Senate version," he said.

Sen. Ben Nelson, D-Neb., has been working with Senate Democratic leadership to attempt to cover states' costs for the Medicaid expansion.

]]>

House leaders return, with health overhaul back on front burner

Anna Edney — Tue, 12 Jan 2010 00:00:00 -0500

House Democratic lawmakers return to town on Tuesday after nearly a month in their districts to talk about health care this evening and give leaders an idea of where to focus as they continue negotiations with the Senate.

Leaders will meet Tuesday afternoon as well and have laid out a handful of priorities. But the order of importance and just how hard they will push for some provisions in their bill is expected to become clearer after Tuesday's meetings, a senior leadership aide said.

The caucus will serve to further reassure members the House will not rubber-stamp a Senate-passed version of the healthcare overhaul bill.

House leadership staffers have focused on the differences in how the two bills finance provisions, including House language that would ban insurers from antitrust exemptions, create a national exchange rather than state-based ones and move up by a year the implementation date of major changes to 2013.

Labor leaders visited the White House on Monday to make their case -- and side with the House -- against the Senate's tax on high-cost health plans to help raise revenue for the overhaul.

"The pharmaceutical industry gets a sweetheart deal and millions of middle-class families get their healthcare benefits taxed for the first time -- no wonder the president no longer wants C-SPAN covering the healthcare debate," said Sage Eastman, a spokesman for House Ways and Means ranking member Dave Camp, R-Mich.

House Democrats prefer to use their 5.4 percent surcharge on those earning $500,000 and joint filers bringing in $1 million to raise revenue.

The International Association of Machinists and Aerospace Workers broke with AFL-CIO on Monday by threatening to oppose any bill that includes an excise tax on "Cadillac" plans.

"For decades, IAM members exchanged substantial wage increases for the best possible health insurance," Tom Buffenbarger, the union's president, said. "Now, in a bizarre turn of events, their insurance premiums will be subject to a 40 percent excise tax if the Senate version of healthcare reform becomes law."

The machinists' union represents 700,000 active and retired members.

As the tug-of-war continues, Sens. Charles Schumer, D-N.Y., and Amy Klobuchar, D-Minn., on Monday supported a provision in the House bill calling on negotiators to grant HHS the ability to negotiate Medicare drug prices in the final bill.

Schumer and Klobuchar pointed to a GAO study they released that found that more than 400 prescription drugs had "extraordinary price increases" ranging from 100 percent to as much as 500 percent between 2000 and 2008. The median increase was 158 percent, though 26 drugs saw increases greater than 1,000 percent.

GAO blamed the spike on a lack of cheaper generic versions and little competition.

Negotiating drug prices would break an $80 billion cost-cutting deal the pharmaceutical industry cut with Senate Finance Chairman Max Baucus, D-Mont., and the White House, but the House bill already includes such a provision.

]]>

Informal negotiations on health bill are likely instead of conference

Anna Edney — Mon, 04 Jan 2010 00:00:00 -0500

The House and Senate will not set up a formal conference to work out differences in the chambers' healthcare overhaul bills, a Democratic leadership aide said on Monday.

Senate Majority Leader Harry Reid, D-Nev., spoke over the weekend with House Speaker Nancy Pelosi, D-Calif., to begin the informal negotiations. Discussions are expected to be ongoing among leaders, key committee chairmen and White House officials as the House is likely to negotiate some changes to the more conservative Senate bill and send it back to the upper chamber for final approval -- a so-called pingpong process.

Leaders blame their decision to bypass a formal conference on Senate Republicans, who pledged to use procedural hurdles required with a conference committee to hamper passage of a final overhaul bill. "We have to work around that," the aide said.

Senators are not in town this week, but House leaders and key committee chairmen plan to meet on Tuesday to discuss melding the bills. House Democrats also plan to caucus on Thursday, some by phone, to discuss priorities and process, House leadership aides said. House staff would not confirm a formal conference committee is off the table.

The Senate bill does not include a public option like the House bill. In addition, it is less restrictive on federal abortion funding and taxes high-cost "Cadillac" insurance plans to help pay for the overhaul rather than taxing the wealthy, as the House bill does.

A senior Democratic leadership aide said the House is prepared to accept a Cadillac tax as long as the threshold for premiums considered high cost is raised so union plans are exempt, while some of the funding gap from the change will be filled in with the House's tax on the wealthy, only with a raised floor for what is considered wealthy.

The House bill imposes a 5.4 percent surtax on individuals earning at least $500,000 and families earning at least $1 million. The Senate bill imposes a 40 percent excise tax on the value of premiums that exceed $8,500 for individuals and $23,000 for families.

The chambers will need to work out disagreements over how to fill a gap in Medicare prescription drug coverage, known as the doughnut hole, and a Senate-created commission meant to make cost-cutting decisions in Medicare. The House is reluctant to give up jurisdiction over Medicare funding.

The White House would prefer the bill be on the president's desk by the State of the Union address in late January. After the Senate passed its version Dec. 24 on a 60-39 vote, Senate leaders were skeptical they could finish the negotiations by early February.

]]>

Senate votes final passage of healthcare bill

Anna Edney — Thu, 24 Dec 2009 00:00:00 -0500

UPDATED, 8:12 a.m. -- The Senate early on Thursday approved, 60-39, sweeping legislation to remake the nation's healthcare system that seeks to expand access to healthcare coverage and rein in insurance companies -- an effort that has eluded many past presidents and Congresses, but which now appears likely to become a reality in the next few months.

The vote came just in time for the White House-imposed Christmas deadline. But key senators said on Wednesday afternoon that getting the bill to President Obama's desk in time to allow him to tout the achievement of a major campaign pledge during the State of the Union speech is unrealistic. Obama is expected to deliver the State of the Union address sometime in late January.

"We need a break to go home to our families, to repair some relationships with our spouses and to relax and recharge and come back. And I think we'll have a much more positive outcome after that break," Senate Majority Whip Richard Durbin, D-Ill., said. "But it does take time away from January, and it may mean that this takes a little longer."

He declined to speculate on when a conference with the House would be complete.

Senate Finance Chairman Max Baucus, D-Mont., said key players will begin calling each other next week to begin conference negotiations.

There were moments of both humor and poignancy during Thursday's 7 a.m. vote, which followed a month of often rancorous floor debate. Sen. Jim Bunning, R-Ky., was the only senator not voting in a tally which -- reflecting a series of procedural votes earlier this week -- broke down strictly along party lines.

Weary from a long slog to this point, Senate Majority Leader Harry Reid, D-Nev., initially voted "no" by accident, and then put his head down on the podium after laughing and changing his vote to "yes." Wisecracked Reid, ""I spent a restless night trying to figure out how I can find some bipartisanship."

And the body's longest serving member, 92-year old Sen. Robert Byrd, D-W.Va., raised his hand when his turn came to vote and declared: "This is for my friend Ted Kennedy. Aye."

Kennedy, who had made reform of the nation's healthcare system a career-long cause, was instrumental in the beginning of the negotiations on the pending legislation -- but died of a brain tumor last August after serving nearly 47 years in the Senate.

Although the Senate bill expands Medicaid and provides subsidies for people to buy insurance through an exchange, it does not include a public option, previously a priority for liberals and Obama. Instead, the $871 billion legislation limits insurance company overhead, bans insurers from discriminating against pre-existing conditions and creates an exchange for those without employer-sponsored insurance that would place other requirements on insurers.

While the Senate bill squeaked by with just enough votes for passage, the House tally was close as well, passing 220-215, meaning neither chamber has much margin for defections.

House progressives plan to push back hard against the lack of a public option in the Senate measure. A senior Democratic aide predicted the party's liberal base needs to see another attempt at the public option to assure them everything was done to include one. But the political will for such a move is missing among moderates.

Liberals insist a government-run plan will show up in future legislation. "The issue of the public option will be revisited. I guarantee it," Senate Health, Education, Labor and Pensions Chairman Tom Harkin, D-Iowa, said.

Senate Democratic leaders were forced to strip the public option from the bill after party moderates objected, thereby denying leadership the 60 votes needed to clear procedural hurdles throughout the week. The House-passed healthcare overhaul bill includes a public option, though leaders have indicated they could accept a bill without one.

The House Progressive Caucus put leaders on notice this week that they will also push for the higher subsidies in the House bill and a national insurance exchange, rather than the state-based ones in the Senate bill. Progressives claim the provision in the Senate measure endangers the overhaul by putting it "at the hands of hostile governors."

How exactly the House and Senate will marry their bills is unclear, but staff will do much of the heavy lifting over the Christmas break. A conference committee is expected to convene, but the intensity of its role is not yet worked out.

Reid said he intends to head home to Nevada and take a few days "to watch my rabbits eat my cactus" before he makes any decision on the conference process.

Each chamber also must reconcile how they plan to pay for the overhaul. The senior Democratic aide said the House is prepared to accept the excise tax on high-cost, so-called "Cadillac" health plans in the Senate measure with assurances it will not affect union families.

House Democrats will seek to raise the premium thresholds for what constitutes a high-cost plan. To fill that gap, they could counter with a version of the House's tax on the wealthy by raising the income level subject to the surcharge. The House version of the bill now would raises income taxes on individuals earning over $500,000 and couples making more than $1 million.

The gap between how each bill handles federal funding of abortion also is expected to cause some problems as the House and Senate marry their bills. "Bart Stupak tells me they're not going to budge," Sen. Orrin Hatch, R-Utah. He was referring to the Michigan Democrat responsible for more restrictive House language than even a provision in the Senate bill negotiated by Sen. Ben Nelson, D-Neb. The latter provision, which was key to bringing Nelson aboard the final bill, requires segregated payments to plans that accept federal subsidies.

Nelson prefers the Stupak language, but negotiated the Senate deal when the more restrictive provision could not gain 60 votes in that chamber.

Lawmakers also must work out differences on the Senate's stricter treatment of illegal immigrants and plug a gap in Medicare's prescription drug coverage known as the doughnut hole. Senators did not fully address the doughnut hole in their legislation, but pledged to find a way to do so in conference.

]]>

Senate moves up final healthcare overhaul vote

Anna Edney — Tue, 22 Dec 2009 00:00:00 -0500

The Senate's final vote on the sweeping healthcare overhaul will take place at 8 a.m. Thursday, about 12 hours earlier on Christmas Eve than it would have been held if Republicans used up all their time to delay the vote.

Senate Majority Leader Harry Reid, D-Nev., and Senate Minority Leader Mitch McConnell, R-Ky., reached an agreement Tuesday afternoon that allows for the earlier vote, followed by one on a $290 billion short-term debt limit bill.

They also agreed to allow up to four amendments for a debate on the long-term debt limit that will occur Jan. 20, shortly after the Senate reconvenes after the holidays.

The timing deal came together after the Senate approved two more procedural steps that keep the health bill on track for final passage Thursday. On identical 60-39 votes early Tuesday morning, senators approved a substitute amendment from Reid and a cloture motion that would cut off debate on the substitute bill that replaces a House bill that had been used as a shell because revenue measures must start in the House.

The debt-ceiling agreement allows for debate on several amendments, including one to create a commission to make recommendations on reducing the debt from Budget Committee Chairman Kent Conrad, D-N.D., and ranking member Judd Gregg, R-N.H., and one to end the Troubled Asset Relief Program from Sen. John Thune, R-S.D.

On health, the Senate will take up more procedural matters Wednesday afternoon, including voting on Reid's substitute bill and a cloture motion on the final bill. Republicans also want to force a point-of-order vote on the constitutionality of the individual mandate to purchase insurance.

Also Tuesday, Sen. Ben Nelson, D-Neb., said he might yank the deal he got for Nebraska from the bill, even as he claimed Tuesday he did other states a favor.

Nelson said he accepted the deal, which has the federal government picking up the entire cost of Medicaid expansion for the state, on behalf of Nebraska Gov. Dave Heineman. Heineman has come out against special treatment, claiming every state should be handled the same.

Nelson insisted he accepted the full federal coverage to help other states gain the same deal. "It's not a special deal, it's a fair deal. All will have access to it and there's plenty of time to get that done," Nelson said.

He said three senators have indicated directly to him they will shoot for the same deal he got, potentially in conference with the House.

As the clock winds down on the year, Reid is also is also hoping to win GOP agreement to allow confirmation of a package of stalled executive nominations by unanimous consent before the Senate heads home, according to leadership aides. A Reid spokeswoman said Tuesday it is not yet clear which ones or how many.

In other year-end business Tuesday, Senate Finance Committee Chairman Max Baucus, D-Mont., and ranking member Charles Grassley, R-Iowa, sent a letter to Reid and McConnell Tuesday vowing early next year to retroactively extend a series of tax provisions.

"Early in the next year, we intend to address the extension of various tax provisions expiring on or before December 31, 2009. We intend to extend the provisions without a gap in coverage, just as the House did on December 9th of this year," Baucus and Grassley said.

Dan Friedman contributed to this report.

]]>

Senate on track to approve health bill

Dan Friedman and Anna Edney — Mon, 21 Dec 2009 00:00:00 -0500

The Senate is on track to achieve one of President Obama's top priorities this year, a major overhaul of the country's healthcare system.

The Senate is expected to hold a series of votes this week on the legislation, with final passage set for Christmas Eve unless Republicans relent and allow an early vote.

Sen. John McCain, R-Ariz., admitted Sunday on Fox News the GOP cannot stop the bill now that Senate Majority Leader Harry Reid, D-Nev., has 60 votes for it, but he indicated they are intent on stretching out the debate, giving Republicans as much time as possible to bash the bill.

"But what we can do is continue winning the battle of American public opinion," McCain said. "We will fight until the last vote because we owe that to our constituents. We must look back and say we did everything we can to prevent this terrible mistake."

Reid got that 60th vote Friday night when he reached a compromise with Sen. Ben Nelson, D-Neb., on language regarding federal funding of abortion.

The abortion language allows states to elect to prohibit abortion coverage in the exchanges and requires those plans that offer abortion coverage to collect separate checks from enrollees to ensure federal subsidies are not used to cover the procedure.

Reid also gave Nelson a sweetener, directing the federal government to pick up the entire cost of the Medicaid expansion in Nebraska. The bill expands Medicaid to 133 percent of the federal poverty level.

After reaching the agreement with Nelson, Reid won a raucous ovation from Senate Democrats as he rose to address them in a special meeting on Saturday.

Passage of the bill will be a major victory for Reid, who has overseen talks since the Finance Committee passed the measure in October. Reid cinched the deal with Nelson just days after some observers claimed the effort was near collapse and about a month after Democrats' division over the public option meant no compromise on the measure, at the time, could get 60 votes.

A bloc of liberals opposed dropping it and several moderates vowed to oppose a bill with a public option.

House abortion rights leaders are opposed to the Nelson language, just as they are to more restrictive House language proposed by Rep. Bart Stupak, D-Mich.

Reps. Diana DeGette, D-Colo., and Louise Slaughter, D-N.Y., co-chairwomen of the Congressional Pro-Choice Caucus, said they have "serious reservations" about the Nelson language.

"This provision is not only offensive to people who believe in choice, but it is also possibly unconstitutional," DeGette and Slaughter said.

DeGette's spokesman said it might be unconstitutional because it discriminates against women by restricting their access to abortions. The caucus is having their lawyers review the language.

House Speaker Nancy Pelosi, D-Calif., and Majority Leader Steny Hoyer, D-Md., meanwhile, said they look forward to reviewing the bill.

"The Senate legislation has been strengthened during the course of the past few weeks, and Sen. Reid is to be commended for moving this process forward," the House leaders said.

After finishing with health care, the Senate will likely seek to take up a $290 billion increase in the statutory debt limit. The Treasury Department has projected that the nation is expected to hit the $12.1 trillion debt limit by the end of the year.

Democrats are threatening to hold a rare session between Christmas and New Years if Republicans do not sign onto an agreement to allow quick passage of a short-term extension of the debt limit immediately after the final healthcare vote.

"We would like to do it before we leave for Christmas, but if Republicans do not cooperate, then we will have to come back between the week of Christmas and New Years to consider the legislation," a Senate leadership aide said Sunday.

A quick debt-limit vote would require unanimous consent. The desire to head home enhances the chances of a such an agreement, but GOP anger over the endgame on health care and Republicans' hopes to make political hay of the debt limit threaten to keep senators in Washington during their normal down-time.

Senate Budget ranking member Judd Gregg, R-N.H., wants to offer four amendments to the debt-limit bill, including legislation to create a commission to recommend to Congress ways to lower the deficit.

The Senate Saturday morning cleared the fiscal 2010 Defense spending bill 88-10, sending the measure to Obama for his signature and wrapping up work on the fiscal 2010 Appropriations process.

The package includes the $636 billion Defense bill, and two-month extensions of various programs including unemployment insurance, COBRA health benefits, a fix to Medicare payments to physicians, surface transportation act funding, flood insurance and Small Business Administration loans. The package also contains funding for the administration of the food stamp program and a 90-day extension of a law governing transmission of broadcast television signals via satellite services.

The Senate on Saturday also approved, by voice vote, a short-term continuing resolution, which was passed by the House last week and expires Wednesday, to give Obama time to review the measure and sign it into law. The previous CR expired Friday.

Humberto Sanchez contributed to this report.

]]>

Senate vote sets up health overhaul passage

Dan Friedman and Anna Edney — Mon, 21 Dec 2009 00:00:00 -0500

The Senate early on Monday voted 60-40 to cut off debate on a manager's amendment to the healthcare overhaul bill, setting up final passage of the sweeping legislation on Christmas Eve and putting President Obama possibly a month away from achieving a major goal of his campaign.

Following final passage, Democrats would still need to merge the measure with a House-passed version before sending it to the president's desk. Democrats say they hope to get the bill to the president before his State of the Union address, which is typically in late January. The conference with the House could be difficult, given the fragile Senate balance and the interest of House lawmakers in trying to restore a public option.

The procedural victory came over the strenuous objections of Republicans, who had promised Sunday to fight to the bitter end Christmas Eve, when support by the same 60 Democrats would pass the final bill.

Majority Whip Richard Durbin, D-Ill., said after the vote he hopes "cooler heads will prevail" and that Republicans would allow a final vote sooner than Thursday. "What is the purpose," he said. "I don't see a purpose" in further delay.

The bill provides federal subsidies to help people buy health insurance, expands Medicaid, attempts to rein in insurance companies and remove barriers to coverage.

Democratic leaders originally sought to include a public option that would compete with private insurers, but could not garner the 60 votes to pass it. Instead, they tapped the Office of Personnel Management to oversee a national plan through private insurance companies and will require insurers to spend 85 percent of premiums in the large-group market and 80 percent of premiums in the small-group and individual markets on health services.

Senators on both sides agreed on the significance of vote, albeit for different reasons. Durbin called it "one of the most significant votes in the history of the United States Senate."

Minority Leader Mitch McConnell, R-Ky., attacking the bill, said "the impact of this vote will long outlive this one frantic, snowy weekend in Washington." He added: "Mark my words, this legislation will reshape our nation."

Democrats have two more cloture votes to go before final passage. Republicans have vowed to extend debate, claiming doing so will help inform Americans about the cost and impact of the legislation.

Republicans also took some heat for a comment Sen. Tom Coburn, R-Okla., made in wishing the vote failed. "The American people ought to pray that somebody can't make the vote tonight," Coburn said. Democrats immediately denounced the comment, suggesting Coburn was wishing ill on fellow senators.

"Calling on people to pray that a senator does not make it back for tonight's vote, as Dr Coburn did, is repulsive," said Jim Manley, a spokesman for Majority Leader Harry Reid, D-Nev.

Democrats had their 60 votes lined up Friday evening, after Reid worked out an agreement with Sen. Ben Nelson, D-Neb., on compromise language on federal funding of abortion. The manager's amendment made some changes to the bill Reid introduced last month, including a sweetener for Nelson, directing the federal government to pick up the tab for Nebraska's expenses under a Medicaid expansion. Republicans decried such deals, and even some Democrats seemed irked.

As she tried to move through a crowd of reporters around Nelson before the vote, Sen. Barbara Mikulski, D-Md., complained, "I know I'm not as important as Sen. Nelson. I didn't get the money for my state. I was too stupid."

Sen. Christopher Dodd, D-Conn., pushed to include a $100 million grant for construction of a university hospital in the overhaul bill, his spokesman confirmed following Republican complaints. The grant could go to about a dozen eligible universities but Dodd will push for the University of Connecticut to win the funding.

Nelson shrugged off attacks on the floor by Republicans and said he has heard no dissent from fellow Democrats. "You know, cheap shots are a dime a dozen in this town ... It's not my style and I have no opinion about them," he said.

While Democrats must win two more procedural votes before lawmakers can start working out differences in conference, some senators were already looking ahead. Senate Finance Chairman Max Baucus, D-Mont., said the two key differences between the House and Senate bills are the public option and pay-fors. The Senate pays for some of the measure with a tax on high-cost health plans and does not include a public option, two provisions Baucus said "have to be in the conference report for the bill to pass the Senate.

]]>

Democratic rhetoric shifts on health plan

Anna Edney — Mon, 07 Dec 2009 00:00:00 -0500

Some Senate Democrats who once demanded that a healthcare overhaul include a strong public option are retreating from that stance and appear willing to accept alternative proposals.

Among them is Sen. Debbie Stabenow, D-Mich., who said she is reviewing the latest weaker public option alternative to see whether it would offer acceptable competition with private insurers.

"The critical issue is not what we call something; it's the end result," Stabenow said on Monday. "What's driving all our healthcare discussions is to make sure people have insurance."

Stabenow's comments came as moderate and liberal Democrats continue to try to forge a public option compromise.

The latest proposal under discussion would create a national plan modeled after the federal employee health benefits program. Under the program, the Office of Personnel Management negotiates with private insurers and limits the companies' profit margins. The group plans to meet again on Monday.

Senate Majority Leader Harry Reid, D-Nev., said on Monday he does not expect the Senate to meet late Monday because of the White House holiday party for lawmakers. He does expect late nights the rest of the week and weekend work.

The OPM-run idea is based on a small business health program drafted by Democratic Sens. Blanche Lincoln and Mark Pryor of Arkansas and GOP Sen. Olympia Snowe of Maine. Snowe is the most likely Republican to vote for the bill as Democrats woo her support.

Snowe said on Sunday she has other concerns on affordability. A key factor for her will be a CBO analysis she requested on "numerous issues regarding premium increases and what exactly would be the affordable choices available to small businesses on the exchange."

"We need to know what is the lowest-cost, minimum actuarial value plan that will be available to small businesses," Snowe said. "That's crucial in terms of affordability. It's not enough to just have minimum reductions in premiums for small businesses. After all, this whole plan is designed around the notion of ensuring that small businesses have access to affordable choices."

She also asked which provisions in the bill would contribute to the rise of prices of premiums before the exchanges created in the bill start up in 2014.

She said she submitted the letter last week and hopes for results soon.

Snowe's support is crucial, given that Sen. Ben Nelson, D-Neb., has said he will not vote for the measure unless it includes more restrictive House language prohibiting federal abortion funding. The amendment Nelson introduced on Monday mirrors the House language, but it is not expected to pass when senators vote, which could happen as early as Tuesday.

Nelson also is a member of the group negotiating the public option compromise. He said Sunday night governors also could expand their state employee benefit programs instead of handing to OPM the administration of a national plan. Nelson has pushed for a state-based rather than national approach.

Stabenow and Sens. Mark Begich, D-Alaska, and Jeff Merkley, D-Ore., attempted to steer the debate away from the public option Monday and talk about a "healthcare bill of rights," essentially a check sheet of seven insurance industry improvements the bill makes.

The idea, Begich said, is to tell people "what they get in a basic and simple form."

Those changes include a ban on insurance companies discriminating against pre-existing conditions or dropping people because they get sick; a prohibition of co-payments for preventive services; and the ability of young people to stay on their parents' insurance until they are 26 years old.

These changes do not all fully kick in until the exchanges are up and running in 2014, but Merkley said a high-risk insurance pool will be immediately created to allow those with pre-existing conditions to get coverage.

Dan Friedman contributed to this report.

]]>

OPM could get role running national health plan

Anna Edney — Sun, 06 Dec 2009 00:00:00 -0500

alternative to the public option, but rather a separate proposal, which she supports.

"It was originally, I think, an alternative but I think it's not that," Snowe said, noting that the change occurred late Saturday night. "It's just a different dimension offering national plans and small business exchanges."

The OPM-administered plan is based on a proposal Snowe and others have made previously that would create a small business health plan modeled after the federal employee benefits program.

Snowe said she is working on the proposal, which would also be offered to individuals, as an amendment with a group of that includes Sens. Blanche Lincoln and Mark Pryor, both Democrats from Arkansas.

Snowe said she would not support allowing states to opt out of the OPM plan in the way Reid has structured the public option in the pending bill.

A group of 10 moderate and liberal Democrats continued meeting Sunday night to forge a public option compromise. They indicated they would work through the night to get a deal, but Sen. Thomas Carper, D-Del., one of the negotiators, was skeptical that a final agreement would emerge late Sunday.

Reid is unlikely to file any cloture motion in an effort to force a vote on health care legislation until he knows that a deal will be in place before the vote, Senate aides said. In a news conference Reid said he was not sure when he will file cloture.

"We're not there yet," Reid said. "We're working hard to find out when we're gonna start the procedural process to finish this legislation."

Sen. Bill Nelson, D-Fla., said on the floor Sunday that "final passage" is "probably a week or eight days down the road." Nelson said later he thinks that after "one more weekend ... it will start to wear."

But Reid aides downplayed that timeline, saying the goal remains to pass the bill before Christmas.

]]>

Senators seek to put OPM in charge of health care public option

Anna Edney — Sat, 05 Dec 2009 00:00:00 -0500

"Yeah, there's sort of a, sort of a kind of a general agreement on where we're headed on this thing," Senate Health, Education, Labor and Pensions Committee Chairman Tom Harkin, D-Iowa, said. "There's still some details, right, the devil's in the details."

"I think we're pretty well set on OPM," Harkin said.

OPM operates the health insurance program for federal employees, and using that office might alleviate the concern with HHS running and setting the rules for the public option. Harkin said OPM sets a 1.2 percent maximum profit for the insurance companies with which it negotiates.

"People are open in ways that they have not been open before. Sometimes people just out of sheer fatigue can agree to things," said Senate Finance Health Subcommittee Chairman John (Jay) Rockefeller, D-W.Va.

The group of negotiators was called together by Majority Leader Harry Reid, D-Nev., in the last few days to forge a compromise on a public option that can get 60 votes. "It should have started several weeks before that," Rockefeller said.

The group consists of Harkin, Rockefeller and Sens. Russell Feingold of Wisconsin, Mark Pryor and Blanche Lincoln of Arkansas, Sherrod Brown of Ohio, Thomas Carper of Delaware, Ben Nelson of Nebraska, Charles Schumer of New York and Joseph Lieberman of Connecticut.

Lieberman, who has adamantly opposed a public option, was not in attendance Saturday, but is on the invitee list, Rockefeller said. "[Lieberman] was today, I think, with the president," he added.

Lieberman's office said he did not meet with Obama Saturday.

The group was scheduled to convene again at 4 p.m. Sunday and hoped to emerge with a deal by Monday. "We'll work 'til midnight or whatever it takes," Rockefeller said.

"We're talking about several proposals floating around right now" on the public option, said Sen. John Kerry, D-Mass., who added that Democrats are waiting on Congressional Budget Office analyses and may not be ready to agree on a compromise during Sunday's conference meeting.

He said he is working with Sen. Olympia Snowe, R-Maine, and that Pryor has an alternative in addition to Delaware Democratic Sen. Thomas Carper's nongovernment-run public option that would kick in for states that do not meet an affordability standard.

Pryor confirmed he is working on a proposal with several senators, including Lincoln. He declined to offer details, claiming the proposal is in the development stage.

Before negotiations resume Sunday, Senate Democrats will meet with President Obama at 2 p.m. Perhaps as many as four votes on amendments are scheduled afterwards.

One of those votes is expected to be on an amendment from Lincoln to limit the tax deductibility of executive salaries above $400,000 for insurance companies. The estimated $650 million raised from the limit over 10 years will go into the Medicare Trust Fund.

Negotiations began Saturday afternoon after the Senate rejected, 53-41, a Republican attempt to strip home health services cuts from the healthcare overhaul bill.

Sen. Mike Johanns, R-Neb., proposed the motion that would have sent the bill back to the Finance Committee to remove $42 billion in cuts in home health services.

It was the third in a string of failed GOP motions to strip the bill of Medicare savings they claim will harm seniors' benefits. Democrats argue the cuts target wasteful and fraudulent spending and will not affect benefits.

The Senate accepted, 96-0, a competing amendment from Kerry that would prohibit any reductions in home health services.

Sen. Byron Dorgan, D-N.D., got some good news from CBO today on his drug reimportation amendment that would allow Americans to import cheaper drugs from other countries. CBO told Dorgan the amendment would save $19.4 billion over a decade, a nearly $9 billion increase over a previous score.

A spokesman for Dorgan said if or when a vote on the amendment will occur is unclear.

]]>

CBO: Nongroup premiums will rise under health care bill

Anna Edney — Mon, 30 Nov 2009 00:00:00 -0500

As the Senate begins debate Monday on Democrats' healthcare overhaul legislation, CBO released a report showing nongroup market premiums will be higher under the bill than current law without taking federal subsidies into account.

The CBO report on premiums could prove problematic for Majority Leader Harry Reid, D-Nev., as he tries to round up 60 votes to reach final passage this month. Moderate senators have expressed concern with supporting anything that could raise premiums.

Sen. Evan Bayh, D-Ind., requested the CBO analysis, but his office did not comment on the report in time for publication.

CBO predicted the measure would increase average nongroup premiums 10 percent to 13 percent by 2016 above what premiums would be if current law remained in place. The change represents an average premium of $5,800 for individual policies and $15,200 for family policies under the proposal.

The increase becomes a 56 percent to 59 percent decrease for the 57 percent of purchasers in the nongroup market that will receive federal subsidies, which totals about 18 million subsidized enrollees. That leaves 14 million coverage purchasers who will pay the higher premiums.

The CBO report said the average premium will be higher, subsidies aside, because the bill will require insurers to cover a "substantially larger share of enrollees' cost for health care (on average) and a slightly wider range of benefits."

Senate Democratic staff said that because the plans will be required to be more comprehensive, enrollees will actually save 14 percent to 20 percent on their premiums if they purchased the same coverage they have today.

Scorekeepers also determined a 40 percent tax on high-cost "Cadillac" plans will affect 19 percent of employer-based policies by 2016. This revelation could cause heartburn for some members who are concerned the tax would hit middle-income workers.

But the bill's effect on employer-based health coverage is negligible, CBO found, coming in at a potential 1 percent average premium increase to a 2 percent decrease for those in the small group market, and no change to a 3 percent decrease for those in the large group market. The large group market, which consists of those employed by companies with more than 50 employees, covers by far the most people with 134 million enrollees.

Twelve percent of the 25 million in the small-group market, which consists of those employed by businesses with fewer than 50 employees, would receive small business tax credits that would decrease their average premium 8 percent to 11 percent.

The report comes as Democrats and Republicans are set on Monday to each offer an amendment on the healthcare legislation.

Sen. Tom Coburn, R-Okla., has already submitted two amendments. One would require members of Congress to enroll in the public option unless their state opts out of the plan. The second would require bills, resolutions and conference reports be posted online along with CBO scores 72 hours before a vote on final passage.

]]>

Cost of Senate health care bill pegged at $900 billion

Anna Edney — Wed, 29 Jul 2009 00:00:00 -0400

The Congressional Budget Office has scored the draft of bipartisan healthcare overhaul legislation that the Finance Committee is working on at just under $900 billion, Senate Finance Committee Chairman Max Baucus, D-Mont., said Wednesday.

"The current draft of the bill scores below $900 billion over 10 years, covers 95 percent of all Americans by 2015, and is fully offset," Baucus said. "In fact, according to the preliminary CBO report, the bill would actually reduce the federal deficit the 10th year by several billion dollars."

Baucus added that the preliminary analysis determined the draft would increase employer-sponsored healthcare coverage. Baucus did not take questions; it is unclear what parts of the bill are included in the score.

The bipartisan group of senators also has largely settled on a tax on insurance companies to help cover the cost of the bill, sources said. The idea is to tax 35 percent on the value of plans above $8,100 for individuals and $21,000 for families. The offset would raise $180 billion over 10 years, sources said.

The Finance Committee was searching for an offset to fill the gap left after concerns from some Democrats and leadership forced them to back off taxing employer-based health benefits.

The scrapping of the offset favored by Baucus also left Finance members hunting for a way to make a significant dent in reducing the growth of healthcare spending, which the insurance tax is also expected to do.

Health insurers promptly expressed dismay.

"A new tax on healthcare coverage takes us in the wrong direction by making coverage less affordable for workers across the country. This new tax would disproportionately impact workers from higher-cost states, such as New York and California, as well as older workers who tend to have more comprehensive healthcare coverage," said Robert Zirkelbach, a spokesman for America's Health Insurance Plans.

The negotiators' goal was to come in under $1 trillion and reduce the growth of healthcare spending, as evident by the deficit decrease. Baucus did not specify how much the deficit would shrink. CBO has said the overhaul versions by Senate Health, Education, Labor and Pension Committee Democrats and House Democrats would increase the growth of healthcare spending.

Whether a markup could proceed before August recess is unclear. Finance Committee staff stressed earlier Wednesday that a deal is not imminent.

"In fact, significant policy issues remain to be discussed among the members, and any one of these issues could preclude bipartisan agreement," said a statement from Finance staff.

Senate Budget Committee Chairman Kent Conrad, D-N.D., said at least two tough issues remain: how to handle people who have employer-sponsored health insurance but cannot afford out-of-pocket costs, and what the governors' reaction to a Medicaid expansion will be.

The committee is eyeing expanding Medicaid eligibility to those with incomes up to 133 percent of the poverty level, but states complain the provision is an unfunded mandate since they share in the cost of the low-income healthcare program.

Peter Cohn contributed to this report.

]]>

CBO sees deficits beyond 10-year window

Anna Edney — Mon, 27 Jul 2009 00:00:00 -0400

The Congressional Budget Office has told key Republican lawmakers that the House Democrats' health care overhaul bill "would probably generate substantial increases in federal budget deficits during the decade beyond the current 10-year budget window."

CBO's analysis, released Sunday, was based on information requests from Ways and Means ranking member Dave Camp, R-Mich., Energy and Commerce ranking member Joe Barton, R-Texas, Education and Labor ranking member John Kline, R-Minn., and Budget ranking member Paul Ryan, R-Wis.

CBO previously determined the legislation would increase the federal deficit by $239 billion during the 10-year budget window.

"When you find yourself in a hole, the first rule is to stop digging. But with this bill, the Democrats keep digging a bigger and bigger deficit hole, and now we have CBO confirming it," Camp said Sunday.

According to CBO, the proposal limits the percentage of income eligible people have to pay when purchasing insurance and specifies that insurance plans must cover a specified portion of health care costs.

"Combining those provisions, increases in healthcare spending in excess of the rate of growth in income would be borne entirely by the federal government in the form of higher subsidy payments," CBO determined.

Democrats focused on other portions of CBO's report, calling attention to the agency's determination that the House Democrats' bill would expand employer-based health care coverage and that Medicaid expansion would not crowd private insurers out of the market.

CBO estimates 3 million more people will receive health care coverage through their employer under House Democrats' health care overhaul bill. Nine million either would drop their employer coverage in favor of joining a health care exchange or have it canceled by their employer. But 12 million people now lacking employer-based health benefits would have it under the new law by 2016.

CBO said businesses would not reduce operating costs under the "pay-or-play" scenario because they would need to increase wages to compensate for the lack of insurance offered. Under the pay-or-play mandate, employers that do not offer insurance would pay a penalty equal to 8 percent of payroll. Health insurance accounts for an average cost of 12 percent of payroll, according to CBO.

The agency determined that 6 million people at qualifying firms would receive coverage through the exchange, and one-third of those would enroll in the public option. The estimate is based on the assumption the exchange will be opened to businesses with 50 or fewer employees.

Even if the government makes the exchange available to most large firms, CBO noted its estimate of people who would enroll in the public plan would be much lower than the oft-quoted Lewin Group estimate of 100 million.

CBO believes employers would have lower administrative costs for enrolling their employees in a private insurance plan outside of the exchange, where the public plan would be offered, because employees in the exchange must be enrolled individually. CBO also estimates the difference between private insurance and public plan premiums would not be as great as the Lewin Group estimated.

The House Democrats' bill also would cause 1 million people who would have had insurance to enroll in Medicaid, CBO found, and 10 million uninsured to enroll in the low-income health care program.

CBO estimates that the coverage scenarios would have "modest" effects on premiums for private insurance plans offered through employers. That reasoning depends on a firewall installed in the legislation that would keep the risk pool for employers largely the same, given the bill prohibits those with an offer of employer-based insurance from gaining a subsidy to pay for coverage through the exchange.

]]>

Senators outline options for public insurance plan

Anna Edney — Tue, 12 May 2009 00:00:00 -0400

Senate Finance Committee leaders Monday released three options for how to set up a government-run public health insurance option, ranging from basing it on a Medicare-style model to a state-by-state solution.

Suggestions from Senate Finance Chairman Max Baucus, D-Mont., and ranking member Charles Grassley, R-Iowa, on the public option include what they referred to as a "Medicare-like" plan that would be administered by a new Health and Human Services agency.

The public plan would be subject to the same rules as the private plans that participate in a health insurance exchange lawmakers want to set up to help consumers choose health coverage.

The public plan would pay healthcare providers anywhere from the same rate as Medicare to 10 percent more. Republicans have argued that a private plan would pay close to Medicare rates and threaten to price private insurers out of the market. The public plan would not have to meet solvency requirements.

The other two options Finance members will meet privately to discuss on Thursday are similar. But instead of an HHS agency operating the plan, either regional third-party administrators would or states operate their own public plan, potentially by allowing people to participate in state-employee plans. The third-party administrators would negotiate their payment rates for providers.

The options paper proposes employer and individual mandates to obtain coverage. The individual mandate would be enforced through a tax on a percentage of the premium for the cheapest coverage offered through the insurance exchange. The penalty would start out totaling 25 percent of the cheapest plan's premium and hit 75 percent in the third year and beyond.

The options paper seems to suggest an individual mandate is a given, while an employer mandate is subject to negotiations. The paper suggests a scenario where an employer mandate is not required, but individuals would be forced to purchase insurance in most cases.

The Main Street Alliance, a network of a dozen state small-business coalitions, plans to tell the Finance Committee Tuesday as lawmakers discuss financing a healthcare overhaul that it is willing to accept an employer mandate as long as a public option is included in the mix, Sam Blair, network director at the alliance said.

"The way our system works now, where responsible employers offer coverage and others don't, it leaves us in a situation with an unlevel playing field," the alliance wrote to Finance Committee members. "If we're contributing but other employers aren't, that gives them a financial advantage over us. We need to level the playing field through a system where everyone pitches in a reasonable amount."

Stephanie Cathcart, a spokeswoman for the National Federation of Independent Business, said the federation disagrees. "The Main Street Alliance is hardly representative of small business," Cathcart said.

Blair argued the alliance formed out of groups that did not feel represented by national organizations like the federation.

]]>

Dems likely to file cloture on HHS nomination

Anna Edney — Thu, 23 Apr 2009 00:00:00 -0400

Despite opposition to Democratic Kansas Gov. Kathleen Sebelius' nomination to serve as HHS secretary, a Senate GOP aide said on Wednesday Republicans had not placed any holds on the confirmation.

Senate Majority Leader Harry Reid, D-Nev., is expected to be forced to file cloture on the nomination, the aide said, because he will not receive unanimous consent to proceed directly to a vote. Republicans oppose Sebelius, in part, for her policy positions and her support of abortion rights.

But one of the Senate's staunchest abortion opponents, GOP Sen. Sam Brownback, happens to be from Kansas and said he plans to support Sebelius. "That's pretty typical for in-state senators to support the nominee from their home state," said Brownback, a contender for the Kansas governor's race next year.

His staff even researched the situation and found just two cases where senators opposed Cabinet nominees from their home states. Sen. Pat Roberts, also a Kansas Republican, supports Sebelius as well and voted for her during Finance Committee approval.

]]>

Ex-FDA official calls for harmonized food-safety strategy

Anna Edney — Tue, 07 Apr 2009 00:00:00 -0400

An official who until recently headed the Food and Drug Administration's enforcement arm said Tuesday the nation's food safety system is in crisis.

"While I recognize the serious problems in the domestic food safety inspection system, I believe that the single biggest challenge facing us is the global market for food," Margaret Glavin, former associate commissioner for regulatory affairs at FDA, told food industry representatives. "Today's market is truly global, and this poses an enormous threat to our food safety system."

Glavin, who left FDA several months ago to become an independent consultant, charged that FDA lacks the funding, staff, and authorities to operate in a global market and lags far behind USDA in its regulatory efforts.

"Our regulations and our program design both envision a regime of regular inspections of domestic food plants and an occasional look at foods arriving from overseas," she said. "This is made worse by the fact that ... imported products are treated completely differently by FDA and USDA."

USDA requires countries importing meat and poultry to meet certain standards, and USDA officials must inspect foreign food plants before they can begin importation. By contrast, FDA does not require prior approval of foreign food firms and has the staff to inspect only a small percentage of imported food at the U.S. border, she said.

Glavin recommended that food-safety laws be modernized and all government agencies involved adhere to an integrated, governmentwide food safety strategy. "That sounds like motherhood and apple pie, but we are so far from that it's not even to be believed," she said. The web of strategies operating over several agencies leads to "inconsistencies and inefficiencies," while the lack of cohesion can lead to poor information-sharing that often prolongs investigations of food-borne illness outbreaks, she added.

Some lawmakers and interest groups advocate combining food safety efforts into a single agency. Glavin said such a move would help align strategies, but she added the costs of such a transition would be enormous. While more funding is a given need at FDA, Glavin said, food safety agencies need the power to require and enforce preventive measures and record-keeping as well as access to records. In addition, she said, food safety agencies need to gain the authority to require that importers put systems in place to ensure safety, and they need resources to ramp up foreign inspections and review other countries' food safety systems.

]]>

Lawmaker calls for vote on HHS nomination this week

Anna Edney — Thu, 02 Apr 2009 00:00:00 -0400

Senate leaders are attempting to confirm Democratic Gov. Kathleen Sebelius of Kansas as HHS secretary this week. The task is no small feat given Thursday's budget votes, but senators hope to get her installed in the post before they leave for the two-week spring recess.

"That's the whole reason we're having this hearing, to get her confirmed this week," Senate Finance Chairman Max Baucus, D-Mont., said on Thursday as Sebelius faced questions from panel members. Former Senate Majority Leader Robert Dole, R-Kan., introduced Sebelius at the hearing and asked the committee to confirm her this week.

Referring to HHS headquarters, he joked that Sebelius "can't even get in the building." It was her second hearing this week, following one on Tuesday with the Senate Health, Education, Labor and Pensions Committee.

Both committees went easy on the nominee despite revelations late Tuesday of tax problems caught by a public accountant. Sebelius and her husband paid $7,040 in back taxes and $878 in interest to amend their 2005, 2006 and 2007 returns. Sebelius said on Thursday the ethics officer informed her she would need to divest a couple of stocks in her husband's portfolio that would pose a conflict of interest if she is confirmed. She did not reveal what those stocks are.

The tax problems, which she called "unintentional errors," stem from charitable contributions and business expenses that she and her husband did not have documentation for, as well as interest they wrongly deducted. Finance members did not ask her to divulge more information about the discrepancies. Tax troubles plagued the previous nominee, former Senate Majority Leader Tom Daschle, D-S.D., who took himself out of consideration for the spot in February. But Sebelius appears poised to sail through her confirmation.

]]>

Sebelius becomes latest Obama nominee with tax trouble

Anna Edney — Wed, 01 Apr 2009 00:00:00 -0400

Kansas Democratic Gov. Kathleen Sebelius Tuesday became the latest Obama administration Cabinet nominee to have tax problems come to light.

The Health and Human Services secretary nominee informed the Senate Finance Committee that she and her husband paid $7,040 in back taxes and $878 in interest for 2005, 2006 and 2007 taxes after a review by a certified public accountant found the errors. Sebelius characterized the discrepancies as "unintentional."

Finance Chairman Max Baucus, D-Mont., stood behind Sebelius and called for quick action on her nomination.

"Congress is going to need a strong partner at the Department of Health and Human Services to achieve comprehensive health reform this year, and we have that partner in Gov. Sebelius," Baucus said in a statement. "There is absolutely no doubt in my mind that Gov. Sebelius has the political experience, determination, and bipartisan work ethic to get the job done with Congress this year."

Sebelius is set to appear before the Finance panel Thursday.

Finance ranking member Charles Grassley, R-Iowa, is waiting to make a decision on Sebelius, a spokeswoman said.

"Sen. Grassley generally reserves judgment on nominees until the vetting process, including the nomination hearing, is completed," she said. "He gives the nominees a chance to give their point of view on all relevant issues, including any tax issues that have come to light through the standard committee vetting process."

Sebelius' tax errors stemmed from discrepancies over charitable contributions, interest on a home mortgage and business expenses. According to the letter to the committee, Sebelius could not locate three acknowledgements out of 49 charitable contributions that prove she could deduct donations of $250 or more.

In addition, Sebelius and her husband sold their home in 2006 for less than the amount left on the mortgage. They continued to pay off the leftover amount of the mortgage and a home improvement loan while wrongly deducting interest for the loans.

Lastly, the couple also had business expenses for which they could not find documentation, but the error did not affect the total taxes owed because they were subject to the alternative minimum tax.

Obama's first pick for HHS secretary, former Senate Majority Leader Tom Daschle, D-S.D., pulled out amid controversy over $140,000 in back taxes he paid from a car and driver he received from a close friend's private equity firm for which he consulted.

Treasury Secretary Timothy Geithner's confirmation was delayed due to tax trouble, particularly $34,000 in back taxes and $8,600 in interest from several years he was employed by the International Monetary Fund.

U.S. Trade Representative Ron Kirk also faced tax woes, having failed to pay almost $10,000 in taxes over three years.

]]>

Drug industry is wary of Obama's pick for FDA deputy

Anna Edney — Wed, 18 Mar 2009 00:00:00 -0400

Food, pharmaceutical and medical device groups have lauded President Obama's pick to lead the Food and Drug Administration, but his selection for second in command is giving the drug industry heartburn.

Industry insiders describe their colleagues as cautiously optimistic about FDA Administrator-nominee Margaret Hamburg, a former New York City health commissioner who works at a nuclear nonproliferation think tank, and nervous in varying degrees about Baltimore City Health Commissioner Joshua Sharfstein.

"Hamburg will be focused on the food supply and creating regulation of tobacco, and to some degree it's expected Sharfstein will have a certain amount of autonomy on pharmaceuticals and medical devices," one lobbyist said. "Companies are clearly going to get more scrutiny."

The drug industry is viewing the dual picks, as one FDA lawyer put it, as a "power-sharing agreement."

Obama emphasized food safety when he announced the selections of Hamburg and Sharfstein, likely keeping in mind the string of deadly foodborne illness outbreaks in recent years. Hamburg's public health and bioterrorism background make food safety a natural fit. She is a senior scientist at the Nuclear Threat Initiative, which publishes Global Security Newswire, a National Journal Group affiliate.

Sharfstein, on the other hand, has a long and sometimes contentious history with the pharmaceutical industry.

"Anyone who spent their career under Henry Waxman ...," said one lobbyist, trailing off with a shudder.

Sharfstein worked under the now-House Energy and Commerce chairman from July 2001 to December 2005, a Waxman spokeswoman said.

Waxman has been tough on drug companies, particularly given several scandals involving contaminated drugs or unheeded warnings in the recent years. Sharfstein has carried the torch on many of his former boss' public health priorities, ranging from cracking down on medication use for illnesses not approved by FDA to criticizing pharmaceutical companies for gifts handed out to physicians.

Sharfstein led the Obama transition team's FDA evaluation and was thought by many to be a shoo-in for the top post at the agency. He raised warning bells as well that led the agency to re-evaluate the safety of cough and cold medicine use for children.

The pediatrician could play a key role implementing 2007 FDA legislation that set up a system for pharmaceutical companies to assess risks associated with their products and come up with a plan to mitigate those risks -- hence the term risk evaluation and mitigation strategy, or REMS. The law affords FDA the discretion to determine how stringent a product's REMS should be, and the drug world fears potentially burdensome REMS could become the norm.

"I think companies are really nervous based on his track record," an industry insider said.

Peter Pitts, co-founder of the Center for Medicine in the Public Interest and a former FDA associate commissioner for external relations, argued the drug lobby's fears are unfounded.

"I don't think you'll see more strident regulations," Pitts said. "I think you'll see a more effective way to use existing regulations."

He anticipates FDA will experience an influx of resources this year that will have the underfunded agency running smoother and more efficiently.

One lobbyist called the new funding on the horizon "a blessing and a curse," adding, "With that money, the question is: What type of additional oversight or regulatory burden [is] not going to be put on just pharma-companies but biotech and medical device companies as well?"

Waxman is a leader in trying to move legislation that would grant FDA the authority to oversee tobacco, a bill Sharfstein worked on with the chairman, as well as his most recent legislation that would allow FDA to approve generic versions of biologic drugs.

]]>

Watchdog blasts FDA on loose test compliance policy

Anna Edney — Wed, 18 Feb 2009 00:00:00 -0500

The independent watchdog group Project on Government Oversight revealed Wednesday that top Food and Drug Administration medical-device officials backed off on a requirement that device manufacturers test their products according to federal standards -- the very standards put into place 30 years ago after a prominent lab provided fake data to FDA.

The lax oversight instituted in 2006 applies to some of the most critical devices, including cardiac defibrillators, pacemakers, replacement heart valves and coronary artery stents.

The report calls the nonenforcement policy of so-called good laboratory practices "a high-stakes, unknown-odds gamble with the lives of patients -- particularly those whose survival depends on life-sustaining medical devices."

The report describes a 2006 confrontation between an FDA scientist and a top official in the device division that resulted in an emergency meeting in which a nonenforcement policy regarding good laboratory practices was reiterated.

The decision to abandon enforcement was not made publicly through rulemaking. It was made behind closed doors among top FDA officials who believed enforcement was not feasible, according to the report.

In addition, FDA's budget has been stretched thin in recent years, causing inspection efforts to suffer.

An FDA spokeswoman said the agency has indeed conducted fewer inspections specific to good laboratory practices in recent years, but she pointed to some guidance documents that do speak to the importance of following the standards, which are in place for the earliest stages of animal testing. The spokeswoman said FDA conducted 31 inspections related to good laboratory practices in 2005, 24 in 2006, 8 in 2007 and one in 2008.

Some device firms and some consumer groups are concerned the requirements can delay a lifesaving product's path to the market and jack up the price of devices out of some patients' reach, but the worries do not justify abandoning enforcement, the report said.

The watchdog group wants the Government Accountability Office and the Health and Human Services Department inspector general to audit records related to good laboratory practices to try to determine the extent of noncompliance. It also wants FDA to start conducting enforcement, particularly through random inspections as well as for-cause inspections.

Lastly, the group called for changes in one of FDA's approval methods that allows device-makers to prove their product is "substantially equivalent" to one already on the market rather than conduct rigorous testing.

The House Energy and Commerce Committee is in the thick of an investigation of how FDA handles medical device approval and is looking to make some changes, potentially through introduced legislation that would improve FDA's ability to police food, drugs and devices.

]]>