Baucus & Kennedy Working on Separate Health Care Proposals|
Decades of work on health policy issues and his passion for covering the uninsured may make Senator Edward Kennedy (D-MA), chair of the Health, Education, Labor and Pensions (HELP) Committee, the natural leader when it comes to health care overhaul. Kennedy and his staff have been emphasizing that they plan to use the health plan of President-elect Barack Obama as a blueprint for a comprehensive health care reform plan, and they are working closely with the president-elect’s team. However, in a press briefing on November 12, Senate Finance Committee chair Max Baucus (D-MT) made it abundantly clear that he intends to be at the center of the action too.
The previous week, on November 7, just three days after the election, Baucus announced plans to unveil the following week his own “specific goals and policy options for comprehensive health care reform in 2009” — without waiting for Obama’s detailed proposals. In a letter to Obama dated November 6, Baucus said, “Next week I will present to you and to the country my plan to move forward on health care reform in the early days of the 111th Congress and of your administration.” He also said, “I made sure the Finance Committee spent this year learning and preparing for action on a comprehensive overhaul of the health care system, and I intend for us to move swiftly and decisively with legislation in early 2009.” Baucus added that he would “work together with the new administration and with my colleagues in Congress in refining and advancing this effort.” Nevertheless, he left no doubt that he intends to have the first say on the matter.
Indeed, in addressing his packed press briefing on November 12, Baucus distinguished himself by releasing a lengthy white paper, entitled Call to Action, Health Reform 2009, outlining his overhaul plan (http://finance.senate.gov/healthreform2009/home.html). In the paper, Baucus calls for creation of a nationwide insurance pool called the Health Insurance Exchange, and for expanding three government health programs — Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP) — as well as opening Medicare to people ages 55 to 64. He also outlines new tax breaks for individuals and small businesses to offset the costs of insurance. As for funding sources, he argues that ideas such as eliminating waste and fraud, focusing on prevention, and using sophisticated data to identify the most cost-effective therapies will save money over the long term. In the short term, he advocates eliminating what Democrats have long criticized as “overpayments” to insurance companies that sell managed care plans to Medicare recipients.
Possibly the most controversial idea in Baucus’s plan is his suggestion to revisit the current tax treatment of employer-sponsored health insurance. Referring to GOP proposals eliminating the tax exclusion for employer-based health insurance premiums and converting the benefit to a tax deduction or credit, Baucus said that approach goes too far. Instead, he would encourage Congress to consider a middle road with some limited modification of the relevant tax code.
Meanwhile, Kennedy — although praising the Baucus plan — will likely present appealing arguments for his own set of overhaul plans. Furthermore, his efforts are expected to carry enormous weight, given his lifelong focus on the issue, his early endorsement of Obama, and his own health status battling brain cancer. Over the past several months, he has directed aides to convene negotiating sessions with a diverse group of stakeholders, including physicians, patient advocates, small-business owners, and insurers. Through an aide, Kennedy said, “We’re doing all we can to unite Congress around a single, unified bill for early action next year.” And, while his aides have refused to indicate what specific direction Kennedy will pursue, they have made it clear he does not intend to cede his longtime leadership role on health policy. He intends to have legislation drafted by Inauguration Day.
At the moment, however, the Baucus plan is getting plenty of attention. A number of lobbies, including America’s Health Insurance Plans, the Advanced Medical Technology Association, and the American Medical Association have commended Baucus for offering his proposal without getting into specifics. Senator Ron Wyden (D-OR) who, with Senator Robert Bennett (R-UT), introduced S. 334, the Healthy Americans Act, also commended the Baucus proposal, noting that it had many of the elements found in his bill with respect to ending the tax exclusion. Wyden realizes that he may be outdone by Kennedy and Baucus, but said his ability to draw as cosponsors of S. 334 six Democrats, 10 Republicans, and one Independent illustrates the salience of the health care reform issue and that it is possible to move in a bipartisan way.
While the HELP Committee will share jurisdiction with the Finance Committee over portions of a health care overhaul, Baucus will have jurisdiction over a large part of any health care reform measure Congress tackles next year. Among other areas, the Finance Committee controls policy for Medicare, Medicaid, SCHIP, taxes, and Social Security.
| Obama Taps Daschle for HHS Secretary Position
President-elect Obama has tapped former Senate majority leader Tom Daschle (D-SD) to serve as his secretary of Health and Human Services (HHS). In addition, Daschle will be the White House health care “czar,” helping to develop and execute the president's reform agenda. Health care advocates and policymakers applauded Daschle’s selection as secretary saying it signals Obama’s commitment to comprehensive health care reform.
Daschle served in Congress from 1978 to 2004, with his Senate tenure beginning in 1986. He was a leading advocate for comprehensive health reform when Congress was debating the issue in 1993-94. Daschle is now an adviser to the law firm of Alston & Bird. He also is a Distinguished Fellow at the Center for American Progress and author of the 2008 book, Critical: What We Can Do about the Health-Care Crisis.
Senators Max Baucus (D-MT) and Chuck Grassley (R-IA), chairman and ranking member of the Senate Finance Committee, respectively, applauded the selection, “Senator Daschle knows clearly the Congress; specifically, he knows the Senate. He knows the rhythms of this outfit and the players, and he's an excellent choice for HHS secretary.” Grassley told reporters it was “a big step forward” from the Bush administration to have Cabinet members who understand Congress.
Earlier this year, Daschle gave the opening address at the Families USA Health Action Conference. Families USA is a national nonprofit, non-partisan organization dedicated to the achievement of high quality, affordable health care for all Americans. Here is an excerpt from that speech that delineates Daschle’s thoughts regarding health care reform.
“One of the biggest tactical mistakes we’ve made is to allow the opponents of health reform to define the debate. As a result, we’ve lived under a number of myths. Perhaps the biggest myth of all is that the US has the best health system in the world. So before the debate can begin, we need to all understand the same basic facts. We need to understand how we got here and where we need to go.
“Incremental change in our system is no longer a viable option. Instead we need comprehensive reform. In growing numbers the American people are demanding that we do something. Our goal should be to build what current and retired members of Congress have today, and make that available for all Americans.”
Elements of Daschle’s health care reform platform include:
- Establishing an autonomous oversight body for health care comparable to the Federal Reserve for our monetary sector. This group would have the responsibility to control costs, starting with chronic disease, which represents the largest block of costs to the system.
- Investing in information technology that would result in quantum leaps in efficiencies and quality improvements
- Pooling to aggregate the risks/costs for small business and individuals
- Negotiating drug pricing — build on and leverage the purchasing volumes that government already has
- Initiating prevention measures — wellness, easy access, and early intervention
- Creating a Comparative Effectiveness Institute. As the Congressional Budget Office and Institute of Medicine have noted, an autonomous national institute that could use large data sets to identify the approaches that work best would clarify and unify clinical practice throughout America, and would have significant impact on both quality and cost.
- Improving patient-provider interactions by taking advantage of technology to smooth the flow of communications between patients and the health system
- Creating universal coverage by increasing access through health vouchers and coverage
Inouye Succeeds Byrd as Appropriations Chair
Ending months of speculation about his status and questions about his health, Senator Robert Byrd (D-WV) announced on November 7 that he would step down as chair of the Appropriations Committee in the 111th Congress. Senator Daniel Inouye (D-HI) will succeed him as the next chair.
Byrd, 90, was hospitalized several times this year and had come under growing pressure to relinquish his gavel as the committee gears up for a busy year under a new Democratic president. But aides said that Byrd made the decision to step aside on his own in light of the changes brought about by the presidential election, and he did not discuss the issue with Majority Leader Harry Reid (D-NV). Reid had reportedly talked about the issue with Inouye before the election, and Byrd issued a statement at the time expressing his disappointment to learn of those talks.
Byrd will be the second-ranking member of the Appropriations Committee and will continue to chair the Homeland Security Subcommittee. In addition, as senior member of the Senate, Byrd will retain his post as president pro tempore, which places him third in line of succession to the presidency. In addition to filling Byrd’s position, Inouye will retain his post as chair of the Defense Subcommittee.
During the past two years, Congress has tangled with President Bush over how much funding should be approved for domestic programs and agencies. While Byrd advocated that Congress pass bills one by one rather than flinch in the face of Bush’s veto threats, congressional leaders have followed the plans of Byrd’s House counterpart, Representative David Obey (D-WI), who has been the major driver of appropriations decisions. This year, Obey successfully advocated holding off on completing domestic spending bills until a new president is in office.
FROM THE STATES . . .
NJ Nursing Education Bill Advances
On December 11, the New Jersey Senate Budget and Appropriations Committee
unanimously approved S. 626, aimed at encouraging nurses to enter the teaching profession. The Senate Health, Human Services and Senior Citizens Committee previously approved the billon October 27. The measure, sponsored by Senator Joseph Vitale (D-Middlesex), would establish the Nursing Faculty Loan Redemption Program in the Higher Education Student Assistance Authority. The program would provide loans to finance the graduate study of eligible participants (i.e., New Jersey residents enrolled in an approved graduate degree-in-nursing program who maintain a grade point average of 3.0 or higher), in exchange for five years of full-time or part-time employment as nurse faculty at a New Jersey school of nursing following completion of the graduate program.
In his comments, Vitale called the state's nursing workforce "absolutely essential to providing quality health care," adding, "While we've made progress in reducing a nursing staff deficit, we're currently facing a critical shortfall of nursing teachers which could jeopardize any progress that we've made. We need to ensure that New Jersey residents looking to enter into the nursing profession have the quality teachers available to give them the strong academic foundation to succeed."
S. 626 was amended in committee to dedicate a fixed percentage of the existing primary care physician and dentist loan redemption program for the nursing faculty loan program. Vitale, who is also a member of the Senate Budget and Appropriations Committee, explained the amendment saying, "We recognize that New Jersey faces a significant budget shortfall for the next fiscal year, in addition to the current national economic crisis which will have an impact on how we spend state funds. However, that does not mean that we can't meet the state's critical needs, if we identify existing programs and funding mechanisms to keep bills like this cost-neutral." S. 626 now heads to the Budget Committee before going to the full Senate for consideration.