Democrats prepare for health reform cost analysis while courting GOP votes

Jun 13 2009

What is sure to be a staggering price tag for health reform has Senate Democrats talking about changing the chamber's normal accounting procedures, The Hill reports.

"Some Democrats are arguing behind the scenes that they should not use the non-partisan Congressional Budget Office's cost estimate, as is custom. Instead, they would use cost estimates from the White House Office of Management and Budget. This unusual option could give Democratic leaders hundreds of billions of additional dollars to work with as they draft their plans. But Republicans would call it an accounting gimmick and a huge spending loophole." Rep. Barbara Boxer, D., Calif., among other Democrats, said she won't abide by the CBO's scores if they don't take illness prevention into account.

"Complaints about CBO's scoring of preventive benefits is not new. Republicans routinely blasted CBO on this issue when they controlled Congress during the Bush administration. CBO experts say they can only rely on hard data in assessing savings, not anecdotal information. … (Sen. Max) Baucus (the Montana Democrat who chairs the Senate Finance Committee) told The Hill Thursday that he estimates that roughly 50 percent of the cost of reform would be covered by savings generated from reforms such as greater emphasis on preventive medicine, improvement of information technology and coordination of healthcare" (Bolton, 6/11).

MSNBC reports that "supporters of the health insurance overhaul are concerned that it could stall if voters doubt that Obama's plan will curb costs while maintaining current levels of care. They are pressuring the CBO to include long-term - and somewhat speculative - savings in its estimate of the health care bill. An early test of the CBO's willingness to venture into such territory could come as early as next week." The CBO has a number of problems in scoring, including speculation on what something will save and pinpointing savings as many as 15 years out (Curry, 6/11).

Kaiser Health News details how Democrats are trying to secure the votes of more than a dozen moderate and conservative Republicans to pass health reform with bipartisan support. To do it, Baucus "emerged from a morning session with key Republicans and Democrats saying he was 'inclined toward' jettisoning a proposed government-sponsored insurance program endorsed last week by Obama in favor of a new proposal to create national, state and regional health care insurance cooperatives. Republicans bitterly oppose the public insurance option, saying it would undermine the private insurance industry and lead to a national health insurance system. Some conservative Democrats also are skeptical of the public plan option, even as they and Baucus support Obama's overall reform goals." Democrats are pursuing Republican Sens. Charles Grassley of Iowa, Olympia Snowe of Maine, Pat Roberts of Kansas, and Mike Enzi of Wyoming, among others.

"Republicans appeared disorganized early in the health care debate, but are beginning to galvanize around a set of objections to the legislation as Democratic committee leaders in the Senate and House have begun to circulate a series of proposals in anticipation of legislative markups, beginning next week in the HELP Committee and later this month in Finance" (Carey and Pianin, 6/11).

House Speaker Nancy Pelosi, of California, however, opposes the cooperative compromise, MSNBC reports in a separate story: In response to a question on the co-op, Pelosi said: "'Not instead of a public option. In our caucus, our members have been very clear about what their concerns might be about a public option, and I agree it should be sound, it should be administrative, it should be self sufficient, it should be a competitor with the private sector and not have an unfair advantage… When you say public option, you have to say right next to it -- level playing field'" (Russert, 6/11).

Meanwhile, CQPolitics writes that Republicans are warning Democrats who continue to insist on a public plan. "'If a government-run plan is a competitor, pretty soon you'll have no other competition,' said Roy Blunt of Missouri, who heads the party's House health care working group. He said the federal government will always have an unfair advantage over the private sector. Such a plan 'will drive people away from the coverage they have now' and lead to rationing of health care and medical decisions made by government bureaucrats, he said" (Epstein, 6/11).

Problems also persist inside the Democratic party itself regarding the public plan: "A coalition of more than 100 moderate House Democrats is hoping to unify as they attempt to limit the size and scope of a government-sponsored health insurance option - a key sticking point as health reform enters a delicate phase of negotiations," Politico reports. "Members of the New Democrat Coalition have organized a meeting with their counterparts in the Blue Dog Coalition on Friday morning in a bid to show some strength in numbers as they haggle with party leaders and the three chairmen drafting the bill. … Moderates want to ensure that that government-backed health care plan doesn't undermine the private market" (O'Connor and Brown, 6/12).