Lawmakers struggle to balance interests as sweeping health legislation negotiations proceed

Lawmakers continue to try to shape health bills as they move closer to floor votes.

Kaiser Health News and Politico report that "Some (senators) seeking to help rural hospitals in their states also want to hold the line on the cost of reform."  They include Sens. Mark Pryor, of Arkansas, Ron Wyden, of Oregon, Sam Brownback, of Kansas, and Kent Conrad of North Dakota.

"Congress created the 'critical access hospital' category in 1997 to ensure access to care in isolated parts of the country. Under the law, hospitals that are at least 35 miles away from other health facilities can be deemed 'critical access' hospitals; those hospitals can collect 101 percent of their costs from Medicare, for a maximum of 25 beds, rather than the usual 95 percent of allowable costs." Lawmakers want to change the rule that they be 35 miles apart (Pianin and Carey, 10/19).

The current health care reform debate is also spotlighting an unlikely figure, Sen. Roland Burris, The Associated Press reports. "For Democrats determined to get a health care bill, [he] is the house guest who couldn't be refused, won't soon be leaving and poses a plausible threat of ruining holiday dinner." Burris, an Illinois Democrat, was appointed to succeed President Obama in the Senate by disgraced former Gov. Rod Blagojevich. He says "he'll only vote for a bill to provide health care to millions more Americans as long as it allows the government to sell insurance in competition with private insurers." And he says he won't compromise on the issue. And now, Senate Democrats need 60 votes more than ever. "By definition, all 100 senators are relevant because any one can block Senate business unless there are 60 votes to override the objection. But Burris' stated position on the public option means that Democrats can no longer take his vote for granted" (Kellman, 10/19). 

The Washington Post interviewed Sen. Olympia Snowe, R-Maine, about her her Senate Finance Committee vote. She said the American people would be "very encouraged" to see how the "Gang of Six" worked together to craft a bill. Snowe also said "I'm still struggling with affordability. The Congressional Budget Office has produced charts showing that the American people will achieve savings, but we have to make sure that is the case." 

About her proposal to use a "trigger" for the government-run public health insurance option: "We need a lever to force the industry to drive down prices. If the goal of the public option is to ensure the industry performs, then the same could be true of a trigger mechanism. That lever could be equally potent in providing the maximum incentive to the industry to perform. The CBO has said we'd realize $15 billion in savings" (Klein, 10/18).

In the House, top Democratic lawmakers are facing challenges of their own, The New York Times reports. House Speaker Nancy Pelosi is directly asking colleagues what it will take to win their vote. "Ms. Pelosi, who has been meeting incessantly with fellow Democrats on health care, said she was now focused on producing the strongest possible legislation that can pass the House to provide her side of the Capitol with as much leverage as possible in future talks with the Senate." Pelosi must meet the needs of the moderates in her caucus without alienating the liberals in her party (Hulse and Pear, 10/18).

The Cleveland Plain Dealer reports that the fight over health care "obscures" common ground. "Both parties support plans that would provide incentives for prevention and wellness, extend coverage to those with pre-existing medical conditions, let job-changers retain their insurance, subsidize insurance purchases by the uninsured, and set up exchanges where the uninsured could shop for insurance." Republicans say their ideas aren't heard simply because they aren't in power (Eaton, 10/17).