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Bipartisan Negotiators Plan More Cost-Cutting in Senate Overhaul Bill

By Jane Norman, CQ HealthBeat Associate Editor

August 21, 2009 – Bipartisan overhaul negotiators on the Senate Finance Committee agreed via teleconference Thursday night to put an increased emphasis on affordability of care and reducing health costs in any bill they produce.

But there was no indication of a final deal or agreement coming out of the 90-minute discussion, or details on how much more they might try to carve out of legislation pegged in an initial estimate to cost $900 billion over 10 years. The group of six senators did agree to meet again before they return to Washington after Labor Day.

The meeting came after a week in which the future of the only bipartisan overhaul negotiations on Capitol Hill seemed in doubt. Republican Sen. Charles E. Grassley of Iowa, the lead GOP negotiator, said he wants to continue working with Finance Committee Chairman Max Baucus, D-Mont., and other Democrats, but also said he would "absolutely not" vote for a health care bill that had only three or four Republicans backing it, giving a more emphatic tone to comments he's made earlier about seeking wide GOP support.

Baucus issued a statement on the "gang of six" meeting, the first since Aug. 6. The group is made up of Baucus, Grassley and Democrats Kent Conrad of North Dakota and Jeff Bingaman of New Mexico, and Republicans Olympia J. Snowe of Maine and Michael B. Enzi of Wyoming.

"As we travel our states, our work on health care reform continues," said the statement. "Tonight was a productive conversation —we discussed our progress and remain committed to continuing our path toward a bipartisan health care reform bill. Our discussion included an increased emphasis on affordability and reducing costs, and our efforts moving forward will reflect that focus. We have come a long way, will continue our work throughout August and plan to meet again before the Senate returns in September."

The task for the negotiators and their staffs will be how much more can be saved in the legislation without affecting the overall goal of extending affordable coverage to the 47 million uninsured and bending the cost curve of health care spending. Len Nichols, director of the health policy program at the New America Foundation, said at a forum Thursday sponsored by the journal Health Affairs that fully-phased in coverage of all the uninsured likely will cost $150 billion a year

"That is a big number," he said. "The question is, and this is what I think is the single biggest question, are we willing to do what it takes to pay for this? And there are only three buckets. You can increase taxes. You can change the way we currently subsidize health insurance. And you can do something about the way we spend money in Medicare and Medicaid programs."

Nichols said in his view, all three actions are necessary. "I think we've got to be willing to do all these things to be willing to pay the price. I don't think it's too big a price, but it's certainly a significant change," he said.

President Obama discussed the ongoing negotiations in a health care rally Thursday at the Democratic National Committee, where he took questions via e-mail, telephone and Twitter. Obama showered praise on the Republican negotiators "because they're under enormous pressure" but said he has "no control" over what Republicans as a group may decide on as a strategy.

"We don't know yet whether we've got any Republican support," said Obama. "We've got three Republicans who've been working very see if we can craft a bipartisan bill coming out of the Senate Finance Committee. I give those three Republicans a lot of credit because they're under enormous pressure not to engage in any kind of negotiations at all. And in the current political climate, they are showing some significant resolve."

"I don't know if in the end they can get there. I hope they can. And we're going to just continue to wait to see if they can get a product done.

"But at some point in the process, there's going to have to be a conclusion that either they can get a bill done or they can't get a bill done. And my commitment to the American people is to get a good product—which will include Republican ideas—but I have no control over what the other side decides is their political strategy. And my obligation to the American people says we're going to get this done one way or another."

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