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Children's Health Bill Headed to Floor

By Drew Armstrong, Alex Wayne and Richard Rubin, CQ Staff

July 27 - A major legislative package that would overhaul and expand a children's health insurance program is headed to the House floor next week after an exhausting two days of parliamentary maneuvering in a pair of committees.

The Energy and Commerce and Ways and Means committees worked late into the night Thursday, with Democrats determined to advance the huge health insurance bill in the face of Republican delaying tactics.

Shortly before 2 a.m., Ways and Means finally approved the legislation (HR 3162) on a 24–17 party-line vote after shooting down a long series of Republican amendments.

The Energy and Commerce Committee—which shares jurisdiction over the package—gave up for the night around 10:30 p.m. Thursday. It resumed its markup Friday morning, but again, Republicans stalled progress on the legislation, forcing the committee clerk to read aloud every one of the bill's hundreds of pages.

At about 4:30 p.m. Friday, nearly 30 hours after the committee convened and 160-some pages into the 495-page bill, Chairman John D. Dingell, D-Mich., used his last remaining option to end the deadlock. He said he would discharge the bill to the full House, without any amendments.

Lawmakers and staff stood to applaud Sharon Davis, the clerk who undertook the marathon reading chore.

Dingell adjourned the committee, ending the markup and any chance of altering the bill there. The Rules Committee will write a rule for floor debate that will include a self-executing provision to discharge the bill from the Energy and Commerce panel upon adoption. The Rules panel might meet as early as Monday to do so, in order to get the bill on the floor in the last week before the August recess.

The bill would renew and expand the State Children's Health Insurance Program (SCHIP), which covers about 6 million low-income children whose families aren't poor enough to qualify for Medicaid.

The measure has become a political flash point. House Democrats want to expand spending on the program by about $50 billion over the next five years, while cutting payments to GOP-championed Medicare Advantage private insurance plans and raising tobacco taxes to offset the cost. Their bill also would block a scheduled 2008 cut in Medicare payments to physicians.

Republicans say the House bill as currently drafted would violate "pay-as-you-go" rules that require bills to be fully offset over separate five-year and 10-year periods. GOP members say that the Ways and Means version of the SCHIP bill is offset over its first five years, but not over a 10-year span. The Energy and Commerce version, they say, flunks the pay-go test over both periods.

A Democratic aide said the problem would be addressed over the weekend, but offered no specifics.

The Senate plans to start debate next week on its own $35 billion expansion of SCHIP, a bipartisan measure that the Finance Committee approved June 19 by 17–4. The vehicle for that debate will be a leftover, House-passed tax measure (HR 976) that will be stripped of its contents and used to carry the SCHIP provisions. Majority Leader Harry Reid, D-Nev., late Thursday filed a cloture motion to limit debate on a motion to proceed to that legislation. A vote is scheduled for 5:30 p.m. July 30.

House Democrats had planned for the Energy and Commerce and the Ways and Means committees to approve the bill Thursday in preparation for a House vote next week. But work bogged down quickly when Republicans complained about the way Democrats were writing and advancing the bill, and resorted to delaying tactics in both panels to slow action on the measure.

Addressing complaints that Democrats did not consult Republicans on the measure, Energy and Commerce Chairman Dingell said that was because Bush has threatened to veto a smaller SCHIP expansion approved by the Senate Finance Committee, and House Republican leaders have said they will back him.

In both committees, Republicans forced the committee clerk to read aloud page after page of the giant bill, consuming hour after hour.

As the Energy and Commerce Committee reconvened Friday, so did the seemingly endless recitation of the bill.

Amendments Rejected
Once the Ways and Means Committee finally began considering its first amendments, it became clear that the GOP stalling tactics could not alter the legislation.

Republican efforts to amend the bill piece-by-piece were defeated wholesale by Democrats. Sam Johnson, R-Texas, tried to strike a provision in the bill that would ban physicians from referring patients to hospitals they own—effectively a ban on specialty hospitals. The amendment was attacked by Rep. Pete Stark, D-Calif., and Johnson decided to withdraw it.

An amendment by Jim Ramstad, R-Minn., that would have redefined a program called Medicare Chronic Care Special Needs Plans, used by very sick patients with certain conditions, was defeated by voice vote.

GOP efforts to spare Medicare Advantage plans from payment cuts failed as well. Under the program, which was created as part of the 2003 prescription drug law (PL 108-173), private insurers provide benefits to seniors in place of the government-run traditional Medicare program. An amendment by Phil English, R-Pa., that sought to allow the Department of Health and Human Services to set county-by-county payment levels for Medicare Advantage plans was rejected on a 14–21 party line vote.

Kentucky Republican Ron Lewis tried to protect his tobacco state constituents with an amendment to strip out the tobacco tax increase that would fund much of the legislation, pleading with Democrats not to hurt his district's industry.

"I don't know how you can find another way to fund this, but I'm sure you can be creative and find another way," Lewis said.

His amendment was defeated 16–23, despite his invocation of the Lord, who, he said in an extended analogy drawing on the Book of Genesis, would not have taxed tobacco.

In the Energy and Commerce Committee, the delays were even longer. Most members delivered an opening statement, which consumed about four hours. Then, the senior Republican on the panel, Joe L. Barton of Texas, offered a motion to postpone debate on the bill until Aug. 1. Republicans engaged in lengthy debate on Barton's motion, and complained when Dingell tried to cut them off and vote after a half-hour of talking.

The arguing was interrupted by votes on the House floor. When the committee returned, Dingell called a vote; Barton's motion failed, 23–29.

Dingell then tried to proceed to debate on the bill by waiving its reading. Barton objected. The clerk, Sharon E. Davis, began to read.

When the clerk skipped the words, "A bill," in the legislation, Barton complained.

"Your clerk has already missed part of the reading," he told Dingell. "It begins, "A bill . . .'"

"The clerk will read the bill," Dingell said. "Correctly."

Lydia Gensheimer contributed to this story.

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