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Could Talk of a Middle Ground on Health Care Lead to Action?

By Jane Norman, CQ HealthBeat Associate Editor

January 19, 2011 -- Beyond the repeal vote in the House and a somewhat more civil tone to the debate lies a new challenge for Republicans and Democrats when it comes to the health care law. Is it possible the two sides are interested in stretching that civility even further and finding some middle ground for changes in the law as Republican committees begin digging into it?

As remote as that may seem judging from the heated rhetoric on the floor and from advocates on both sides, the words do crop up—though as yet there's no indication that a middle ground is actually in sight. "No one will negotiate on our side until they're ready to negotiate on theirs," said Rep.Robert E. Andrews, D-N.J., a top member of the House Education and Labor Committee.

Republicans fresh from their vote on repeal—something they'd campaigned on and promised to voters—will offer a resolution instructing committees to begin work on changing the law, though the changes are not yet specified and there's no timeline. House Speaker John A. Boehner, R-Ohio, described the changes as "common-sense reforms that will bring down the cost of health insurance for the American people and expand access."

It's widely expected they will include extending access to insurance across state lines and strengthening health savings accounts, neither of which have historically garnered much Democratic support.

Andrews said he does have a list of what he sees as middle-ground fixes he'd like to see in the law, some of which majority Republicans already back, such as a repeal of the highly unpopular requirement that businesses file a 1099 form with the IRS. Lawmakers in both parties would like to do away with that provision but have been unable to agree on how to pay for it.

Andrews said he'd also like to see the small business tax credit changed to allow mom-and-pop businesses to qualify, some easing of calculations for the employer mandate and examination of technical issues brought up by states struggling to implement the health insurance exchanges.

"The consensus of the public is we should assess areas of the bill to be fixed," said Andrews, but he also predicted that not much will happen until Republicans resolve how they will proceed on any plans to withhold funding for implementation of the law and what legislative vehicle to use.

Democrats eager to be seen as bipartisan regularly point to President Obama's willingness to deal with the GOP, though Republicans say their earlier attempts to have a voice when they were in the minority were rebuffed. Obama in a statement about the repeal vote cited the law's new consumer protections, added benefits for senior citizens and reductions in deficits—and repeated a pledge he has made in the past to consider changes.

"So I'm willing and eager to work with both Democrats and Republicans to improve the Affordable Care Act," Obama said. "But we can't go backward."

Democrats continued to fight back hard against the repeal vote, bringing Health and Human Services Secretary Kathleen Sebelius to the Hill to meet with their caucus for a pep talk in the morning, along with Agriculture Secretary Tom Vilsack and Small Business Administrator Karen Mills. "Repeal, repeal, repeal is not a plan, nor is it a solution," said Connecticut Rep. John B. Larson, chairman of the Democratic Caucus.

But Larson also raised the possibility of the parties reaching out and working together in response to a greater public desire for bipartisanship, though he didn't offer specifics. He did say Obama would lead the charge. "I believe as we look out across America there is that great hope for us," he said. "Our president continues to reach out to the other side."

But there's a canyon in between. On MSNBC, Tennessee Rep. Phil Roe, a Republican, and Ohio Rep. Dennis J. Kucinich, a Democrat, sat together and discussed a tempering of the tone in Congress in the wake of the shooting in Tucson, Ariz., of Democratic Rep. Gabrielle Giffords.

"I see members of Congress, Democrat and Republican, making an effort to go across the aisle and talk with each other," said Kucinich. "There really is a feeling that . . . we may not close ranks on an issue, but we understand that we need to try to proceed in a way that is civil."

The two then listened to a replay of remarks by former Sen. Bill Frist, a Republican, about the health care law made at a forum encouraging bipartisanship on health care. "It's not the bill that I would have drafted," Frist said. "But it is the law of the land, and it is the platform, the fundamental platform upon which all future efforts to make this system better for that patient, for that family, for that community will be based."

Responded Roe: "I just respectfully disagree." He said that a dozen members of the House GOP Doctors' Caucus were never consulted on the health care law or about problems they could see about how it would be implemented.

"That was very frustrating to me to bring 30 years of experience in health care and never be asked," he said. "We couldn't even get a vote on the House floor in 80 amendments."

At least that lack of input will change when House Judiciary Committee Chairman Lamar Smith, R-Texas, convenes a hearing on an overhaul of medical malpractice laws titled "Medical Liability Reform—Cutting Costs, Spurring Investment, Creating Jobs."

While doctors traditionally have lined up on the side of Republicans and trial lawyers with Democrats, it's an issue that could possibly present a middle ground. The health care law included funding for demonstration grants aimed at reducing legal claims against physicians, though Republicans say they didn't go far enough.

The witnesses will be Ardis Hoven, chairwoman of the Board of Trustees of the American Medical Association; Stuart L. Weinstein of the Health Coalition on Liability and Access, a group made up of doctors, hospitals, and insurers; and Joanne Doroshow, executive director and founder of the Center for Justice and Democracy, which describes itself as "the only national consumer organization in the country exclusively dedicated to protecting our civil justice system."

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