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Democrats Debate Health Care Overhaul Options

By Paul Jenks

Democrats, encouraged by President Obama's State of the Union address, consider options to pass a health care overhaul measure. A freeze looms on discretionary health spending.

Weekly Review
Prospects for legislative action on a health care overhaul measure remained in limbo this week but Obama pressed Congress to act in his State of the Union address Wednesday evening. Virginia's Gov. Bob McDonnell, in the customary GOP response address, called for a scaled-down health measure. CQ reported on initial lawmaker responses to the address and Roll Call reported Thursday on distinctly negative reactions from Democratic Sens. Mary L. Landrieu of Louisiana and Mark Pryor of Arkansas. Roll Call also reported Thursday that House Speaker Nancy Pelosi, D-Calif., vowed to press ahead with a two-pronged legislative approach that will broach the differences between the House (HR 3962) and Senate (HR 3590) measures.

Congressional anxiety about the path forward for a health care overhaul measure was evident all week in both the Senate and House. Roll Call reported Thursday that Senate Majority Leader Harry Reid, D-Nev., is actively considering a health reconciliation measure. But CQ reported Thursday that Senate Majority Whip Richard J. Durbin, D-Ill., suggested that budget reconciliation rules could delay action on a new measure until April. Also, several moderate senators hedged their opinions on moving new legislation through the Senate using budgetary reconciliation rules, which allow a simple majority vote for passage. CQ reported on wavering positions of several key moderate Democrats and HealthBeat reported that Sen. Joseph I. Lieberman, I-Conn., is also uncertain about voting for a health reconciliation measure. Conversely, HealthBeat reported that Sen. Ben Nelson, D-Neb., who cast the deciding vote for the Senate health bill last month, wants the Senate to vote again on the bill.

House Democrats, who likely hold the cards for any initial action, have not decided on whether to adopt the Senate approved bill (HR 3590) and offer new legislation with adjustments or proceed with smaller measures. CQ reported Thursday that the House might begin considering smaller options before the Presidents Day recess, which starts Feb. 11. Earlier in the week, House Democratic Leader Steny H. Hoyer of Maryland blasted (view Roll Call report) the Senate's past actions on the health care bill. Roll Call also reported Wednesday that House Democratic Whip James E. Clyburn of South Carolina pressed to move a bill through the reconciliation process.

Congressional Republicans, almost content in letting debate on health care options play out between Democrats, echoed all week a go-slow approach to a health measure. The House Budget Committee's top Republican, Paul D. Ryan of Wisconsin, on Wednesday reintroduced an alternative tax and health care overhaul measure as an alternative option).

Obama also raised congressional anxiety about fiscal 2010 health discretionary spending when he announced a freeze on non-defense and national security spending. The White House will unveil its new budget proposal Feb 1. The Senate this week debated a longer-term spending overhaul plan but rejected an amendment Tuesday to create a congressionally authorized panel to suggest changes to federal spending including Medicare. Obama vowed on Wednesday to create a similar panel to advise lawmakers on budget reform options.

On Tuesday, the Congressional Budget Office released its key annual Budget and Economic Outlook report that links a leveling of future Medicare spending to lower Medicare physician payments, an action Congress is likely to block. The Senate prepared the ground for action to block the scheduled decrease in physician Medicare rates on Thursday by adopting a pay-as-you-go (PAYGO) budgeting amendment to a measure to increase the federal debt level (H J Res 45). The amendment applies statutory pay-as-you-go budgeting rules for new spending measures and includes special provisions for adjusting the Medicare physician rates.

In committee action this week, CQ reported that House Energy and Commerce Chairman Henry A. Waxman, D-Calif., is amenable to calling for White House documents on closed-door negotiations on a health care overhaul bill with various health groups. Here is a list of upcoming committee meetings and news events scheduled for next week.

Finally, CQ HealthBeat reported Thursday on a new report from the Surgeon General on curbing obesity and the Department of Health and Human Services published a final ruling on changes to reporting requirements for medical errors.

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