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Emotions Still Swirling on Capitol Hill Day After the Obama Speech

By John Reichard, CQ HealthBeat Editor

September 10, 2009 -- Bipartisanship—to the extent the word has any place in the health overhaul debate—was hanging on by a thread Thursday thanks to a case of perfect attendance at a morning session by the "Gang of Six" Senate Finance Committee bipartisan negotiators.

But if the health overhaul speech of the night before by President Obama psyched Democrats up to get health care done this year, Republicans were in a sour and combative mood Thursday. At a mid-day press briefing, Senate Republican Whip Jon Kyl of Arizona made comments suggesting he felt disrespected by Obama's "disingenuous" address to a joint session of Congress and what he saw as its tinge of "Chicago politics."

And on the steps of the Capitol Thursday afternoon, chants urging a stop to "government health care" could be heard from a FreedomWorks rally across the way in the upper Senate Park as boisterous foes of Obama policies began gathering for a planned weekend march on Washington.

In the first and last venue on Capitol Hill in which bipartisan talks are occurring, Democratic Sen. Kent Conrad of North Dakota emerged from the Finance Committee negotiating session calling it a "productive" meeting, as he has so many times before.

Asked if there is new zeal to reach consensus, Conrad said the group has been making a serious effort all along. "But I think the speech helped. He made some very important offers," he said, referring in part to Obama's pledge to test new approaches at the state level to settling malpractice disputes.

Committee Chairman Max Baucus, D-Mont., also emerged from the talks saying Obama had breathed new life into negotiating efforts in this issue.

Conrad said that "we talked in some detail about how we absolutely assure that those who are here illegally would not get the benefit of any of these initiatives."

He said, "We have had an additional discussion about Medicaid, and staff are going to come back with proposals. . .we've also asked for a staff recommendation on abortion and medical malpractice. The president's speech last night was very helpful on medical malpractice reform, and so we're pursuing that. So this was very good."

But Conrad admitted that "we are not the committee of jurisdiction" on medical malpractice revisions, which Obama offered as an olive leaf to Republicans who insist that changes would sharply lower rising health care costs. Still, Conrad said, "there's no reason why we can't put a suggestion forward and that's what we're going to be meeting on later today or perhaps tomorrow.

"I think we're seeing consensus along the lines of safe harbor for doctors who use best practices," Conrad said, referring to protection in malpractice suits. Also under discussion, he said, is the use of "medical courts" in which health care experts preside as judges, and the use of arbitration rather than full-blown litigation to settle disputes. "I'm anticipating now the staff will come back with recommendations on medical malpractice, abortion and Medicaid."

Each in its own way is meant to buff the allure of the Finance overhaul to moderates or to calm some of the most vociferous criticism of overhaul efforts. Finance Committee negotiators know it is likely that their legislative vehicle that has the best shot of getting through a bitterly divided Congress. They are trying to prepare for the battering that will occur in the days ahead as the committee's proposal is released and enters into the markup phase, set to occur the week of Sept. 21.

Foes of abortion rights are bitterly opposed to Democratic proposals, viewing them as a vehicle to increase the number of abortions despite Obama's insistence in his speech that no taxpayer dollars would be spent on abortion as part of his overhaul plan.

Conrad described the issue of Medicaid expansion costs as one of the most difficult the committee faces. States are mired in the depths of financial crisis, yet under the Finance plan would share in the costs of a Medicaid expansion that could make uninsured Americans earning up to 133 percent of the federal poverty line eligible for Medicaid.

"We have continued to make refinements in the Medicaid area," Conrad said. "We are having discussions with governors, and so we need more refinement." In order for those discussions to advance, Conrad said the committee needs to have a state-by-state estimate of the impact of Medicaid provisions, something that the Congressional Budget Office (CBO) does not provide and that the committee is procuring from outside analysts.

"It is both dealing with the overall cost and it is dealing with how those costs are shared between the government and the states," he said of the Medicaid cost data negotiators are seeking.

Meanwhile, Kyl heard the Obama address much differently, repeatedly calling it "disingenuous."

There was "no reference" to listening to what the American people have been saying in recent weeks, Kyl said, referring to angry protests at town hall meetings in August. "It's basically his way or the highway.

"I was perplexed by the fact that throughout the entire speech, it appeared as if he was trying to ram something through. . .rather than to refer to what the people have been saying to all of us for the last six or seven weeks."

At one point in his speech, Obama said, "I will not waste time with those who have made the calculation that it's better politics to kill this plan than to improve it. I won't stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what's in this plan, we will call you out."

Kyl depicted the "call you out" remark as an example of "Chicago politics."

"The president spoke in a very partisan political way last night, a way that I think is unconstructive," said Kyl. "I think it's my obligation to point out the fact that this isn't the way that you get people to cooperate. You don't say that "if you disagree we're going to call you out," and to use all the pejorative terms that he used. It's harsh for me to criticize him for doing that," but "I think it's honest."

As an example of Obama being disingenuous, Kyl said that for months the president has been saying "if you like your insurance you get to keep it." But "it's not true," Kyl said.

Kyl said, for example, that Medicare cuts would lead millions of seniors to lose their current Medicare Advantage plans. Kyl added that according to a Lewin Group estimate, more than 88 million people would get coverage through a new government insurance option as employers stop offering coverage (the CBO has estimated public plan enrollment in 2019 at 12 million).

Joined by House Minority Whip Eric Cantor, R-Va., Kyl sketched out alternatives he thinks should be proposed by Republicans, including a half-dozen individual bills "to try to target specific solutions to specific problems." A big comprehensive bill is too much; it's better to take "one bite at a time," Kyl said.

Kyl said he favors introducing a bill to guarantee that coverage can be taken from job to job, another to allow insurers to compete across state lines, and a third allowing small businesses to band together to get better deals on health care coverage, for example.

Cantor said he does see areas in which Democrats and Republicans can work together, such as portability of coverage, and the creation of pool of "high risk pools" to provide coverage to those with expensive medical conditions who are unable to find affordable coverage.

Senate Democratic leaders took over the press briefing room a short time later, humming a much different tune. Majority Leader Harry Reid of Nevada called the speech a "game changer." Reid also suggested that he is open to compromise on the issue of having a public plan, saying what those plans are is really in the eye of the beholder. Asked if he considered co-operatives as public plans, Reid indicated that he did if they acted as a spur to competition and helped improve quality of care.

Reid also said he hopes that health overhaul legislation can be passed by Congress by Thanksgiving.

But the day made clear that Republicans are very unlikely, with the possible exception of Sen. Olympia J. Snowe of Maine, to be casting "aye" votes.

Republican Sen. Michael B. Enzi of Wyoming announced a CBO estimate of the cost of the overhaul bill passed by the Senate, Health, Education and Labor Committee he said "would balloon the national deficit by more than $1 trillion, drive up total spending on health care and force millions of Americans to lose their employer-sponsored health insurance plans."

And at the rally of Obama foes at the upper Senate Park, House Minority Leader John A. Boehner, R-Ohio, told hundreds of assembled protestors that "people are scared to death" by policies coming out of the White House. "The American people can stop this nonsense in Washington!" Boehner said.

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