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House Dissidents Still Not Satisfied on Health Bill

By Drew Armstrong, Alex Wayne and Edward Epstein, CQ Staff

July 24, 2009 -- Despite claims of a "significant breakthrough" on their health care overhaul bill, House leaders still face trouble from dissident Democrats who have blocked action in a key committee.

Majority Leader Steny H. Hoyer, D-Md., said that chances are "very small" they will bring the bill to floor before the House's scheduled July 31 break for the August recess. But he said it was possible the leadership would hold the chamber in session beyond that date. The Senate is not scheduled to begin its recess until Aug. 7.

"It's possible that we would move onto it Saturday the first, or Monday or Tuesday the 3rd and 4th, if need be," he said.

Hoyer also said a stalled Energy and Commerce Committee markup will proceed next week. Leaders will assess after the panel finishes its work whether to attempt a floor vote before the House leaves for its summer break, he said.

Meanwhile, Rep. Mike Ross, D-Ark., said there would be no deal Friday between conservative Blue Dog Democrats on the Energy and Commerce Committee and panel Chairman Henry A. Waxman. "It pretty much fell apart this afternoon," he said.

However, that didn't mean panel members had quit talking. All committee Democrats went into a closed-door session late Friday to assess where they stood on the bill.

Rep. Zach Space, D-Ohio, one of seven Blue Dogs who serve on Energy and Commerce, said they would stay at the table. "I think that there are some changes and some setbacks....But this is too important to just walk away from," he said.

Ross bristled at remarks Waxman made earlier in the day that he would not allow the Blue Dogs to help Republicans "take over the committee."

"We're actually trying to save the bill, and we're trying to save the party," Ross said. "That kind of rhetoric is not helpful."

Earlier Friday, Waxman and other leaders trumpeted "a significant breakthrough in resolving the outstanding issue of regional disparities in Medicare [payments] and therefore in the public plan" that the bill would create to compete with private insurers.

Blue Dog Democrats and others within the caucus had raised concerns about the differing rates that Medicare uses to pay doctors, hospitals and other health care providers.

Many members from rural areas say those rates are unfairly low, and they have refused to endorse a bill that does not address the problem—both in Medicare and the proposed public plan.

But Ross said the leadership had not gone far enough to satisfy Blue Dog demands for a beefed up, independent commission to set payment rates for Medicare and possibly other parts of the health system.

He said the Blue Dogs were not part of the deal to address regional disparities in Medicare payments. "That was a whole different group they've been negotiating with," he said.

Asked if he thought leaders were trying to bypass Blue Dogs, Ross said he thought leaders were trying to get votes where they could. "There will be a lot of deals made over the next few days to pick off votes," he said.

He predicted Blue Dogs would stick together in their demand for changes to the bill. Democrats, with 256 House seats, will need votes from the 52-member group to pass the bill, but Ross estimated at least 45 Blue Dogs currently would vote no.

Charlie Melancon, D-La., another Blue Dog on Energy and Commerce, said Waxman and Democratic leaders had not treated the group's suggestions seriously. He said the Blue Dogs had submitted a list of 10 items they wanted included or changed in the bill but were stonewalled.

"We never got anything back on any of them, and then summarily he [Waxman] took them off the table."

"They took nothing that we brought to them. Absolutely nothing. Not the first idea, not the first concept, nothing," Melancon said.

Markup or Bypass Route?

Waxman broke off his committee's markups early this week as the Blue Dogs made clear they could line up with panel Republicans to reshape the health bill.

He said early Friday he wanted to reach a deal with his Blue Dog members that would allow the committee "to go forward with a markup and not vote with Republicans to eviscerate the legislation." He added, "I will not allow them to turn over control of the committee to Republicans, as they've threatened to do."

Waxman said if he couldn't reach a deal that would hold panel Democrats in line behind a bill, "then my view is we're going to have to look at perhaps bypassing the committee."

"I think the Blue Dogs raised a number of important issues when we started the discussions," he said, "but we haven't been able to conclude any agreement. The discussions can't be interminable."

Ross said scrapping the markup was "a decision the chairman will have to make. I think it would be a mistake and a PR nightmare for the party. We're not trying to kill health care reform, we're trying to save it."

Although Waxman was clearly losing patience, party leaders for now threw cold water on the idea of halting the markup and discharging the bill from Waxman's committee.

"I'm not interested in that, and I don't think the Speaker is either," Hoyer said.

But he made clear the leadership isn't prepared to negotiate forever.

"Certainly interminable would be into the fall; we don't want to do that," Hoyer said.

Rep. Joe Barton of Texas, the top Republican on the Energy and Commerce Committee, predicted the rule for debate of the health overhaul would fail if the leadership were to take the bill directly to the floor at this point.

"I don't think that Speaker Pelosi really is going to do that," Barton added, saying it would amount to "a direct slap at all 36 of the Democrats" on Energy and Commerce, because it would eliminate their chance to amend the measure.

"I don't see the votes being there to get a rule on the floor," Barton said.

Regional Disparities

Under the deal outlined Friday by Waxman and others, the Institute of Medicine would conduct an analysis of regional disparities in Medicare rates and then send its assessment to the Department of Health and Human Services, which would implement the study's recommendations.

The Institute of Medicine is a non-profit organization of health policy experts chartered by Congress in 1970 as a component of the National Academy of Sciences. It provides independent analysis and guidance to Congress and others in government and the private sector.

"We assume there would be a change in rates," said Education and Labor Committee Chairman George Miller, D-Calif.

Ways and Means Committee Charles B. Rangel, D-N.Y., said Congress would have the option to block the new rates once the commission reports back.

House Democratic Caucus Chairman John B. Larson of Connecticut said early Friday he plans a multi-hour caucus meeting starting at 4 p.m. Monday to go through the health care overhaul (HR 3200) "section by section and answer every question members have."

The caucus will take a break at 6:30 p.m. for floor votes and then resume, continuing as long as needed into the night.

Larson said that even though the bill isn't final yet, most of the legislation is in writing and ready for members' analysis.

At a caucus meeting Friday morning, he passed out section-by-section summaries to members to take home and study over the weekend.

Richard Rubin and Jane Norman contributed to this story.

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