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Study Sessions Dissect Health Bill

By Edward Epstein, CQ Staff

October 2, 2009 -- Dutiful House Democrats trudged through the Capitol basement last week to yet another caucus on what many consider the biggest domestic policy issue they will face as legislators: overhauling the health care system.

The Oct. 1 meeting was part of what leaders say is an unprecedented effort to help all 256 House Democrats understand every nuance of a bill that is expected to be more than 1,000 pages long.

The sessions are key to Speaker Nancy Pelosi's goal of unifying her caucus to the point that she can count on at least 218 Democratic votes—the number that would guarantee House passage.

The meetings have consumed more than 60 hours, according to caucus Chairman John B. Larson of Connecticut. Party leaders plan to continue the sessions this week and right up to floor consideration, which Democrats hope will take place by the end of the year.

The central stumbling block remains the inclusion of a government-run health insurance plan to compete with private insurance. Liberals want such a plan, popularly known as the "public option," but moderate and conservative lawmakers are opposed.

If Democrats were united, the House would most likely have already voted on health care. In the face of solid Republican opposition to the majority's legislation (HR 3200), the leadership is trying to reconcile a number of Democratic factions.

In addition to attending the full caucus sessions, those factions—including the Congressional Progressive Caucus, New Democrat Coalition, Congressional Black Caucus, Congressional Hispanic Caucus and fiscally conservative Blue Dog Coalition—have each held meetings and met separately with leaders to discuss their particular concerns.

In addition, the Democratic leadership and the chairmen of the three committees that marked up the legislation—Energy and Commerce, Ways and Means, and Education and Labor—hold daily meetings on melding the three bills and on finding compromises that House Democrats can support.

At the Democratic Caucus meetings, Pelosi digs into the fine print of the legislation, fields questions and frames options, participants said. The Californian also exhorts her troops. "I've said to the members, 'This is the moment you were born for — to be here at such a historic moment,'" she said Sept. 30.

So far, Pelosi has resisted the customary arm-twisting required when rounding up votes on a consequential bill. Instead, she continues to use the meetings to take the caucus's temperature, aides said.

No formal whip count has been taken to gauge whether a sufficient number of Democrats will back a public option. That will wait, aides say, until the details of how the plan would work are in writing.

Financial Services Chairman Barney Frank of Massachusetts, among the most senior House Democrats, said he cannot recall such sustained and intense caucus meetings on a single topic. "With bills from three committees, the caucus is actually a supercommittee on this," said Frank.

The intense caucus meetings on the Troubled Asset Relief Program, which addressed the economic crisis, provide the closest comparison with the health care sessions, Frank said. But those only lasted about a week, while health care has been discussed for much of this year.

Caucus Vice Chairman Xavier Becerra of California said the meetings, which included a five-hour marathon in July, have allowed leaders to whittle points of concern down to all but the most controversial issues.

"More and more, we are closing the door on unanswered questions. More and more members can respond to those who say, 'You don't know what's in the bill.' They can say, 'Absolutely I do,' " he said.

Controversial Issue Remains
Pelosi insists nearly daily that efforts toward fashioning a single bill are progressing, but she has stopped predicting when a bill can be brought to the floor.

Congressional Progressive Caucus Co-Chairman Raúl M. Grijalva of Arizona suggested a reason for Pelosi's reticence. Soon, he said, she is going to be forced to decide how to resolve contentious issues that could tear apart the consensus she has been working to build.

"The crunch is coming, and it's coming pretty soon," said Grijalva, a leading advocate of a "robust public option."

The sessions have done little to bridge disagreements over whether to include a public option.

Grijalva is convinced that the caucus supports a public insurance plan. "We're past whether we should have a public option. It's the mechanism for doing it right that we're discussing now," he said.

But Earl Pomeroy of North Dakota demurred. "The politics of our caucus now look like the Senate Finance Committee," he said, referring to that panel's defeat of two amendments that would have put a public plan into its draft bill on Sept. 29.

Nature of the Sessions
In recent weeks, the meetings have been part lecture hall, part question-and-answer period, with outside experts discussing the arcane aspects of the proposed overhaul.

Robert E. Andrew—the chairman of Education and Labor's Health, Employment, Labor and Pensions Subcommittee—and others describe the caucus meetings as unusually detailed, zeroing in on the specifics of such topics as whether to tax generous "Cadillac" health insurance plans or what formula to use when reimbursing medical providers for health services.

At one session, Andrews urged the caucus to avoid taxing health plans that middle-class unionized workers won through collective bargaining. "There is a very broad consensus that that is the last place we want to go," the New Jersey Democrat said.

For Pomeroy, whose state has one of the nation's lowest Medicare reimbursement rates, the sessions provide a forum to try to correct that situation. At every turn, he said, he exhorts his colleagues to address the issue upfront—or forfeit his support for the bill.

"I have a threshold issue: You cannot have a Medicare payment rate for a public-plan option unless you fix Medicare or have negotiated rates, as opposed to Medicare rates," Pomeroy said.

But so far, he said, party leaders have shown no willingness to tackle the Medicare reimbursement-rate issue. "They want to fix Medicare going forward. I want to fix it now," he said.

Steve Cohen of Tennessee, a Congressional Progressive Caucus member, said the meetings have broadened his understanding of health care policy. He said he used to view universal health care as a moral issue, and now he views it in economic terms.

"Health care costs have a devastating impact on our economy. I've learned that, in the long run, it's important to control the costs to correct the economy," he said.

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