House Democratic leaders are trying to zero in on the right mix of cuts to get the cost of their health care overhaul down to $900 billion, the target identified by President Barack Obama.
Leaders and committee chairmen met Tuesday to discuss their options for shaving $200 billion from their proposals, and Speaker Nancy Pelosi (D-Calif.) affirmed in an afternoon press conference that her team has a plan for reaching its goal. But the lawmakers broke without making final decisions and are expected to resume the discussion after receiving new estimates on the proposed cuts.
The cost-cutting conundrum is one of several that are vexing House Democratic leaders as they seek to blend three committee drafts into a single bill that can muster a majority on the floor. Pelosi said leaders have agreement on more than 90 percent of the measure. But the issues that remain are knotty.
Pelosi and her lieutenants are still wrestling with how to pay for the package, since a proposed surcharge on the rich has raised the hackles of freshmen and others in wealthy districts.
One potential source of extra revenue is the pharmaceutical industry. In June, drug makers struck a deal with the White House and Senate Finance Chairman Max Baucus (D-Mont.), in which they agreed to cuts and discounts aimed at saving $80 billion over 10 years. House leaders never signed on to that pact, however, and they have sought deeper concessions. They decided Tuesday to seek new assurances from the White House that no more money can be squeezed from the industry, according to one source familiar with the session. “The Democratic leadership wants to hear from the administration on this,— the source said.
[IMGCAP(1)]Among other issues, Democratic leaders are continuing to work toward a package that lowers health care costs over the long term. “Whatever specific issue we’re discussing … the overarching issue is lowering cost,— Pelosi said Tuesday. House Democrats will focus on long-term costs in a Caucus meeting today that will feature a presentation from Karen Davis, president of the Commonwealth Fund, a health policy research group.
Leaders are working on smoothing regional disparities in Medicare reimbursement rates, allaying concerns among anti-abortion Democrats that the bill won’t spend federal dollars on abortions and determining the final shape of a public insurance option likely to be included.
It’s complicated work, since the solution to one problem often affects others. For example, pegging reimbursement rates in a public insurance option to Medicare rates would save an extra $85 billion over requiring the plan to negotiate with providers. But that approach would cost Democrats support among their moderates. If leaders opt for negotiated rates, however, they need to find new pay-fors to make up for the lost revenue. “When you touch one part of the bill, it has an impact on another part of the bill,— said Rep. Chris Van Hollen (Md.), Assistant to the Speaker and chairman of the Democratic Congressional Campaign Committee. “It’s all interrelated, and we’re trying to make sure we understand how it all interrelates.—
Leaders have been careful to avoid talk of deadlines, insisting they will bring a bill to the floor when they are ready. But top staffers are anticipating floor action in the second half of October.