With Manager’s Amendment, Leaders Look to Allay Fears, Avoid Controversies
With Manager's Amendment, Leaders Look to Allay Fears, Avoid Controversies
November 5, 2009
By: Alex Wayne
A package of amendments to the House health care overhaul that Democratic leaders unveiled late Tuesday is less an attempt to buy the votes of wavering members than an effort to firm up support among Democrats whose votes were probably never in doubt.
With Manager's Amendment, Leaders Look to Allay Fears, Avoid Controversies
November 5, 2009
By: Alex Wayne
A package of amendments to the House health careoverhaul that Democratic leaders unveiled late Tuesday is less anattempt to buy the votes of wavering members than an effort to firm upsupport among Democrats whose votes were probably never in doubt.
Unlike many significant pieces of legislation, Democratic leaders do not appear to have used the 42-page manager's amendment to provide rifle-shot provisions that benefit individual members or their districts.
"There's not much in it," said Jason Altmire, D-Pa., who says he has not decided how he will vote on the bill (HR 3962).
To Altmire, the amendment's brevity is commendable: "I would prefer they do what they did than load up a 300-page bill and try to buy off people with sweeteners," he said, contrasting it with the 310-page manager's amendment to a climate change bill (HR 2454) earlier this year.
House leaders always intended to treat the health care bill differently, said Diana DeGette, D-Colo., a chief deputy whip.
"The leadership has been pretty clear from day one: This bill, as much as possible, is going to be about a national health care reform plan, not about individual districts and members' projects," she said.
For the most part, the amendment addresses concerns shared broadly across the Democratic caucus. For example, it includes language requiring insurers who sell policies in new government-run "exchanges" to provide justification to the government for any premium increases. Premium increases considered "excessive" — a term that is not defined — could lead to the insurer being booted from the exchange.
"We want to protect people from insurance companies that are unreasonably charging them," said Energy and Commerce Chairman Henry A. Waxman, D?Calif. "A lot of members have been concerned that insurance companies have been threatening to raise their rates."
Robert Zirkelbach, spokesman for America's Health Insurance Plans, the industry's trade association, said that House Democrats were aiming at the wrong target.
"The fact of the matter is, government data shows that premiums follow costs," he said. "If the goal here is to make health coverage more affordable, policy makers need to address the cost of underlying care — something they've been unwilling to do so far."
Black Caucus Concerns
In some cases, Democratic leaders sought to assuage concerns of smaller segments of their caucus. The Congressional Black Caucus, for example, won a provision in the manager's amendment that would elevate the influence of the Department of Health and Human Services' Office of Minority Health and create satellite minority health offices in several federal health agencies, including the Food and Drug Administration, the Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services.
Del. Donna M. Christensen, D-V.I., who worked on the provision, said CBC members were concerned that the existing Office of Minority Health did not have enough influence within the department.
"We have an extremely disproportionate burden of disease," Christensen said of the black community. "The coordination of the activities of the department, it's not set up so that the problems of people of color are always taken into account."
Another amendment would change a ban on the construction or expansion of physician-owned hospitals, allowing such hospitals that have larger populations of Medicaid patients than their local competitors to qualify for an exception and expand their main campuses to up to twice their current size.
Though the provision seems targeted to members from relatively low-income areas, several Democratic aides either could not or would not say who asked for the language.
Large hospital associations have lobbied for a ban on physician-owned hospitals for years, arguing that doctors will tend to refer patients to facilities they own and then prescribe more procedures than necessary to drive up billings. (Physician-owned hospitals deny the charge.) One hospital lobbyist said that he did not think the provision in the manager's amendment would apply to many hospitals, and perhaps even none.
"My guess is this was probably meant to assuage someone's concerns who may have thought their hospital was different," the lobbyist said.