House Leaders Setting Stage for Action on Reform Bill This Week

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House Speaker Nancy Pelosi (D-Calif.) is expected to send the chamber's health care bill (HR 3962) to the House floor today, setting up the possibility that the legislation could be voted on as early as Thursday, The Hill reports (Allen/Soraghan, The Hill, 11/2).

Last week, Pelosi unveiled the House bill, which merged bills passed earlier in the year by two House committees.

The legislation would ensure insurance coverage for 96% of U.S. residents and would create a public insurance option with physician reimbursement rates negotiated between doctors and the government, create a new insurance exchange, expand Medicaid and impose new rules on insurers governing how they select their enrollees (California Healthline, 10/30).

Plans for Debate

House Democrats have repeatedly pledged to allow 72 hours for the public to study the legislation before the House votes on it. However, several sources have indicated that it is unlikely House leaders will allow much debate or many amendments to the legislation during that three-day period.

Although the House Rules Committee has not yet determined the structure of debate on the bill, House Majority Leader Steny Hoyer (D-Md.) on Thursday said that he expects Democrats to introduce a "manager's amendment" on Monday that would function as the means for adding any last-minute changes and negotiated deals into the bill (The Hill, 11/2).

On Friday, House Education and Labor Committee Chair George Miller (D-Calif.) said, "Unless there are major problems I would expect the opportunity for amendments to be very limited, if at all."

House Steering and Policy Committee Chair Rosa DeLauro (D-Conn.) and Miller said that dozens of closed-door caucus meetings and private discussions between House leaders and the heads of several Democratic factions preclude the need for amendments to be offered and considered on the House floor.

Pelosi signaled that she preferred a debate with few opportunities to add amendments, although she did not completely rule out the possibility of allowing amendments (Soraghan, The Hill, 10/30).

During a floor exchange with Hoyer Thursday, House Minority Whip Eric Cantor (R-Va.) spoke out against Democrats' plans to allow few amendments to the legislation and the short period of debate on the bill (Epstein, CQ Today, 10/30).

Democrats Hope To Offer Amendments

Nonetheless, progressive Democrats might seek an up-or-down vote on a public plan that would tie physician reimbursement rates to Medicare plus 5%.

In addition, Rep. Bart Stupak (D-Mich.), an abortion-rights opponent, hopes to introduce an amendment that would prevent individuals who receive subsidies to purchase insurance coverage from using those subsidies for plans that cover abortion procedures (The Hill, 11/2).

Prospects for Passage

According to The Hill, it remains unclear whether Democrats have the 218 votes needed to pass the bill on Thursday.

Some House Democratic leaders have cautioned that the Democratic caucus could work all next weekend to secure passage of the legislation (The Hill, 11/2).

Hoyer Challenges GOP To Craft Its Own Health Care Bill; Boehner Accepts

In the floor exchange with Cantor, Hoyer challenged Republicans to offer their own health care overhaul, which he said that he would help bring to the floor as a substitute amendment and would help facilitate the alternative bill's scoring by the Congressional Budget Office (CQ Today, 10/30).

House Minority Leader John Boehner (R-Ohio) appears to have accepted the challenge, telling CNN's "State of the Union" Sunday that he has sent legislation to CBO for analysis. The bill could be offered as an amendment, he said, adding, "I'm hopeful that Speaker Pelosi will allow us to offer an alternative" (O'Connor, "Live Pulse," Politico, 11/1).

During the weekly Republican radio address, Boehner emphasized Republican bills and proposals aimed at improving the health care system. "[O]nly Republicans have offered solutions to lower health care costs and make it easier to obtain quality, affordable coverage without imposing a massive burden on the American people," Boehner said (Romm, The Hill, 10/31).

Boehner highlighted four specific GOP proposals, including:

  • Allowing U.S. residents to purchase coverage across state lines;
  • Letting individuals, small businesses and trade associations pool together to purchase insurance coverage;
  • Providing states with the "tools to create their own innovative reforms that lower health care costs"; and
  • Crafting medical malpractice reforms (Koffler/Kurtz, Roll Call, 10/31).

Barton Seeks Public Hearing With HHS Secretary on House Bill

House Energy and Commerce Committee ranking member Joe Barton (R-Texas) sent a letter to committee Chair Henry Waxman (D-Calif.) seeking a public hearing on Wednesday with HHS Secretary Kathleen Sebelius regarding the House reform legislation.

Barton said that the bill "creates a government-run health plan where the secretary of HHS would be permitted to negotiate rates with providers," adding, "However, it seems clear from the legislative language of [the bill] that doctors could, and most likely would, be paid a base rate at Medicare levels and the HHS secretary would be authorized to pay providers less than the Medicare rate" (Hooper, The Hill, 11/1).

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