Senate health care reform faces tough issues on short leash

Last week in a speech to the Senate Democratic Caucus luncheon, former President Bill Clinton told his party colleagues not to let the perfect be the enemy of the good. “This is an economic issue,” Clinton said of health care reform. “The second thing is that on the policy there is no perfect bill because there’s always going to be consequences. So there will be amendments to this effort, whatever they pass. … It’s not important to be perfect, but it’s important to move, to get the ball rolling.”

Echoing Clinton’s sentiments, Obama administration aides are pushing hard for Senate passage of a health care reform measure by Christmas, with a conference report early next year.

Meanwhile, opponents of health care reform are already testing their arguments in court, and expect to begin litigation over health care reform mandates as soon as the legislation is signed into law. The Fund for Personal Liberty already filed a lawsuit challenging mandatory Medicare enrollment, as a test of the argument against requirements in health reform legislation forcing individuals to buy health insurance. The government’s motion to dismiss that case in the U. S. District Court for the District of Columbia was denied a couple months ago.

In the Senate legislative debate, peripheral issues including who and what will be covered by reformed health insurance now overshadow the policy issues of cost control and wellness efforts. Lobbyists arguing about abortion coverage and benefits for illegal immigrants far outnumber those concerned about how the legislation will affect medical care delivery.

The Center for Reproductive Rights has launched an ad campaign on the theme “Don’t let Congress ban abortion coverage millions already have.” The Stupak Amendment, banning federal funding for abortion procedures and for purchase of insurance covering abortions, garnered 40 votes for Speaker Pelosi’s bill, but could cost her 40 progressive votes in her caucus and scotch the legislation altogether if it remains in a conference report. Pelosi herself conceded that the Stupak Amendment in fact does
restrict women’s access to abortion services.

With the U.S. Conference of Catholic Bishops coming down hard in favor of the Stupak Amendment, abortion rights becomes an issue that won’t go away as the legislation moves through the Senate.

The abortion flap is just one of the many sidelights in the ongoing Senate battle. Monday’s new guidelines for mammography issued by the US Preventive Services Task Force, recommending an end to annual mammograms for women between 40 and 50, will be seized upon by reform opponents as one example of ways cost cutting efforts under government run health care can in effect deny care to millions of patients. While the Task Force denied cost was a consideration in the new guidelines, the American Cancer Society’s refusal to go along with the recommendation sets up a real argument that there is little other basis for taking away the annual test for women during this decade of their lives.

A recent Washington Post/ABC News poll shows the citizenry evenly split on health care reform legislation, with 48% favoring it and 49% opposed to it. This is just the sort of opinion division that gives Senators heartburn.

In the last month, opponents lobbying against the bill have outspent groups in favor of the bill $24 million to $12 million in their advertising efforts. Employers for a Healthy Economy adopted the catchy theme “Call Congress. Tell them the new health care bill is a bill America can’t afford to pay.” On the other side of the issue, President Obama’s political front, Organizing for America, is circulating an E-mail blast urging millions of Obama supporters to show up in person at Congressional and Senatorial district offices supporting the legislation in person.

On the cost side of the policy debate, the American Medical Association is feeling a bit duped by legislator’s moves separating the permanent physician pay fix for Medicare from the reform measures. AMA’s support for health care reform was premised on a permanent reform in the formula for Medicare reimbursements to doctors, which otherwise will cut doctor pay 21.5% this year, causing many physicians to refuse to take on Medicare patients. Already apparent divisions within the doctor lobby are being exacerbated by the split of doctor pay reform from health care reform. Prospects for a permanent fix in the Senate this year look dim. While the House will probably pass a $209 billion permanent fix, the Senate doesn’t want to push such a costly bill without any way to pay for it. Meanwhile, with the consumer price index falling 1.3% this year, drug price increases averaging as much as 9% seem mysterious in the absence of legislative change as an impetus for price hikes.

The final peripheral issue in the Senate mix is the ability of illegal immigrants to buy health coverage on the federally sponsored exchanges set up in the health care reform legislation. President Obama and Senate leaders have pledged to keep illegals from participating, but the House bill permits them to buy on the exchanges, though denies them federal premium subsidies. There’s a lot of territory to cover before Christmas if the Senate expects to come up with a bill which will garner 60 votes there and still pass the House.