In the wake of Saturday’s Senate vote to take up the chamber’s health reform legislation, the focus of the debate has shifted back to the public option, over which no fewer than four Democratic caucus members — Sens. Mary Landrieu (D-La.), Blanche Lincoln (D-Ark.), Ben Nelson (D-Neb.) and Joe Lieberman (I-Conn.) — have threatened to kill the bill.
With Congress out of town for the Thanksgiving break, there’s been little to distract Washington’s prognosticators from offering their predictions over the public plan’s fate. Truth is, no one is quite sure how this saga is going to play out. Based on comments from several of the four moderates since Saturday’s vote, it’s tempting to argue that Democratic leaders will at the very least have to scale back the public plan to pass the larger bill. Then again, the way Landrieu melted Saturday at the chance to secure millions of federal dollars for Louisiana indicates that there’s much more at play here than mere principle.
With all of that in mind, Sen. Sherrod Brown (D-Ohio) offered his own optimistic take on how the drama over the public option will end, telling CNN yesterday that the historical significance of the reform vote will ultimately be enough to sway the four moderates in favor of the bill.
In the end, I don’t want four Democratic senators dictating to the other 56 of us and to the country, when the public option has this much support, that it’s not going to be in it. [...]
I don’t think they want to be on the wrong side of history. I don’t think they want to go back and say, you know, on a procedural vote, I killed the most important bill in my political career. I don’t think they want to be there on that. So I think in the end, we get them.
This article was originally published at Washington Independent and is republished here as part of a partnership between RH Reality Check, Washington Independent and the Center for Independent Media.
Not even nine months after President Obama, with much fanfare, signed into law a five year, $33 billion reauthorization of the popular Children’s Health Insurance Program, House Democrats have proposed to dismantle it.
Under the $894 billion health reform legislation that House leaders unveiled last week, CHIP would cease to exist at the end of 2013, with kids enrolled in the program transitioning to plans on a proposed insurance exchange.
The move is raising concerns in the children’s advocacy realm, with some groups worried that higher costs on the exchange will prevent some kids from receiving health care.
In the Senate, Democratic leaders had also proposed to kill the CHIP program, but the program was salvaged by Sen. Jay Rockefeller (D-W.Va.), whose amendment preserving CHIP was passed by the Senate Finance Committee last month.
The House is expected to take up its health reform bill this week, with the Senate to follow later in the month. If those bills pass, the gaping disparity in approaches to the CHIP program will leave the fate of the program in the hands of the conference negotiators representing each chamber. Expect fireworks.
This article originally appeared at Washington Independent and is reprinted in partnership with Washington Independent and the Center for Independent Media.
The Senate will vote Monday evening on legislation extending unemployment benefits — a procedural vote that could clear the way for final passage as early as late Tuesday, Senate Majority Leader Harry Reid (D-Nev.) announced Thursday. The bill has been held up for weeks as party leaders have tangled over amendments, procedure and probably their picks in the World Series.
Monday’s cloture vote won’t pass the bill, but only ends the GOP filibuster, allowing the staging of the final vote. Senate rules dictate, however, that 30 hours must pass between the cloture vote and that on final passage — meaning that, absent a deal, the Senate can’t pass the bill much sooner than midnight on Tuesday.
Reid said the bill will include only two additional amendments: A tax credit for homebuyers, and a tax benefit allowing businesses to recoup taxes they paid in recent profitable years.
If an agreement is struck between the parties, all of this could change at any time.
Sen. Jay Rockefeller (D-W.Va.), interviewed this weekend in The Washington Post, points to the central reason that a health reform bill that hits the floor with a public option already included stands a better chance of ultimately keeping that provision: Namely, the burden of getting 60 votes would shift from supporters trying to add it to opponents trying to carve it out. From the transcript:
Kind of fun, isn’t it? We’re the ones that have always been trying to get 60 votes, now they’ll have to get 60 votes to remove.
You know, Harry Reid will, you know, make the final decision on it.
But I know the president is for it. I know Chris Dodd is for it. Max Baucus didn’t speak against it. He just talked about the need to get 60 votes. ‘I can’t do it because I have to get 60 votes.’ Well, if they do it there, he doesn’t have to get 60 votes. So, we’ll get it.
Last week, a group of 30 Democrats sent a letter to Reid (D-Nev.) urging the Senate majority leader to include a public option in the compromise package he’s currently weaving together from elements of the Finance and HELP committee bills. Sen. Tom Harkin (D-Iowa), chairman of the HELP panel, told reporters today that the actual number of Senate Democrats supporting a robust public plan tops 50.
Well, today it happened again.
According to the office of Senate Majority Leader Harry Reid (D-Nev.), Democrats on Tuesday asked for consent to pass the bill, only to be shot down by GOP leaders.
The Wall Street Journal is reporting that Republicans aren’t objecting to the extension, but to how it’s funded. (The Democrats’ plan would tap an expiring surtax on businesses, while the Republicans want to use unspent money from the stimulus bill.)
The House has already passed its version of the extension. With unemployment numbers creeping up each month, the pressure’s on the Senate to work out a deal quickly.
]]>This article is published in partnership with the Washington Independent, the Center for Independent Journalism and RH Reality Check.
With so much speculation on whether Sen. Olympia Snowe (R-Maine) will support the health reform bill finalized by the Senate Finance Committee last week, the world might be surprised to learn that some panel Democrats are also wary of the legislation. Yet Sens. Jay Rockefeller (D-W.Va.) and Ron Wyden (D-Ore.) have both “refused to pledge support” for the bill, The Washington Post reported today.
Wyden, who for years has pushed an enormous health reform strategy of his own — one that would move the country away from employer-sponsored care — tried unsuccessfully last week to attach an amendment granting employees cash vouchers to shop around for insurance plans in lieu of signing blindly to their companies’ plan.
“More needs to be done to hold insurance companies accountable, to hold premiums down for the American people,” Wyden said in an interview Sunday. “I want to continue these discussions.”
Wyden, the Post says, is in “intensive talks” with White House officials and Senate Majority Leader Harry Reid (D-Nev.) to tweak the bill.
Rockefeller, meanwhile, has been among the most vocal Senate proponents of the public plan, a government-administered insurance option to compete with private insurers. Proposals to create such a plan fell twice during the Finance Committee’s debate, though Rockefeller and others have vowed to try again when the bill hits the chamber floor. Indeed, amendment opportunities (not to mention pressure from the White House) will probably be enough to convince both Wyden and Rockefeller to vote the bill out of the committee later this week.
The new regulation — unveiled by the Dept. of Health and Human Services (HHS) earlier this month — expands the rights of some healthcare workers to withhold treatments and counseling services, possibly including contraception, based on their moral or religious sentiments. The White House argues that the change — known as the “right of conscience” rule — is necessary to clarify similar worker protections surrounding abortion and sterilization procedures that already exist as law. But many Democrats have joined women’s health advocates, healthcare providers and some state officials in blasting the rule as a sweeping expansion of existing statute that threatens women’s access to reproductive health services.
“Congress,” House Speaker Nancy Pelosi (D-Cal.) said in a terse Dec. 18 statement, “will work with President-elect [Barack] Obama to reverse this rule.”
But party leaders aren’t saying how they’ll try to do it. Representing one option, Sens. Hillary Clinton (N.Y.) and Patty Murray (Wash.) introduced legislation last month that would simply prevent HHS from implementing the new rule. Reps. Diana DeGette (D-Col.) and Louis Slaughter (D-N.Y.) have vowed to introduce similar legislation in the House next year.
“The Bush Administration continues to pursue its extreme ideology over sound public health policies,” DeGette said in a statement earlier this month.
Congress could also simply refuse to fund the new rule, which is estimated to cost $44 million.
Or they could nix it altogether by invoking an obscure law — known as the Congressional Review Act (CRA) — which allows Congress to reject White House regulations passed within 60 legislative days of Congress’s adjournment. The law would leave Democrats several months next year to kill the rule.
An advantage of the CRA route is that the vote would be exempt from the dreaded Senate filibuster, which has snuffed dozens of Democratic bills over the past two years. The disadvantage is that the measure would have to stand alone and couldn’t be buried in another bill as a rider.
Jessica Arons, director of the Center for American Progress’ Women’s Health and Rights Program, said that invoking the CRA is not as easy as it sounds, particularly when the issue relates to abortion. Conservative-leaning Democrats might not support it, she said, and party leaders might not have the political will to bring it up to begin with.
The Congressional fight could shift to the White House. The HHS under Obama could simply propose a new regulation. Obama has already criticized the rule, issuing a statement in August saying the change “complicates, rather than clarifies the law.”
“It raises troubling issues about access to basic health care for women, particularly access to contraceptives,” Obama said. “We need to restore integrity to our public health programs, not create backdoor efforts to weaken them.”
Yet the issue could be a thorny one for Obama, who ran on a platform of reaching across the aisle to Republicans. Despite his early opposition to the rule, he might not want to make an abortion-related issue one of his first battles, if only because it might threaten that message of bipartisan healing.
Health care advocates point out that crafting a new White House regulation would also be time-consuming, calling for periods of public comment that could extend the process to six months or longer. The legislative options, advocates say, could happen much more quickly.
Spokespersons in the offices of Pelosi and Senate Majority Leader Harry Reid (D-Nev.) said that discussions over how to reverse the regulation are underway, but no final decision has been made.
Plenty of laws on the books — both federal and state — already protect health care workers from having to participate in abortion and sterilization procedures based on moral or religious objections. The new rule would expand those laws by forcing any healthcare entity receiving federal dollars to attest that employees aren’t forced to assist in practices and procedures they deem to be “morally coercive or discriminatory.”
“A trend that isolates and excludes some among various religious, cultural, and ethnic groups from participating in the delivery of health care is especially troublesome,” the rule states, “when considering current and anticipated shortages of health care professionals in many medical disciplines and regions of the country.”
Yet the rule doesn’t specifically define which practices and policies would be covered, leaving many lawmakers and women’s health advocates to fear that contraception and other family-planning services would apply. Additionally, the rule will apply to anyone who “assists in the performance of a procedure,” a group defined broadly as anyone who participates in “any activity with a reasonable connection to the objectionable procedure, including referrals, training, and other arrangements for the procedure, health service, or research activity.”
“It goes well beyond doctors and nurses to include almost anyone who works in the health care sector,” said Arons of the Center for American Progress. “It allows people to withhold relevant medical information and not inform patients about all their options.”
HHS estimates the new regulation will affect roughly 572,000 health-related facilities, including hospitals, pharmacies, laboratories and medical schools. The rule was published in the Federal Register Dec. 18 and will take effect 30 days afterwards — just 48 hours before Obama takes office.
HHS did not return calls for comment.
There is also worry that the new rule will allow healthcare workers to take jobs in certain facilities - a family planning clinic, for example - for the sole purpose of withholding certain information, counseling services or treatments they find objectionable. Tait Sye, a spokesman for the Planned Parenthood Federation of America, pointed out that, under the new rule, it would be difficult to identify such a saboteur.
“Your boss doesn’t know,” Sye said. “The patient doesn’t know. The hospital doesn’t know … No one knows. And it creates an enormous potential for chaos.”
Meanwhile, states aren’t waiting around for Washington lawmakers to act. In Connecticut, for example, state Attorney General Richard Blumenthal is considering legal action to prevent the new regulation from taking hold. Blumenthal says he’s worried that the change could prevent victims of rape from receiving emergency contraception.
“We went through a very lengthy, painstaking, contentious process to reach our statute in Connecticut which has worked well for everyone,” Blumenthal told The Associated Press earlier this month.
Attorneys general from at least a dozen other states have joined Blumenthal in their vocal condemnation of the new rule. More recently, health officials and lawmakers in New Mexico, Iowa and Colorado are also weighing in with concerns.
The right-of-conscience rule is not the only regulation to be ushered from the White House in recent weeks. Rules to ease restrictions on mountaintop mining, expand oil shale development and allow commercial fisheries to police their own polluting have all emerged from the White House in the final moments of President George W. Bush’s lame-duck term. Still, none has inspired the outcry of the “right to conscience” rule.
“On its way out the door,” DeGette said, “the Bush Administration has, once again, stubbornly and irresponsibly attacked Americans’ access to health care.”
]]>The issue is a sensitive one in American Indian communities, where women are statistically more likely to be victims of rape or sexual assault than other American women—but also where victims very rarely use the exceptions to the current federally funded abortion ban in the wake of those crimes. In the face of that discrepancy, advocates say, Congress should encourage victims to take advantage of the available services, not impose tighter restrictions.
The debate pits anti-abortion lawmakers on both sides of the aisle against health-care advocates who fear the latest move could set the stage for broader abortion prohibitions under federal programs outside the realm of Indian health services. In addition, there is the intrigue of scandal, for the sponsor of the controversial amendment, Sen. David Vitter (R-La.), made headlines last year for his earlier entanglement in a prostitution ring. Several abortion-rights sources suggested that Vitter—who built his political career on family-values issues—is trying to bolster his conservative credentials in the wake of that embarrassment.
The controversy swirls around a federal law—known as the Hyde amendment—that prohibits abortion coverage under Medicaid, Medicare and Indian Health Service programs. While the Hyde law must be renewed by Congress each year, the Vitter amendment—which the Senate approved on Feb. 26—would apply Hyde’s restrictions permanently to IHS beneficiaries. For that reason, tribal health advocates charge that the Vitter language treads on the sovereignty of Indian communities and places unique constraints on native women.
"It’s a very racist amendment," said Charon Asetoyer, executive director of the Native American Women’s Health Education Resource Center, "[because] it puts another layer of restrictions on the only race of people whose health care is governed primarily by the federal government. All women are subject to the Hyde amendment, so why would they put another set of conditions on us?"
Vitter’s office did not return several calls and e-mails requesting comment.
A number of women’s health groups have criticized the Vitter amendment as well, claiming it will have no practical effect on women’s health services.
"Apart from being bad public health policy," Planned Parenthood said in a statement, "this language is duplicative of current law and serves only to politicize important legislation regarding comprehensive health care for Native Americans."
Though the Hyde amendment—named for its sponsor, the late Illinois Rep. Henry Hyde (R)—first took effect in 1977, Congress must reapply it annually through the appropriations process. That, according to Vitter, puts the Hyde language "in a tenuous and precarious posture. It puts it up for debate and possible change of policy every year, every time we debate a new Health and Human Services appropriations bill. Therefore, it doesn’t make the policy very solid, very secure, or very clear.
"Vitter’s amendment, attached last week to the Indian Health Care Improvement Act, would eliminate that uncertainty by codifying the Hyde amendment as a matter of authorization, not appropriation. "I suggest that would be a positive statement for life, for positive values for the future," he said on the Senate floor Jan. 22—the same day that thousands of anti-abortion marchers descended on Washington. A month later, the Senate approved Vitter’s amendment by a vote of 52 to 42.
But critics say the creation of a second law governing IHS-funded abortion services might confuse the issue if inconsistencies are found between the two mandates. Indeed, certain elements of Vitter’s amendment stray from the Hyde language. For example, while Hyde allows federally funded abortions for victims of incest at any age, Vitter specifies that the incest exception pertains only to minors.
Marlene Fried, a founding board member of the National Network of Abortion Funds, said the practical implications of that difference would be minimal. Still, she added, the change is significant as "another way of narrowing the [Hyde] exceptions."
The issue is especially charged because Native American women are more than three times as likely to suffer rape and sexual abuse as other women in the United States. Yet despite that statistic, only 25 abortions were performed at all IHS facilities between 1981 and 2001, according to figures gathered from the IHS by the Native American Women’s Health Education Resource Center. (An IHS spokeswoman declined to release more recent IHS-funded abortion figures, suggesting that a reporter file a Freedom Of Information Act request.)
But, advocates say, Indian women continue to have the procedure off the reservation. "Native American women have abortions," Asetoyer said, "and anyone who tells you differently is out of touch with their community."
Susan Cohen, the director of government affairs at the Guttmacher Institute, a nonprofit reproductive health research group, said the Hyde restrictions don’t prevent abortions, but they can delay them as low-income women are forced to save the money to fund the procedures out-of-pocket. That delay, Cohen added, can lead to dangerous complications. "Having later abortions is in no one’s best interest," she said.
Meanwhile, some tribal advocates are concerned that the Vitter amendment might carry additional political significance, as the Senate bill now moves to the House for consideration. Several sources said the controversial amendment is potentially a poison pill for the overall bill, for House Democratic leaders have been loathe to codify the Hyde amendment.
Not that the issue is entirely partisan. A number of Democratic lawmakers voted to approve the Vitter provision last week, including Sens. Ken Salazar (Col.), Evan Bayh (Ind.), Robert Byrd (W.Va.), Robert Casey (Pa.), Tim Johnson (S.D.), Mary Landrieu (La.), Ben Nelson (Neb.), Mark Pryor (Ark.) and Majority Leader Harry Reid (Nev.). Of that group, Landrieu and Johnson are up for reelection this year in relative conservative states, with Landrieu facing a tight race.
Three Republicans—Sens. Susan Collins (Me.), Olympia Snowe (Me.) and Arlen Specter (Pa.)—voted against the amendment. All three have historic records of bucking their party on the abortion issue.
Vitter, for his part, voted against the final IHCIA bill on the same day that his amendment passed. The final bill was approved, however, by a count of 83 to 10.
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