Democrats' Plans To Use "Deem And Pass" Spark Controversy.

Customized Briefing for Kimberly Barry-Curley                                                                               March 17, 2010

From NAHU                            Public Health and Private Healthcare Systems                               Also in the News
Leading the News                     Uninsured
Legislation and Policy

Leading the News

Democrats' Plans To Use "Deem And Pass" Spark Controversy.
A key focus of the media coverage of the healthcare reform debate was the House leadership's plan to use a legislative rule known as
"deem and pass" or a "self executing rule," to pass the Senate bill without an explicit vote on the measure in conjunction with the
reconciliation package of "fixes." Most media outlets noted that it has been used in the past by both parties, but not on landmark
legislation, and that it has contributed to the growing partisan warfare on the healthcare issue. The Washington Post (3/17, Goldstein) calls
the self-executing rule an "obscure parliamentary maneuver," adding it has "suddenly ignited Tuesday as the latest tinder in the year-long
partisan strife over reshaping the nation's healthcare system, triggering debate over the strategy's legitimacy and political wisdom."
Republicans "condemned Pelosi's idea" as "an abuse of the legislative process," while "parliamentary experts of both parties said the tactic
has been used with increasing frequency in recent years by Democrats and Republicans alike, usually earlier in the legislative process."
Political analysts "wrangled over whether the use of the 'self-executing rule,' also known as a 'deem and pass,' would further antagonize an
electorate whose enthusiasm for Democrats has dimmed in the past year."
      ABC World News (3/16, lead story, 2:55, Karl) reported it is "a procedure that's been used about 20 times over the last 30 years, by
both Democrats and Republicans. But never on legislation as seismic as healthcare reform. Speaker Pelosi says what matters is the final
product." Republicans "call it a slight of hand, even unconstitutional. And one undecided democrat told ABC News he doesn't like it, either."
      Roll Call (3/17, Dennis, Newmyer, subscription required) says the "procedural morass, borne of House Democrats' distaste for deals
included in the Senate healthcare bill, overshadowed leadership's efforts to tout the overall package as a history-making endeavor on par
with enactment of Social Security or Medicare." The New York Times (3/17, A18, Herszenhorn, Pear) reports Democrats "struggled
Tuesday to defend procedural shortcuts they might use to win approval for their proposals in the next few days." Republicans "paraded to
the House floor on Tuesday to denounce the maneuver as a parliamentary trick."
      The Los Angeles Times (3/17, Hook, Levey) reports Republicans "used the same parliamentary shortcut to avoid difficult votes when
they controlled Congress, but on Tuesday they accused Democrats of being high-handed and unseemly." The "controversy over an arcane
point of procedure is the latest example of how Republicans, though virtually powerless to change the content of the healthcare overhaul,
have tried to hobble Democrats by discrediting the legislative process."
      The Hill (3/17, Allen, Young, subscription required) reports the "deem and pass" procedure was the "driving issue of the debate
Tuesday," and it "dominated leadership press conferences on Tuesday as well as the White House briefing." Majority Leader Steny Hoyer
(D-MD) "said at his weekly news conference that a rule deeming the Senate bill passed is consistent with procedures and practices used
by Republicans and Democrats, and that it's appropriate for a bill that will be moments away from being amended."
      Under the headline, "Self-executing Rule Decried As A Trick," the Washington Times (3/17, Haberkorn) reports Republicans "called
the potential use of the procedure another trick to circumvent the public and protect House Democrats at the ballot box in November."
      The Christian Science Monitor (3/17, Chaddock) reports that deeming is "typically used as a convenience for issues that aren't
controversial. But this week, 'deem and pass' could also give members cover for the toughest and most historic vote of their careers."
Senate Minority Leader Mitch McConnell (R-KY) said, "Anyone who endorses this strategy will be forever remembered for trying to claim
they didn't vote for something they did. It will go down as one of the most extraordinary legislative sleights of hand in history."
      Politico (3/17, Barbash) reports, "No lawyer interviewed by POLITICO thought the constitutionality of the 'deem and pass' approach
being considered by House Democrats was an open-and-shut case either way. But, most agreed that it could raise constitutional issues
sufficiently credible that the Supreme Court might get interested, as it has in the past."
      The Hill (3/17, Youngman, subscription required) notes White House spokesman Robert Gibbs "dismissed the controversy," calling

GOP complaints "a legislative process game."

    From NAHU

    We know many of you have been extremely active with legislative issues and we want to thank you for your hard work and assure
    you it is making a difference. We are seeing some inroads on the legislative front and continue to work diligently with Congress to
    keep things on the right track.
    The next few months will be the most intensive of times for our association's government affairs efforts. We have every reason to
    believe that health system reform legislation will move forward, and we need to preserve the role of agents and brokers and
    ensure continuance of the private market. It is for these reasons that we have decided to reinstate our Grass Roots Initiative
    Program. GRIP is a voluntary donation program created some years ago for our legislative expenses at the national level.
    We are now soliciting both individual and chapter contributions to GRIP, and would greatly appreciate any additional help as there
    is still much to be done on the legislative and regulatory front. Please click here to make a donation to GRIP today.

Legislation and Policy

Undecided Democrats Pressed From All Sides On Healthcare Vote.
As the final House vote on healthcare reform legislation nears, media reports note that all the parties involved (from President Obama,
unions, and liberal advocacy groups to Republican campaign organizations, the US Chamber of Commerce, and anti-abortion advocates)
continue their fierce outreach to wavering Democrats. In positive terms, a number of media reports generally portray President Obama as
deeply engaged in the effort to win undecided House Democrats, delaying his trip to Indonesia and other Asian countries to personally
lobby lawmakers. For instance, at the end of its report, ABC World News (3/16, lead story, 2:55, Karl) reported White House officials say
the President "had one-on-one meetings with a handful of undecided Democrats at the White House, where officials say they are
increasingly optimistic they will get the votes to pass healthcare."
     USA Today (3/17) reports Obama, "his Cabinet and White House staff have been reaching out to Altmire and a few dozen other
Democrats with increasing frequency." That "same personal touch is being applied to liberals. Rep. Luis Gutierrez, a usually loyal
Democrat from Obama's hometown of Chicago, got an invite to come to the White House with other Hispanic caucus members."
     McClatchy (3/17, Lightman) reports moderate House Democrats "face relentless pressure as they juggle personal pleas
from...Obama, a multi-million-dollar ad barrage and constituents who are fed up with the convoluted congressional process."
     In its whip count of House Democrats, The Hill (3/17, subscription required) reports 37 remain "firm," "leaning," or "likely" no votes. In
order to pass the House, Democrats would need to limit defections to 37, which would result in a 216-215 vote, assuming all members vote
and all Republicans are opposed. The Hill lists 53 Democrats as undecided.

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Groups Tout Medicare Provisions In Health Reform Bill.
CQ HealthBeat (3/17, Norman, subscription required) reports, "Despite a ferocious onslaught of criticism from Republicans, House
Speaker Nancy Pelosi (D-CA) on Tuesday didn't rule out use of a legislative procedure that would allow the healthcare overhaul to be
approved by Democrats without a direct up-or-down vote on the Senate-passed healthcare bill." CQ notes that "it was the second
afternoon in a row in which Pelosi held a press event surrounded by allies who defended the overhaul. This time, the Medicare provisions
were touted by emissaries from seniors groups like AARP, the American Association of Homes and Services for the Aging, and the
Medicare Rights Center."

Missouri House Approves Constitutional Amendment To Block Health Insurance
Mandate.
The AP (3/17, Blank) reports that yesterday, by a 109-46 vote, "the Missouri House approved a state constitutional amendment Tuesday
that seeks to block a government mandate to buy health insurance," by prohibiting "penalties or fines from being levied against individuals
and employers in Missouri who opt out of insurance and pay directly for their own healthcare." In addition, medical "providers could not be
penalized for accepting direct payments for healthcare." So far there are "five other states with similar measures approved by at least one
chamber." Of those, "Virginia already has enacted its measure into law, and Idaho's governor is considering whether to sign or veto that
state's version," while "the Arizona Legislature has approved a constitutional amendment that will appear on the ballot."

Kentucky House Passes Measure To Help Uninsured Residents Pay For Colon Cancer
Screenings.
The Louisville Courier-Journal (3/16, Gerth) reported, "The Kentucky House passed a bill Tuesday to help Kentuckians who have no health
insurance pay for colon cancer screenings." After an "amendment that would require doctors performing abortions to show women
ultrasound pictures of the fetus" was scrapped, "House Bill 72 sailed through the House on a 97-0 vote." If the bill is signed into law,
$300,000 would be committed "in each of the next two fiscal years," and the state Department for Public Health would have "to develop a
sliding scale based on income for individuals to help pay for the tests."

Public Health and Private Healthcare Systems

Massachusetts Treasurer Says Healthcare Plan Is Bankrupting The State.
The Boston Globe (3/17, A1, Levenson) reports on its front page, "State Treasurer Timothy P. Cahill, an independent candidate for
governor making a play for fiscally conservative voters, said yesterday that the state's universal healthcare law is bankrupting
Massachusetts and will do the same nationally if Congress passes a similar plan." Cahill "was seeking to insert himself into a fight that
Governor Deval Patrick picked last week with his Republican rival, Charles D. Baker, former chief executive of Harvard Pilgrim Health
Care, whom Patrick accused of doing nothing to stop dramatic premium increases that he said are crushing small businesses and
families." Cahill's "criticism echoed that leveled by Senator Scott Brown during his run for US Senate."
      The AP (3/17, Leblanc) reports that Cahill "said Tuesday that Congress will 'threaten to wipe out the American economy within four
years' if it adopts a healthcare overhaul modeled after the Bay State's." He added that "the 2006 law has succeeded only because of huge
subsidies and favorable regulatory changes from the federal government." Cahill also said that "the Health Care Connector had helped
only 5 percent of those who bought private insurance without any type of government assistance."
      BGlobe Advocates Allowing Insurers, Providers To Negotiate Rates. The Boston Globe (3/17) editorializes, "State
Treasurer Tim Cahill's denunciation yesterday of the state's much-praised 2006 healthcare overhaul is an irresponsible act of
demagoguery." The Globe notes that "the only realistic solution is a system in which insurers are able to negotiate better rates from
providers, and patients feel satisfied that they will receive high-quality care even if their plans lack the priciest hospitals or doctors."
     Widmer Proposes Changes To Reduce Insurance Costs. Michael J. Widmer, president of the Massachusetts Taxpayers
Foundation, writes in an op-ed in the Boston Globe (3/17), "Whether real or manufactured, Beacon Hill is struggling with the 2010 version
of the healthcare crisis. The focus this time is on the escalating costs of health insurance for small businesses." Yet, "the governor has
taken drastic, and troubling, action to address this problem -- proposing regulations to cap insurance premiums for small businesses and
proposing legislation to cap rates for hospitals and other providers." That would "create a gaping, self-inflicted wound in the state's
healthcare system." Widmer recommends "an annual open enrollment period for the small group and individual markets to help prevent
individuals from opting in to insurance plans only when they expect to need medical care" and plans "with a limited network of doctors and
hospitals at a significantly lower cost."

Pennsylvania Insurance Program Nearly
Doubles In Monthly Cost.
The New York Times (3/17, A18, Urbina) reports, "Facing a sharp
rise in costs, Pennsylvania has almost doubled the monthly bill for a                                                                  state
health insurance program for poor people who do not qualify for
Medicaid and are on a waiting list for a less costly option." Beginning                                                                March
1, the cost of the AdultBasic program increased "to about $600 a                                                                       month,
up from $313 a month." But, "Joel Ario, the state insurance
commissioner, said that while unavoidable, the price increase would
probably make matters worse." He added that the program may
become even more expensive if those most in need of coverage drop                                                                      out of
the program as a result of the rise.

Seniors In Medicare Drug Plans' Coverage                                                                                               Gap
See Dramatic Price Increases.
Kaiser Health News (3/16, Marcy) reports, "Seniors who hit the coverage gap in their Medicare prescription drug plans and must use their
own money to buy drugs are facing price increases that are far outpacing inflation," according to a study by the Kaiser Family Foundation,
which found that prices "increased 5 percent or more since January 2009 for half of 10 brand-name drugs most commonly used by
seniors." The report found that the increases "are part of a longer-term trend" as "between January 2006 and January 2010...prices of
drugs bought by seniors who hit the coverage gap increased" at much greater rates than general inflation or that medical care prices.

Louisiana Health Department's Deficit May Lead To Larger Medicaid Cuts.
The AP (3/17, Deslatte) reports, "A looming midyear deficit will worsen budget troubles in the Louisiana health department and could
disrupt proposals for balancing the department's budget next year, Health and Hospitals Secretary Alan Levine told lawmakers Tuesday."
The deficit "could mean deeper cuts to the state's Medicaid program for the poor, elderly and disabled, which already was slated to lose
$300 million next year in Gov. Bobby Jindal's (R) 2010-11 budget recommendations." Those recommendations include "a $7.7 billion
health department budget" that "would cut payments to the hospitals, nursing homes, and other private health providers that care for
Medicaid patients, cuts that providers warn would worsen access for those patients."

Medicare Patients Having An Easier Time Finding Doctors Than Privately Insured
Seniors.
The Seattle Times /Marketwatch (3/17, Gerencher) reports, "Every year or so, Medicare patients and the doctors who treat them
go through a ritual of guessing whether physicians' Medicare payments will be cut, possibly reducing access to seniors' care. This year is
no different, but at 21.2 percent, this potential doctor-payment cut is the largest ever, raising the stakes." Nora Super, director of federal
government relations for AARP, said, "It's certainly an unstable position for Medicare beneficiaries, and we have been urging Congress to
find a solution to this." So far, "Medicare patients have an easier time finding doctors than their privately insured counterparts who are age
50 to 64, according to the new annual report from the Medicare Payment Advisory Commission. ... But many doctors are considering or
already closing their practices to new Medicare patients."

Uninsured

Number Of Uninsured Middle-Income Texans Rose 40%.
The Dallas Morning News (3/17, Roberson) reports on "a growing number of middle-income Texans between 2000 and 2008 moving into
the ranks of the uninsured." According to a Robert Wood Johnson study, "during that period, uninsured middle-income Texans -- families
earning between $48,000 and $85, -- grew 40 percent, from 1.22 million to 1.71 million." Across the nation, "the total number of uninsured
middle-income people increased more than 2 million since 2000, to 12.9 million in 2008."
     Between 2000 and 2008, "Texans made up about 1 in 5 middle-class Americans who lost health insurance," the Fort Worth Star-
Telegram (3/17, Hunt) notes. "The study was conducted by the State Health Access Data Assistance Center at the University of Minnesota
and was based on information from the US Census Bureau and the US Department of Health and Human Services." The report found that
"only California reported more middle-class residents without health insurance in 2008 than Texas. But the increase there has been much
slower, with only 10 percent more middle-class uninsured residents since 2000."

Also in the News

Spending On Cancer Care More Than Doubled Since 1990.
USA Today (3/17, Szabo) reports that, according to research published in the Journal of the American Medical Association, "the cost of
cancer treatment is 'skyrocketing' -- both for individual patients and the nation." Data indicate that "from 1990 to 2008, spending on cancer
care soared to more than $90 billion from $27 billion." The trend may be due to advances in treatment that allow "older, frailer patients" to
"have less invasive operations or more tightly focused radiation treatments...says" one analysis.
     The increase in spending on "cancer research and care...is straining the US health system and needs to be restrained, commentators
said" in "six journal reports," Bloomberg News (3/17, Gibson) reports. Researchers suggested lowering the price of drugs by combining
drug costs and other care in a single provider payment. They "also suggested...that doctors and hospitals should be grouped into
accountable-care organizations" to "nudge physicians to act more cohesively."

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