Some House Dems warming to idea of scaled-back healthcare reform

There is growing consensus in the House Democratic Caucus that comprehensive healthcare legislation is dead and the only option is to pass a series of piecemeal measures.
 
House leaders have shied away from committing themselves to the scaled-back approach, but a leadership aide acknowledged that, behind closed doors, the idea is rapidly gaining traction.
 

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“Today the momentum of support was for sequencing this bill and bringing provisions to the floor individually,” the aide said Thursday.
 
While Speaker Nancy Pelosi (D-Calif.) and other Democratic leaders aren't publicly embracing the notion, rank-and-file Democrats are pushing the idea.
 
“Both of the [House and Senate] bills as they stand now are dead,” Rep. Bill Pascrell (D-N.J.) said, reflecting the sentiment that had grown in the Caucus.
 
After Republican Scott Brown’s victory in Massachusetts cost Senate Democrats their filibuster-proof majority, the party has been forced to confront how they could proceed with healthcare legislation.
 
When the House Caucus met Thursday, Pascrell was one of the lawmakers who talked about boiling down the massive House and Senate bills into smaller base elements, and moving them one at a time.
 
“One of the things the Caucus was in agreement on was that we can’t take up the Senate bill, and that we would be arrogant if we simply took up our own bill again,” he said.
 
One option under discussion is passing the Senate bill, which would send the legislation directly to President Barack Obama for a signature.
 
But Pelosi threw cold water on that idea since the Senate bill includes a number of provisions liberals and conservative Democrats in the House object to, including the tax on high-cost health plans and less restrictive language on coverage for abortions.
 
"I don't see the votes for it at this time," Pelosi told reporters during her weekly press conference. "The members have been very clear."
 
Obama indicated Wednesday he would work with a piecemeal approach, suggesting lawmakers focus on the core elements of reform. He told ABC News: “I would advise that we try to move quickly to coalesce around those elements in the package people agree on.”
 
The White House has pushed back at the notion that Obama has downscaled his expectations, however. Obama is allowing House and Senate Democratic leaders to figure out what their members want, White House press secretary Robert Gibbs said Thursday.
 
“The president believes it's the right thing to do to let the dust settle and give those on Capitol Hill some time to search for the best path forward,” Gibbs said.
 
But Democrats are already picking up on the idea of scaling back the effort. Pascrell said his idea was one of many in an early series of plans put forth Thursday morning for incremental healthcare reform.
 
The New Jersey Democrat said he has 25 Democrats with him on his plan, which he said consists of building popular insurance reform measures into a Patient’s Bill of Rights framework; working on creating competition; breaking the private insurance anti-trust exemption; and addressing liability reforms in stages from there.
 
Beyond saying that the excise tax was “dead,” Pascrell did not say how his plan would be funded.
 
Disappearing under Pascrell’s idea – which he said has drawn interest from Republican leaders he did not name – are a public option, individual health insurance mandates and an expansion of Medicare and Medicaid designed to expand coverage beyond the limits of any new public insurance exchange
 
Rep. Raul Grijalva (D-Ariz.), co-chairman of the House Progressive Caucus -- which spent months fighting the chamber’s centrists over a government-run “public option” -- said that momentum was shifting toward a step-by-step strategy.
 
And Grijalva said he could support such a strategy “if we have tough insurance reform, if we deal with the donut hole, if we deal with prescription drugs, and if we deal at some point with an expansion of Medicare and Medicaid.”
 
Asked if that meant he could support a plan like Pascrell’s, which would not expand entitlement programs such as Medicare and Medicaid, Grijalva laughed and walked away.
 
Pelosi addressed the step-by-step approach on Thursday, but suggested she doesn’t see it as a complete answer despite its appeal.
 
“Certainly there would be great consensus to take the most popular part of the bill and advance it, and that would be positive, but we have serious other structural things that have to be done,” Pelosi said.
 
At the same time she was careful not to make any firm declarations about either bill’s future or strategy, reiterating that “everything is on the table.”
 
Other Democrats elaborated on the downsides of scaled-down or incremental healthcare reform.
 
“I love health insurance reforms. I just salivate at the very thought of them but that’s not enough. It’s not enough. In healthcare, everything fits together,” said Sen. Jay Rockefeller (D-W.Va.). “It’s very hard to say ‘We could just cut this out’ and do that.”
 
Rep. Rob Andrews (D-N.J.) made a similar point, noting that insurance reforms not paired with broader coverage would lead to higher premiums because more sick people would enter the system, driving up costs for healthier people.
 

The Senate has little interest in drawing out healthcare reform for as long as it would take to debate several bills, Sen. Charles Schumer (D-N.Y.) indicated. “How long will each one take? I don't think we want to do healthcare the next three months,” he said.
 
House Energy and Commerce Chairman Henry Waxman (D-Calif.) suggested a scaled back effort would also fail to achieve the goals Democrats established in the first place.
 
“We have to is keep our eye on the objectives of covering all Americans, holding down healthcare costs, providing reforms in the insurance system so they can’t keep people from getting coverage,” Waxman said.
 
Waxman, one of the principal authors of the House bill and a lead negotiator with the Senate and White House leaders, said Democrats are still open to forcing changes to the Senate bill through the upper chamber using special budget rules that only require a simple majority.
 
Waxman hinted it’s his preferred strategy.
 
An option the White House floated earlier in the week was for the House to pass the Senate bill and then move the changes in a separate bill under the budget reconciliation process.
 
Senate Budget Committee Chairman Kent Conrad (D-N.D.), who would have authority over the bill under reconciliation protection, said he is open to using that process for healthcare changes, but would need to see the language before backing the approach.
 
“I would not agree in advance to using reconciliation without understanding what that agreement entailed,” Conrad said.
 
Waxman called it a “perfectly legitimate” option.
 
“It’s a perfectly legitimate procedure under the rules,” Waxman said. “What’s amazing to me is that a majority in the Congress can’t work its will.”
 
Reconciliation was met with stiff resistance from the leaders of the Blue Dog Coalition – the largest block of Democrats opposed to the House bill – who in a Wednesday meeting with Pelosi likened it to legislative trickery that will hurt them considerably in their conservative districts.
 
And without a guarantee that a deal on the excise tax would be included in the final language, House liberals appeared just as reluctant to go along with a strategy of reducing the Senate’s passage threshold to a simple majority.
 
-- Jeffrey Young, Jordan Fabian, and Alexander Bolton contributed to this report

-- This article was updated at 7:56 p.m.