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Feinstein feels left out of healthcare talks

Sen. Dianne FeinsteinDianne Emiel FeinsteinCoalition of 44 groups calls for passage of drug pricing bill An open letter to the FBI agent who resigned because of Trump Nunes 'memo' drama proves it: Republicans can't govern, they only campaign MORE (D-Calif.), who has proven critical in forging compromise on major issues in the past, says she feels cut out of negotiations to overhaul the nation’s healthcare system.

Feinstein fired off a warning Tuesday by threatening to vote against the bill if it takes tens of billions of dollars in Medicare funds away from high-cost areas such as New York and California to cover uninsured patients in low-cost and rural areas of the country.

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Feinstein’s concern represents the possible re-emergence of a longstanding feud over how to pay for healthcare that has traditionally pitted large, populous states against their small, rural counterparts. Senate Democratic leaders are trying to tamp down these tensions before they threaten to derail healthcare reform.

Senators working on healthcare reform that could include a new public insurance program are considering reimbursing doctors based on the outcome of treatment instead of on quantity, which could punish populous states.

“The surest way to tank healthcare reform is to let us break down into arguments between big states and small states. That has been in every major health discussion for years and years,” said Sen. Ron WydenRonald (Ron) Lee WydenWATCH: Dems say Trump will look like he has something to hide if he avoids Muller interview House funding bill includes bipartisan Medicare reforms Trump approves Indiana Medicaid work requirements MORE (D-Ore.), a member of the Senate Finance Committee.

Tensions between lawmakers from big and small states are likely to heighten in the wake of a Congressional Budget Office analysis estimating that Democrats need to find $1 trillion over the next 10 years to pay for their leading healthcare reform proposal.

A split between urban and rural states could complicate talks between the Senate Finance and House Ways and Means committees, both of which are tasked with paying for healthcare reform. While Finance’s leaders come from small states, the senior Democrats on Ways and Means come from New York City, California and Michigan.

One member of the Finance Committee predicted that discussion over payments to large and small states would escalate into a major debate between Sen. Max BaucusMax Sieben Baucus2020 Dems pose a big dilemma for Schumer Steady American leadership is key to success with China and Korea Orrin Hatch, ‘a tough old bird,’ got a lot done in the Senate MORE (D), chairman of the Finance Committee, who represents rural Montana, and Sen. Charles SchumerCharles (Chuck) Ellis SchumerGOP lawmaker: Dems not standing for Trump is 'un-American' Trump called for unity — he didn’t even last a week Overnight Defense: GOP plays hardball by attaching defense funding to CR | US reportedly drawing down in Iraq | Russia, US meet arms treaty deadline | Why the military wants 6B from Congress MORE (D-N.Y.), another panel member.

Feinstein said she’s seriously worried that states like California, which is already considering cuts to public healthcare because of a state budget crisis, could be hurt by the emerging healthcare reform bill.

“All of us are very concerned. We don’t know the specifics of the plan,” said Feinstein, who does not sit on either of the Senate panels with primary jurisdiction over the issue. “This is one of the big frustrations that accompany healthcare reform for those of us not on [the Finance] committee [who represent] big states with complicated and very serious healthcare industries.”

The New York Times reported last week that lawmakers are seriously considering proposals to rein in the cost of health spending by shifting tens of billions of dollars of Medicare money away from high-cost areas to cover the uninsured in low-cost regions.

Feinstein said if leaders decide to shift billions of Medicare dollars away from California, “I can’t vote for it.”

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Healthcare isn’t the only major legislative issue threatened by Democratic infighting along regional lines. The opposite seems to be happening in the House with a climate change bill that is a top priority for Speaker Nancy Pelosi (D-Calif.). It has come under fire from farm-state members who claim the bill’s sponsors are favoring their coastal states.

Sen. Tom HarkinThomas (Tom) Richard HarkinOrrin Hatch, ‘a tough old bird,’ got a lot done in the Senate Democrats are all talk when it comes to DC statehood The Hill's 12:30 Report MORE (D-Iowa) said he has followed that debate and agrees with House Agriculture Committee Chairman Collin Peterson (D-Minn.) that the legislative language in that bill needs to be more equitable, considering the interests of large urban areas and more rural states. But he acknowledged those places have competing interests.

“The bigger states and the industrial states are going to have differences with Southern states and mountain states in the West,” he said. “Big differences.”  

Feinstein said she would like Democratic leaders to slow down the pace of healthcare reform legislation so that she has time to meet with constituents in California to better understand how it affects them.

 “I have a hard time understanding the need to push something through,” she said, warning that healthcare reform could crash and burn if lawmakers aren’t given enough time to satisfy various questions and concerns.

California’s other senator, Barbara BoxerBarbara Levy BoxerDems face hard choice for State of the Union response Billionaire Steyer to push for Dem House push Billionaire Steyer announces million for Dem House push MORE (D), also said her state should have more of say in early discussions.

“I do feel that we do have to get more involved and I have been trying to do it via members on the committee, but I think she’s absolutely right, because whatever policy is made, we’re going to feel it more than any other state because we’re so large.”

Finance’s senior members — Baucus, ranking Republican Sen. Chuck GrassleyCharles (Chuck) Ernest GrassleyOvernight Cybersecurity: Tillerson proposes new cyber bureau at State | Senate bill would clarify cross-border data rules | Uber exec says 'no justification' for covering up breach Overnight Finance: Senators near two-year budget deal | Trump would 'love to see a shutdown' over immigration | Dow closes nearly 600 points higher after volatile day | Trade deficit at highest level since 2008 | Pawlenty leaving Wall Street group Grassley to Sessions: Policy for employees does not comply with the law MORE (Iowa), Sen. Jay RockefellerJohn (Jay) Davison RockefellerOvernight Tech: Trump nominates Dem to FCC | Facebook pulls suspected baseball gunman's pages | Uber board member resigns after sexist comment Trump nominates former FCC Dem for another term Obama to preserve torture report in presidential papers MORE (D-W.Va.) and Sen. Kent Conrad (D-N.D.) — hail from small, rural states. They will be charged with finding ways to pay for the $1 trillion-plus costs of reform.

Finance does have several junior members from populous states, including Democratic Sens. Bill NelsonClarence (Bill) William NelsonInterior head to travel to Carolinas to discuss off shore drilling Overnight Finance: Trump touts trade agenda in State of the Union address | Consumer Bureau ruled constitutional | Fed leaves rates unchanged Green group backs Sens. Baldwin, Nelson for reelection MORE (Fla.) and Robert MenendezRobert (Bob) MenendezJustice Dept intends to re-try Menendez in corruption case DACA is neither bipartisan nor in America's interest Senate DACA deal picks up GOP supporters MORE (N.J.).

Sen. Debbie StabenowDeborah (Debbie) Ann StabenowDems press Trump for 'Buy American' proposals in infrastructure plan Kid Rock: Al Franken shouldn't have resigned Michigan State president resigns amid sexual abuse scandal MORE (D-Mich.), another member of Finance who represents a populous state, said it’s not certain how altering the reimbursement formula will affect big states. She said it is an oversimplification to characterize the proposed change to reimbursement formulas as a shift of Medicare money away from populous states.

Conrad noted that treatments at Mayo clinics cost “about half as much” as at the University of California Los Angeles and “get better outcomes.”

Mayo is headquartered in Rochester, Minn., a small city of about 100,000.

But Conrad argued that a new reimbursement scheme wouldn’t necessarily favor more rural areas. He noted that Mayo operates a successful clinic in Jacksonville, Fla., which has about 800,000 residents.