Side deals stack up as health bills move along

The $300 million Medicaid fix that Sen. Mary Landrieu got inserted into the Senate healthcare bill wasn’t the first “Louisiana Purchase” of the healthcare debate.

Before Rep. Joseph Cao (La.) cast the lone Republican vote for the healthcare bill in the House, he secured assurances from President Barack Obama to work on Medicaid funding, loan forgiveness and issues related to two of his local hospitals.

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House Transportation and Infrastructure Committee Chairman Jim Oberstar (D-Minn.) also reportedly promised a visit to Cao’s hurricane-ravaged district.

Those pledges are a little less concrete than the $300 million Medicaid fix that Landrieu (D-La.) says is needed because disaster-relief money has skewed funding ratios by making her state appear wealthy.

But it’s one of several last-minute deals cut as Obama and House Speaker Nancy Pelosi (D-Calif.) rounded up the last votes they needed to pass the healthcare bill in the House earlier this month, and members found that there was a way to make a controversial vote for the bill pay off.

Besides the promises secured by Cao, the best-known deal involved Reps. Dennis Cardoza and Jim Costa, two Blue Dog Democrats from the Golden State who secured funding for a medical school for California’s Central Valley.

Other lawmakers won carve-outs for their state healthcare systems.

Rep. Mazie Hirono (D-Hawaii) got her state’s existing health program exempted by what the Honolulu Advertiser called the “Hirono Amendment.” As a result, the reform measures will be a non-event for many people in Hawaii.

Hawaii’s Prepaid Healthcare Act of 1974 mandates employer-sponsored healthcare insurance for Hawaiian workers who regularly work 20 or more hours a week, and the state already has the second-lowest uninsured population in the country.

Lawmakers from Massachusetts ensured that their state’s universal coverage program, the Health Insurance Connector, could continue operating independently. The program was a model for the “exchanges” in the Democrats’ national bill, but some drafts of the healthcare bill would have left the program’s future in question or might have weakened its ability to negotiate with insurers. Massachusetts officials say the program is working well and should be left alone.

White House spokesman Robert Gibbs refused to weigh in on Landrieu’s deal Monday afternoon. He referred questions to the Senate, saying he had not spoken with Obama about it.

Last-second trade-offs are hardly a novel concept. Wavering legislators, fearful that a vote could cost them back home, hold out until leadership promises them a little sweetener.

“I believe there is a long tradition,” said Carl Tobias, a law professor and political observer at the University of Richmond.

Pelosi packed a 300-page last-minute “manager’s amendment” to the cap-and-trade vote in July with carve-outs, regulatory exemptions and tax breaks to win the votes of fence-sitting lawmakers. It included language making it harder to develop wind power in western states and a section by Rep. Melissa Bean (D-Ill.) to prevent regulatory action she said could shut down the multitrillion-dollar market for over-the-counter derivatives.

And Republican leaders made all sorts of promises during the infamous three-hour vote in 2003 to pass Medicare prescription drug coverage. They stretched a 15-minute vote to three hours while they wheeled, dealed and pleaded with Republican lawmakers. Then-House Majority Leader Tom DeLay (R-Texas) offered to endorse the son of then-Rep. Nick Smith (R-Mich.), who was seeking his father’s seat. Months later, DeLay was admonished by the ethics committee for his handling of Smith that night. During the investigation, it was even alleged that another lawmaker offered to get Smith’s daughter an acting job in Hollywood.