By Christopher Lee
Washington Post Staff Writer
Monday, December 25, 2006
Health care is set to return to the national political stage in 2007, setting up partisan clashes in Congress that could end with rare vetoes from President Bush and help to define the 2008 presidential campaigns.
After years in which Iraq and national security dominated the debate -- and memories of the 1994 Clinton health plan debacle made major health-care changes politically radioactive -- the return of Democratic control in the House and Senate and the ramping up of the presidential campaigns are expected to bring health policy back into the legislative mix.
Two of the House Democrats' top priorities in their "Six for '06" campaign agenda involved health care. Within the first 100 hours of the new Congress, Democratic leaders intend to pass bills in the House that would lift restrictions on federally funded embryonic stem cell research and require the government to negotiate for lower prescription drug prices for Medicare beneficiaries. Their counterparts in the Senate, where it takes 60 votes to keep a bill moving, say those issues will be on the agenda there, too, but are unlikely to advance as quickly.
Key lawmakers and their aides in both parties say other health-policy initiatives likely to surface include renewing funding for the state-federal health-insurance program for children of the working poor, expanding access to health insurance generally, and beefing up drug-safety efforts at the Food and Drug Administration. Also in the works are efforts to promote electronic medical records, ease restrictions on the importation of low-cost prescription drugs from Canada, devise a better way of paying doctors under Medicare and improve the subsidized drug coverage for low-income Medicare beneficiaries.
"There is really a lot of excitement on our side of the aisle in Congress," said Wendell Primus, senior policy adviser on budget and health issues to House Speaker-elect Nancy Pelosi (D-Calif.). "The members are ready to get down to work."
Sen. Charles E. Grassley (R-Iowa), the top Republican on the Senate Finance Committee, said that several issues are ripe for bipartisan compromise but that others, such as drug-price negotiations, will be more contentious. Expanding coverage for the uninsured also will be difficult, he said, "because Democrats don't like the small-business-insurance reform that Republicans do, and they are never going to be able to get a universal plan because it gets right back to Hillary Care, and everybody knows what a debacle that was."
Kevin Smith, spokesman for incoming House Minority Leader John A. Boehner (R-Ohio), said Republicans would try to work with Democrats, but "if they start charting a path that we believe is not right for the American people, then there are going to be some very interesting battles on Capitol Hill."
Passage of the initiatives in many instances is far from certain. A few face strong opposition from the White House and in some cases would require significant new funding at a time when Democrats say they want to demonstrate fiscal responsibility by reining in the federal budget deficit.
Still, even measures that do not win approval can be recycled into political grist for the 2008 presidential campaign, in which health care is expected to be a major issue. When Sen. Ron Wyden (D-Ore.) said this month that he would introduce legislation in the next Congress to create a centrally financed system of private health insurance for every American, his goal seemed as much to influence the presidential debate as to win passage of a bill that many analysts consider a long shot.
"Medical costs are hitting every part of this nation like a wrecking ball," Wyden said. "The last time America tried to fix health care was in 1993 and 1994. . . . Getting this on the presidential agenda so that candidates of both political parties have got to get beyond position papers is an especially important point."
The debates will unfold against a backdrop of growing dissatisfaction with the health-care system and mounting frustration over rising costs. Fifty-nine percent of 1,000 people surveyed by the Employee Benefit Research Institute between May and June rated the nation's health care system as "poor" or "fair."
Census figures show that a record 46.6 million Americans, including 8.3 million children, had no health insurance in 2005, up from 45.3 million in 2004. Meanwhile, premiums for those with coverage were up 7.7 percent in 2006, to $11,480 for a family of four in employer-sponsored plans.
A poll by the Harvard School of Public Health and the Kaiser Family Foundation found that majorities of Democrats, Republicans and independents want government to help lower health-care costs.
The question is whether and how such public sentiments will translate into political action. Here is a look at some of what will be on the agenda in the new Congress:
· Medicare prescription drug price negotiations. Proponents, mainly Democrats, argue that repealing a provision in the 2003 Medicare drug benefit law and forcing the Bush administration to haggle with drug companies over prices could save billions of dollars a year. But Democrats no longer say the savings would be enough to fill the "doughnut hole," the gap in coverage during which beneficiaries are responsible for all drug costs.
Opponents favor the current system, in which private insurers negotiate prices with drug companies. They say government negotiations would amount to price controls and be logistically difficult and might reduce seniors' choice of drugs. Prospects for passage are better in the House than the Senate, where incoming Senate Finance Committee Chairman Max Baucus (D-Mont.) has committed only to holding hearings on the idea. Bush opposes government negotiations, and some Democrats expect him to veto any bill to create them.
· Stem cell research. In July, Bush used the only veto of his presidency so far to quash a bill that would have lifted federal funding restrictions on embryonic stem cell research. Scientists say embryonic cells are more versatile than adult stem cells and are promising in the treatment of paralysis and many diseases because they have the potential to develop into any tissue or organ. Bush said that the bill "would support the taking of innocent human life in the hope of finding medical benefits for others" and that it "crosses a moral boundary that our decent society needs to respect." Advocates in both parties say the bill will pass again -- but many expect another veto.
· State Children's Health Insurance Program. There is bipartisan support for reauthorizing this 10-year-old program that provides health coverage to more than 4 million children whose families do not qualify for Medicaid but cannot afford insurance on their own. The fight will be over how much money to add to the $5 billion annually that the federal government now spends on the effort. Experts say at least $12.7 billion more is needed over the next five years just to keep covering the same number of children. Some Democrats have discussed using the program to expand coverage to some uninsured adults -- a move that would add billions more in costs and bring stiff opposition from Republicans, who say the program should focus on attracting more eligible kids.
· Health information technology. Both the House and Senate approved bills in the last Congress to promote the use of electronic health records and other information technology, in part by setting in motion efforts to develop standards for data storage and ensure that different systems can communicate with one another. But disputes over privacy concerns and potential financial conflicts of interest if hospitals were to sell such technology to their doctors scuttled attempts to reconcile the two bills. Lawmakers say they are confident they can overcome those hurdles and win bipartisan final approval in the 110th Congress.
· Drug safety. Lawmakers of both parties have complained that the FDA has fallen short in monitoring drug safety. They cite the 2004 withdrawal of the painkiller Vioxx because it raised the risk of heart attacks as one example. Leaders of the Senate health committee have signaled that they will push for changes on that front when the panel considers reauthorizing a law that allows the FDA to collect fees from drug companies to speed the new drug-approval process.