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House Committee Approves Health-Care Package

By Paul Kane and Perry Bacon Jr.
Washington Post Staff Writers
Saturday, August 1, 2009

The House Energy and Commerce Committee Friday night approved a sweeping package of health-care measures, clearing a critical hurdle that sets the stage for a five-week battle for both Democrats and Republicans to define the legislation in voters' minds before the full House votes next month.

The final pieces of an intense two-week negotiation came together Friday morning, when rank-and-file liberals on the committee struck a deal with conservative Democrats that could lead to larger subsidies for lower-income workers to pay for health insurance. The committee then approved its portion of the House's health-care bill on a 31 to 28 vote, with five Democrats joining all 23 Republicans opposing the measure.

The committee's vote on the bill was the last thing keeping the House from adjourning for its August recess.

While lawmakers return home to their districts, Democratic leaders in the House plan to spend the next month weaving together what three committees -- Energy and Commerce, Ways and Means, and Education and Labor -- have passed on health care, preparing the 1,000-page bill for a post-Labor Day vote.

Across Capitol Hill, a bipartisan collection of Senate negotiators on Friday set a new, mid-September deadline to reach an accord on their own version of a health-care bill.

The House legislation's centerpiece is a government-financed alternative to compete against private insurance in an effort to drive down health-care costs. Special interests on both sides of the issue expect to spend millions of dollars in the roughly 50 to 60 congressional districts that are considered swing votes, in an effort to define the "public option" proposal on their terms.

Sensitive to the hard-hitting advocacy campaigns already targeting some members, Democratic leaders gave lawmakers marching orders to promote the plan in their congressional districts during the recess or face the prospect of its defeat once it comes to the House floor.

"If we want the public option, we have to sell it to the American people," House Speaker Nancy Pelosi (D-Calif.) said Friday.

The debate is already intense in many states because of a flood of television and radio ads in recent weeks from outside groups.

Pelosi urged members to use town halls and other events to get away from the complicated debates that have resounded in Washington and to focus instead on issues more likely to resonate with voters, such as a provision in the legislation that would bar insurance companies from denying coverage to people with pre-existing conditions.

House Republican leaders say their members will host events on health care but will also discuss broader economic issues. GOP leaders believe they can defeat the Democratic health proposals by connecting them to the $787 billion stimulus, which passed earlier this year but has not reversed the nation's rising unemployment rate. Republicans plan to call in to sympathetic radio programs and blast the stimulus on Aug. 17, exactly six months after Obama signed it into law.

Some Democrats acknowledge that Republicans have gained momentum on the issue in the past few weeks. "It's kind of like death by a thousand cuts," said Rep. John Yarmuth (D-Ky.). "The Republicans have raised a lot of little issues. We haven't done enough in saying this is about security and stability for your family."

GOP leaders gave their members a copy of a dizzying chart of agencies that would oversee aspects of the Democratic health plan.

"Anytime the President talks about [health-care legislation], they like it even less," said House Minority Leader John A. Boehner (R-Ohio) wrote in a memo distributed to Republicans. "Our Democratic friends are going to feel the heat in August from the American people."

To help sell the plan, Democrats have given each member a card, tailored to his or her district, to take home. On one side is practical data on the impact of the bill. The other side includes talking points, such as emphasizing that under the bill "there is no need to change doctors or plans."

"We're going to make sure that health care reform won't get Swift-boated in the month of August," said Rep. Chris Van Hollen (Md.), chairman of the Democratic Congressional Campaign Committee, harkening back to August five years ago, when conservative activists ran ads that questioned the military service of Democratic presidential nominee Sen. John F. Kerry of Massachusetts.

Van Hollen's committee announced Friday a month-long campaign of radio ads and telephone calls in 25 Republican districts, many of which were won by President Obama in last year's presidential race. Van Hollen said the decision to put off a final vote on the bill until September allows Democrats in vulnerable districts to have a "conversation" with voters and acknowledge that the bill might change as Congress discusses it.

The House legislation seeks to insure the nearly 50 million people currently lacking health-care coverage while increasing efficiencies in a sector that accounts for more than a sixth of the national economy. The House bill would mandate that individuals get health-care insurance, would expand coverage of the Medicaid program for the poor, and would provide a "pay-or-play" provision that forces most businesses to provide insurance or else pay a surcharge based on its overall payroll.

The legislation, which is likely to cost more than $1 trillion over 10 years, would be financed by cuts in the Medicare and Medicaid system and by taxes on wealthy individuals and businesses.

Many insurance companies have questioned parts of the bill and warned that some versions of the public plan could destroy their businesses and lead to worse care for those who already have health insurance. House Republicans have so far been unanimously opposed to the legislation and largely stood aside the past few weeks, watching Democrats quarrel over the massive proposal.

After two weeks of closed-door talks, Energy and Commerce Committee Chairman Henry A. Waxman (D-Calif.) struck a deal Wednesday with four key Democrats from rural districts on his panel. It exempted more small businesses from the "pay or play" penalty and altered the payment provision for the public plan -- forcing the health and human services secretary to negotiate with health-care providers, in a fashion similar to how private insurers do now, rather than tying the program's payouts to the Medicare reimbursement rates.

Many liberals on Waxman's panel balked at the concessions, particularly an agreement that cut subsidies to lower-income families for insurance premiums. "That added insult to injury," said Rep. Diana DeGette (D-Colo.). The new deal would force the Centers for Medicare and Medicaid Services to pay claims electronically and would allow the federal government to negotiate prescription drug prices under the Medicare program. Dollars saved by those actions would be directed into health-insurance subsidies for lower-income people.

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