Robin Hood, the Amended Version

By Dana Milbank
Thursday, October 1, 2009

It's getting late in the Senate Finance Committee's writing of a health-care bill, but not too late for Republicans on Wednesday to make one more valiant stand for the health insurance industry.

Late in the afternoon, Sen. Chuck Grassley (Iowa), the top Republican on the committee, requested consideration of the "Grassley F-1 Modified Amendment." Its goal: eliminate $7 billion a year in fees that the government would charge private health insurance companies, and make up the shortfall by reducing benefits to poor people and legal immigrants.

It was dangerously close to a parody: Republicans demanding that fees be reduced on a profitable industry and shifted to low-income Americans. But Grassley pressed on, unafraid. The fees on the corporations, he said, are a "bad idea" and would undoubtedly result in higher insurance premiums. "I urge my colleagues to vote for my amendment, to strike the fees," he exhorted.

Sen. Jay Rockefeller (D-W.Va.) recognized the fat target that Grassley had just set up. "I think it's a 'message amendment,' " he said, suggesting Grassley was sending a symbolic signal to the conservative base. "It certainly takes on legal immigrants and Medicaid in a very sharp way."

Grassley looked hurt. "You don't really believe that this is a message amendment, do you?"

Now, why would anybody get that idea?

Committee Republicans have made it clear they would not propose, as Sen. Jon Kyl (Ariz.) put it, a "massive GOP alternative" to the Democrats' health-care bill. Rather, they offered nearly 300 amendments to the legislation that would, if adopted, represent a most curious piece of social policy.

Consider Hatch Amendment F-7, which adds "transition relief for the excise tax on high-cost insurance plans for any state with a name that begins with the letter 'U.' " There's only one state that begins with the letter U, and that's Utah, home state of the amendment's sponsor, Sen. Orrin Hatch. He wanted to send a message that the Democrats were being "arbitrary."

Or consider Kyl Amendment D-6 (Modified 2): "An amendment to protect the First Amendment rights of health plans." Kyl, it seems, was concerned that the Medicare authorities had cracked down on Humana, a Medicare contractor, for sending out a letter to its Medicare recipients warning that health-care reform could harm "millions of seniors and disabled individuals."

Democrats have had what amounts to a two-word response to such amendments: Your mama. That's just about literally what Sen. Debbie Stabenow (D-Mich.) said the other day when Kyl proposed an amendment (C-10) that would prohibit the federal government from defining benefits that insurers must offer. "I don't need maternity care," Kyl reasoned.

"I think your mom probably did," Stabenow replied.

Some of the Republican amendments are based in principle. Hatch, for example, sponsored an amendment spending $50 million on abstinence education, and another making sure that no money goes to support physician-assisted suicide.

Others were based in GOP politics: Sen. John Cornyn (Tex.) proposed Amendment D-14, "Eliminating Junk Science in Medical Liability Lawsuits," and D-19, "Protecting Doctors From Frivolous Lawsuits"; Kyl devised one that would "Prohibit the Federal Government's Takeover of Health Care" by striking the main element of the legislation.

But other amendments aren't as easy to explain. There was Kyl Amendment D-9, for example, prohibiting federal funding of "cost-effectiveness research." That was similar to Grassley Amendment D-3, eliminating funding for "comparative effectiveness research."

While his colleagues were opposing effectiveness, Sen. John Ensign (R-Nev.), who devised several amendments targeting immigrants, also offered Amendment C-10, titled only "Transparency in Czars." He also proposed the very constructive Amendment F-4, "to strike the word 'fee' everywhere it appears in the bill and replace with the word 'tax.' "

Then, of course, there were the various attempts to strike the fees the legislation would charge industry -- including Grassley's effort Wednesday to drop the fees on the health insurance industry and instead cut Medicaid administrative reimbursement rates, impose a five-year waiting period on legal immigrants before they can receive health insurance tax credits, and otherwise reduce help for low-income Americans.

"That doesn't sound friendly to me," Rockefeller informed Grassley. "I think it affects Medicaid people seriously, and I have a problem" with it, he said.

The chairman, Max Baucus (Mont.), added his view that "the effect of this amendment is to take money away from lower-income people, take money away from Medicaid, in effect, and shift that income, give it to the insurance industry."

"I respectfully disagree," said Kyl (R-Humana). "What's really hurting people, what's really adding to their bills, are the fees that Senator Grassley is dealing with here."

The senators voted on Grassley's "message amendment," and, in a party-line vote, the committee sent a message to health insurance executives: The fee stands.

Maybe the insurers would have better luck if they moved to a state with a name that begins with the letter U.

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