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Moderate Democrats star in health care debate

July 24, 2009
In The News

Wisconsin Rep. Ron Kind and other moderate Democrats in the House are playing starring roles in the evolving congressional debate over health care reform.

As a potentially decisive voting bloc in Congress, moderates are now at the center of the action in Washington, heavily courted by President Barack Obama, who counts health care as his top domestic priority, and in the thick of negotiations with congressional leaders who are changing the legislation to accommodate their concerns.

On Friday, Kind and a handful of other House Democrats held a news conference on Capitol Hill to announce that they had reached a deal with congressional leaders on a major point of contention for them: containing Medicare costs.

But even as House Speaker Nancy Pelosi was calling the agreement a "giant step forward" on the health care bill being considered, key conservative Democrats continued to express doubts about the legislation.

At the same time, Obama met with two top senators at the White House Friday as he tried to nudge Congress to approve a measure that appeared to be stalling in the past few days. As Democrats splintered on the issue, Obama went on the offensive this week, traveling to Ohio to participate in a town hall meeting on health care reform, giving a prime-time news conference on the subject and meeting with lawmakers who have not yet lent their support for the bill.

"The negotiation really going on is among the Democrats," said Robert Blendon, a health policy professor at Harvard University.

In recent days, moderate and conservative Democrats have balked at the cost of the legislation: $1 trillion over the next decade. It's a tough sell at a time when the country is going further and further into debt, and lawmakers already have been asked to approve a number of costly measures to help stem the economic downturn.

Some Democrats also worry that the bill would lead to significant tax increases and put a burden on small businesses forced to provide health care benefits to their employees. Although Democrats now control both the House and Senate, a significant number of defections from within the party's ranks could effectively kill the legislation.
'Value over volume'

House leaders announced their deal with moderate Democrats after a round of talks that stretched late into the night over changes in Medicare to reward doctors and hospitals for the quality of care provided to patients rather than the number of services rendered. The changes made to the health care legislation in the House, Kind said, could be summarized in three words: "value over volume."

"I think it's going to lead to enhanced quality of care at substantial cost savings," said Kind, who last week was one of six Democrats who voted against the legislation in key House committees.

Kind said the changes were significant enough to garner his support for the larger legislation. Under the deal, the Institute of Medicine would issue recommendations in the next two years on how to change the way that fees are paid to providers. The changes would go into effect in 2012, unless Congress decides to block them.

The institute also would examine regional differences in payments to Medicare providers; changes would be implemented in 2014.

Rural hospitals tend to be paid less than hospitals in urban areas, and Kind has long railed against the disparity, arguing that Wisconsin is getting shortchanged despite the fact that many providers in the state were providing higher quality care. The changes would not only possibly change the way Medicare rates are set, he said, but also have the "capacity of transforming the entire health care system."

Kind said he and roughly 30 other House members spent about six hours Thursday night hashing out the deal with Pelosi, three key committee chairmen and others. It was almost midnight by the time the group broke for the night, and members gave a final nod to the deal Friday morning.

In addition to Kind, other Wisconsin lawmakers are being closely watched as the legislation makes its way through Congress. Advocates for health reform say they are keeping an eye on Sen. Herb Kohl, a Wisconsin Democrat who has not yet indicated whether he supports the current bill. The Republican National Committee is running radio ads against the legislation in the congressional district represented by Rep. Steve Kagen, a former allergist.

State events planned

Groups on both sides of the issue are organizing a number of rallies and events in swing congressional districts in the state. Mark Block, the Wisconsin state director for the conservative Americans for Prosperity, is throwing "tea parties" across the state to protest the recent levels of spending in Washington. And many of the people who attend are expressing concerns about the health care bill currently being debated, he said.

"It's a government-mandated takeover of the health care system, and they're very concerned about it," Block said.

Robert Kraig, of the liberal Citizen Action of Wisconsin, held a health care forum in Eau Claire Thursday night designed to put pressure on Kind to support the House's health proposal. He called Kind's renewed support for the bill "fantastic news for health care reform. It may well be a signal that these issues that moderate Democrats have with the bill can be quickly resolved, and health care can be on track."

Kind's hands-on involvement with the bill could make the legislation more palatable to moderate Democrats in the House, said Joseph Heim, a political scientist at the University of Wisconsin-La Crosse. "He's well positioned to influence this debate," he said.

But even as Democrats hailed the agreement with moderates on Medicare costs, other Democrats say they can't yet lend their support to the bill. Rep. Mike Ross, an Arkansas Democrat who leads a health care task force for the conservative Blue Dog Democrats, told reporters that their talks with congressional leaders had fallen apart Friday afternoon.

Republicans are standing back and watching the Democratic infighting slow down a bill that they vehemently oppose.

"It all comes down to the Blue Dogs," said Rep. Paul Ryan, a Janesville Republican. "The question is: Will they keep up their resistance or not?"

The current health proposal would require every American to obtain health insurance, provide government subsidies for those who can't afford to pay for their insurance premiums and create a government insurance program that would compete with private insurers. Obama hopes to sign the bill into law by the end of the year.

"This is such an important issue," Kind said. "There are consequences to whatever we do. In taking action, there will be consequences; there are going to be severe consequences if we don't do health care reform."