House Health Plan Bold On Benefits, Quiet On Cost Issue

June 19, 2009

Investor’s Business Daily

Even as health care reform slows in the Senate over huge program costs, House Democrats doubled down Friday, betting on a more-expansive plan while offering few clues on how to pay for it.

Members from the House Ways and Means; Education and Labor; and Energy and Commerce committees released a "discussion draft" bill that reads like a reform wish list that will appeal to the Democrats’ base. It includes a public plan, a Medicaid expansion, subsidies for those up to 400% of the federal poverty level, and individual and employer mandates. Democrats expect it to cover about 95% of Americans.

It also might prove more costly than those of Sen. Ted Kennedy, D-Mass., and Sen. Max Baucus, D-Mont. The Congressional Budget Office estimated that those bills would each cost over $1 trillion, while leaving tens of millions of people without coverage.

That sent Baucus back to the drawing board, announcing his Finance Committee would delay its hearings until after July 4.

He isn’t the only one pushing dates back. President Obama has backed off his July 31 deadline for getting a reform bill to his desk.

"I don’t think it’s a surprise that this is going to take some time to do. It’s an issue that we’ve been discussing for 40 years," said White House spokesman Robert Gibbs. "The president isn’t pessimistic about being able to get this through Congress this year."

House Bill’s Cost Unknown

The CBO has yet to score the cost of a public plan or increasing Medicaid eligibility to 133% of the federal poverty level, as the House Democrat plan proposes.

Energy and Commerce Chairman Henry Waxman, D-Calif., said, "We’re going to pay for this bill. We’re going to pay for it by cutting down on expenditures in public programs like Medicare and Medicaid, and by reforms in the system that will hold down costs for everyone. And we’re going to pay for it with revenues."

On the latter point, Ways and Means and other House panels are mulling a variety of tax hikes to pay for health care, including a value-added tax and a soda levy.

Tax hikes could be politically poisonous and cut the legs out from a tentative economic recovery. But the public also is increasingly worried about soaring budget deficits.

Also, a health plan would need 51 Senate votes if it’s fully paid for — but 60 if it’s not.

A previous CBO report concluded that some Democrat reforms would save money. The employer mandate and community rating would increase federal revenues by $48 billion and $5 billion, respectively, over 10 years. Requiring drugmakers to give the same rebate to Medicare Part D that they give to Medicaid would save $110 billion.

But the Democrats’ plan increases costs by closing the "donut hole" in Medicare Part D and eliminating annual Medicare physician payment cuts. CBO estimated that doing the latter would cost at least $318 billion over 10 years.

Rep. Frank Pallone, D-N.J., chairman of the Energy and Commerce health subcommittee, was noncommittal on the cost of reform.

"We haven’t figured out exactly where we want that line to be," he said when asked if the House would have to keep the cost at about $1 trillion. "A lot may depend on the level of cuts and savings. We don’t have CBO scores, so we really can’t say at this point."

Baucus Balks

CBO scoring compelled Sen. Baucus to rework his plan. A new draft leaked to the media showed he had cut subsidies from 400% of poverty to 300% and Medicaid’s expansion from 150% of poverty to 133%.

Liberal Washington Post blogger Ezra Klein took the CBO score of the Baucus plan as a bad sign. "(H)ealth reform has just gotten harder. The hope that we could expand the current system while holding costs down appears to have been just that: a hope."

At least one key House lawmaker seems unfazed.

"Everything is on the table. Nothing is locked in cement," said Ways and Means Chairman Charles Rangel, D-N.Y. "I’ve been here a long time. We’ve got momentum."