Health Bill Veto / Senate passage of CHIP renewal / AMA gearing up for final passage of SCHIP

CAL/AAEM News Service calaaem_news at yahoo.com
Tue Nov 6 10:22:25 PST 2007


Missteps on Both Sides Led to Health Bill Veto

Source: The New York Times ( http://www.nytimes.com )
Date: November 5, 2007


WASHINGTON, Nov. 4 — They met almost every day in the spring and summer, a handful of
powerful senators who had cleared their schedules to forge a bipartisan compromise
providing health insurance to 10 million children.

President Bush voiced his opposition to the health insurance plan in June while it was
still taking shape, saying it would lead to “government-run health care for every
American.”

It was a remarkable commitment of time for the senators, who sequestered themselves for
two hours a day in the office of Senator Max Baucus, a Montana Democrat whose conference
room is decorated with an Old West motif and filled with small sculptures of cowboys and
buffaloes.

But even before they finished their work, President Bush attacked it.

In a pre-emptive strike on June 27, Mr. Bush — standing before another Western image, an
equestrian portrait of Theodore Roosevelt as a Rough Rider — said the proposal would
“cause huge increases in government spending” and lead to “government-run health care for
every American.”

Senators were taken aback by what they saw as the ferocity of the president’s comments.
Telephone logs and e-mail messages show that Republican senators and their aides had
frequently consulted White House officials as the bill took shape.

One participant in the talks, Senator Charles E. Grassley, Republican of Iowa, called the
criticism and veto threats premature, “disappointing, even a little unbelievable.”

The testy exchange illustrated the misconceptions and frustrations on both sides as
Congress and the White House lurched down the path that led to Mr. Bush’s veto of a bill
that had bipartisan support.

For now, Mr. Bush has won the fight by rejecting a bill that he says would have vastly
expanded the federal role in health care and covered some children whose families could
afford private insurance. But Democrats say they have won because, in elections next
year, they can portray Republicans as having neglected the needs of low-income children
while pouring hundreds of billions of dollars into the Iraq war.

Missteps by each side made compromise impossible. Democrats say that Mr. Bush described
the bill in wildly inaccurate terms, got bad advice from his staff and missed many
opportunities to find common ground. Republicans say that Democrats misjudged the
president; excluded House Republicans, who in the end were crucial, from negotiations;
and aimed negative advertisements at the very members whose votes they needed to override
a veto.

The bill symbolizes the inability of Mr. Bush and the new Democratic leaders of Congress
to work together, but it also highlights the rift between Mr. Bush and members of his own
party, including many who helped create the child health program 10 years ago.

Supporters of the bill have revised it, in an effort to address Republican concerns and
pick up more Republican votes. But their efforts to satisfy the president have proved
futile. They find themselves where they were in June, facing another veto.

The Senate on Thursday passed the revised version of the legislation, clearing the bill
for the president, who said Congress was wasting time.

In the last four months the bill has changed substantially, but the criticism has not,
and this frustrates lawmakers like Senator Orrin G. Hatch, Republican of Utah, who said
the president had been “given some pretty bad advice” by his staff.

Staff members who shaped the White House strategy include Allan B. Hubbard, director of
the National Economic Council; Keith B. Hennessey, a former policy director for Senator
Trent Lott, Republican of Mississippi; and Julie L. Goon, a special assistant to the
president.

In an interview, Mr. Hubbard said his work on the bill had been extremely frustrating.

“I was told last January or February by Democrats that their game plan was to send the
president a bill that was too big to swallow, and it would be a beautiful political issue
for them,” Mr. Hubbard said.

>From the start, said Michael O. Leavitt, the secretary of health and human services,
administration officials viewed the debate in ideological terms, as “a center court
match” pitting supporters of government-run health care against proponents of private
health care markets.

Senator John D. Rockefeller IV, Democrat of West Virginia, said White House officials
“have never been helpful in the entire process.”

Representative Michael R. Turner, an Ohio Republican who voted for the bill, said, “The
administration did not come forward with any real offer of a solution or a compromise
that would break the logjam.” And the Democrats, Mr. Turner said, often seemed more
interested in politics than in policy.

In June and early July, Mr. Bush denounced the legislation taking shape in Congress. This
infuriated senators of both parties, who were still drafting the bill.

While the small group of senators was hashing out details of their bipartisan proposal,
White House officials urged lawmakers to provide tax breaks for anyone buying private
health insurance. Mr. Hubbard, a business school classmate of Mr. Bush’s, kept promoting
this idea even after Senate Republican leaders told the White House the time was not ripe
for this broader debate.

Senator Hatch tried to bring White House officials into the negotiations, believing their
involvement would produce a better bill. But, lawmakers said, the administration did not
want to discuss the child health program except as part of a broader discussion that
included the president’s tax proposals.

In early June, the White House sent a message to Republicans saying the president hoped
they would not cut a deal with Democrats. The White House predicted that Republicans
would have more “negotiating leverage” in the fall. That appears to have been a
miscalculation.

“I have zero impact on what the Democrats do,” Mr. Leavitt said last week.

By contrast, Mr. Grassley and Mr. Hatch maximized their influence by working with
Democrats behind the scenes. They held the cost of the bill far below what Democrats
originally wanted.

For their part, Democrats misjudged the president. When the Senate Finance Committee
approved the child health bill in July by a vote of 17 to 4, Mr. Rockefeller said, “It’s
not clear to me that the president has any intention of vetoing this,” because the
political consequences could be disastrous.

Explaining why he vetoed it, Mr. Bush said “we weren’t dialed in” to the negotiations.
But after checking their calendars, lawmakers said they and their aides had had more than
35 meetings and telephone conversations on the issue with Mr. Hubbard, Mr. Hennessey and
Ms. Goon from January through September.

While Senate Republicans were deeply involved in writing the bill, House Republicans said
they had been shut out.

On Oct. 25, just hours before the House took up the revised version of the child health
bill, Democratic leaders met with several dozen House Republicans to seek their votes for
the measure, which had just been introduced the day before.

“The Democrats were simply telling us what was in the bill,” said Representative Thelma
Drake, Republican of Virginia. “There was no dialogue.”

Mrs. Drake added that “the Democrats refused to delay the vote because they had already
purchased ads to be used against us in our districts.” Some of those have been directed
against the Senate Republican leader, Mitch McConnell of Kentucky, who is up for
re-election next year.

“It’s hard to negotiate with somebody when they are shooting at you,” said Don Stewart, a
spokesman for Mr. McConnell.

- Robert Pear
____________________________________________________________________

AMA applauds Senate passage of CHIP renewal

Source: AMA eVoice ( http://www.ama-assn.org/ )
Date: September 28, 2007


“The American Medical Association applauds the members of the U.S. Senate who voted to
protect the health of America’s low-income children through the renewal of CHIP and urges
the president to reconsider his veto threat.

“If CHIP is not reauthorized, millions of children will be in danger of losing access to
the health care that the program makes possible. The health care kids in low-income
families get through the program is vital to their growth and development. America’s
children are our future, and without proper health care they are not given a fair chance
to succeed.

“This important opportunity to both renew and make improvements to the program should not
be squandered. The AMA stands on the side of millions of parents and their children in
our call for President Bush to keep his promise to America’s future and sign this bill
into law.”

For more information, please visit:

http://www.ama-assn.org/ama/pub/category/18019.html
____________________________________________________________________

AMA gearing up for final passage of SCHIP and Medicare legislation

Source: AMA eVoice ( http://www.ama-assn.org/ )
Date: September 6, 2007


With Congress reconvening this week, the AMA is working to secure final passage of
legislation that would reauthorize the State Children's Health Insurance Program (SCHIP)
and replace projected cuts in Medicare physician payments with positive updates.

A bill approved last month by the U.S. House addresses both these issues, but a bill
passed by the Senate focuses solely on SCHIP reauthorization. Now both chambers of
Congress must come to an agreement on provisions in the final legislation, and the AMA is
aggressively lobbying lawmakers to expedite the conference process and finalize a bill to
both stop the Medicare payment cuts and reauthorize SCHIP.

While it is not yet known whether SCHIP and Medicare legislation will advance in one bill
or as separate legislative packages, the AMA is framing negotiating positions for members
of Congress that focus on:

•	Increased funding for SCHIP to cover all eligible children 
•	A positive payment update for all physicians treating Medicare patients 
•	Extending expiring provisions governing physician payments in rural areas 
•	Eliminating restrictions on physician-owned hospitals 
•	Opposing additional cuts for imaging services





Abid Mogannam &
Brian Potts MD, MBA
Managing Editors, CAL/AAEM News Service
University of California, Irvine

The CAL/AAEM Archives are available at: http://maillists.uci.edu/mailman/public/calaaem/


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