Party tries to lock up health bill backing

Appeasing factions a must for Democrats

By Susan Milligan
Globe Staff / October 17, 2009

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WASHINGTON - Seeking to preserve critical public support for a health care overhaul, the White House and congressional Democrats are busy tailoring the sweeping package to appeal to physicians, women, union leaders, and others whose enthusiastic backing will be needed to pass the legislation.

Doctors are expected to win a $240 billion boost in reimbursement rates that would shield them from a 21 percent pay cut next year for treating Medicare patients. Women who now pay higher insurance premiums for caesarean sections would be protected under antidiscrimination provisions. And although Congress is strongly considering a tax on high-cost “Cadillac’’ insurance plans, the charge is likely to be imposed on a smaller number of health plans, appeasing angry labor activists.

The overhaul faces broader opposition from conservatives ideologically opposed to greater government involvement in health care or tighter control of the private insurance industry. But Democrats are increasingly confident they have the votes to pass the legislation without much GOP support, so their focus is on mollifying key factions within their own party as high-stakes negotiations continue on the final wording of the bill.

“There’s been so much focus throughout this debate on whether or not to create a government-run insurance plan that it’s crowded out other very important issues that need to be discussed,’’ said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, an industry lobby that supports some of the changes Democrats have made or are considering. “Now that we’re getting closer to enacting health care reform, a lot of these issues are getting closer focus.’’

Representative Edward J. Markey, a leading player on the health care package and major climate change legislation, said the sweeping bills presented similar challenges in winning over disparate constituencies.

“In the end, like with the energy bill, we’re going to be able to thread the needle, overcome regional, ideological, and philosophical differences, and get the bill passed,’’ said Markey, a Malden Democrat. “We had to do that in the energy bill, and we have to do that in the healthcare bill.’’

Yesterday, AARP and the American Medical Association sent a letter to senators, urging them to pass the bill that would prevent a pending cut in Medicare payments to doctors. The groups said the cuts would hurt older Americans who rely on Medicare, asserting that the uncertainty over the cuts has prompted some doctors to stop taking Medicare patients. The AMA on Thursday announced a 12-state television ad campaign that says the bill would “protect seniors’ access to quality care.’’

“What we’re seeing is that physicians can no longer take care of Medicare patients. It becomes an access issue,’’ said Dr. Rebecca Patchin, chairwoman of the AMA board of trustees. Veterans are also affected by the cuts, because the reimbursement rates for their care are also tied to the same Medicare formula, she said.

The “doctor fix,’’ which would cost about $240 billion over 10 years, will not be included as part of the overall bill because it would vastly increase the price tag of the measure. The Senate Finance Committee version approved earlier this week would cost $829 billion over 10 years, according to the Congressional Budget Office, and House Speaker Nancy Pelosi’s office estimates that the final House bill - now being cobbled together from three committee versions - will amount to less than $900 billion over 10 years, per President Obama’s request.

Instead, the restoration of the Medicare cuts will probably be done in separate legislation scheduled for an initial Senate vote next week, lawmakers said.

The legislation would help keep the support of doctors for the overall health care package, said Representative Richard E. Neal, a Springfield Democrat and a member of the House Ways and Means Committee.

Women - more than half of the population and a great majority of Democratic voters - also “better receive consideration that makes sure health care reform is a positive improvement for them,’’ said Ron Pollack, executive director of Families USA, which advocates a health care overhaul.

Senator John F. Kerry of Massachusetts secured language in the Senate Finance Committee’s version of the health bill that would ban insurers who sell individual policies from charging women more for coverage or denying them coverage for pregnancy and maternity costs.

The legislation would also prohibit insurers from denying coverage to victims of domestic violence, which a handful of states allow insurers to consider a preexisting condition. Massachusetts does not allow this gender-based discrimination.

“There’s a lot of things in here for women,’’ said Judy Waxman, vice president for health and reproductive rights at the National Women’s Law Center, which conducted a comprehensive study of the issue last year.

But she said the Finance Committee bill does not go far enough, because it does not protect women covered by large group policies from being forced to pay higher premiums based on gender. The center is pushing the broader antidiscrimination language in the House version.

Labor unions, another critical group, won a small victory in the Senate Finance version, which increased the threshold for a proposed excise tax on high-cost insurance plans. The unions argue that generous benefits are often negotiated in lieu of pay increases and that the tax would hurt the middle class.

Democratic lawmakers have upped the threshold for the tax, sparing more insurance plans. Kerry is pushing for further relief, limiting the tax to those that cost $9,000 or more a year for an individual plan and $25,000 for a family plan. The House bills do not include the tax.

Kerry also said he is planning to introduce an amendment on the Senate floor requiring employers to provide health insurance. The Finance Committee bill includes a mandate on individuals, but not on employers.

Susan Milligan can be reached at

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