" States 'opting out' is a healthcare option"

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Post by racehorse » 11-24-2009 11:19 AM

http://online.wsj.com/article/SB1259004 ... TopStories

* CAPITAL JOURNAL

* NOVEMBER 24, 2009

Lieberman Digs In on Public Option

*
By GERALD F. SEIB


Sen. Joseph Lieberman, speaking in that trademark sonorous baritone, utters a simple statement that translates into real trouble for Democratic leaders: "I'm going to be stubborn on this."

Stubborn, he means, in opposing any health-care overhaul that includes a "public option," or government-run health-insurance plan, as the current bill does. His opposition is strong enough that Mr. Lieberman says he won't vote to let a bill come to a final vote if a public option is included.

WSJ's Jerry Seib discusses his exclusive interview with Sen. Joseph Lieberman, in which the lawmaker says he will stubbornly oppose any public option for U.S. health care.

Probe for a catch or caveat in that opposition, and none is visible. Can he support a public option if states could opt out of the plan, as the current bill provides? "The answer is no," he says in an interview from his Senate office. "I feel very strongly about this." How about a trigger, a mechanism for including a public option along with a provision saying it won't be used unless private insurance plans aren't spreading coverage far and fast enough? No again.

So any version of a public option will compel Mr. Lieberman to vote against bringing a bill to a final vote? "Correct," he says.

This is, of course, more than just one senator objecting to one part of health legislation. This is the former Democratic vice presidential nominee, now an independent, Joe Lieberman, still counted on to be the 60th vote Democrats will need to force a final vote on health legislation. In opposing a public option, he is opposing the element some Democratic liberals have come to consider the cornerstone of a health-care bill.

Maybe the Lieberman stance is posturing, or a maneuver to force a watering down of the public option into something he and like-minded Democratic conservatives can swallow. In any case, as Senate Majority Leader Harry Reid tries to solve the Rubik's Cube that is health legislation, Mr. Lieberman just might represent the hardest piece to flip into place.
[Lieberman] Associated Press

Sen. Joseph Lieberman, shown at a hearing this month, says he opposes a public option because of the fiscal risk.

In spite of that, Mr. Lieberman insists he wants a bill. He voted with Democrats over the weekend on a procedural motion to let debate begin on a version that definitely includes a public option, albeit one states could choose not to join. "I want to get to the health-care debate, and I want to be part of creating, working on and passing health-care reform," he says. "I've been working on it for years, so that's my goal. But I'm not going to vote for anything and everything called health-care reform."

He says he wants the government to help uninsured Americans get coverage, as the bill envisions, and likes the provisions designed to bring down overall health costs. And he favors the consumer protections it would impose on private insurers, including one that bans insurance companies from denying coverage to those with pre-existing health conditions.

But none of that trumps his opposition to a public option, Mr. Lieberman says. And he insists his objection isn't based on the oft-expressed conservative fear that a public option would lead to a government takeover of health care. He says he doubts this or any subsequent Congress would allow that.

Rather, his objection is based on fiscal risk: "Once the government creates an insurance company or plan, the government or the taxpayers are liable for any deficit that government plan runs, really without limit," he says. "With our debt heading over $21 trillion within the next 10 years...we've got to start saying no to some things like this."

Mr. Lieberman also notes that the public option wasn't a big feature of past health-overhaul plans or the campaign debate of 2008. So he says he finds it odd that it now has become a central demand -- which it has, he suspects, because some Democrats wanted a full-bore, single-payer, government-run health plan, and were offered a public option as a consolation.
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* Vote: Should the Senate pass the overhaul?

Critics, of course, think Mr. Lieberman is merely protecting insurers from his home state of Connecticut. He, of course, insists otherwise, arguing that regulation and litigation are the traditional and more appropriate ways to keep the private market honest. The real risk he sees, he insists, is government debt.

Yet he still thinks that, somehow, health legislation will get done, probably not by Christmas but early next year. "At the end of the day," he says, "I feel strongly health-care reform will pass the Senate and the Congress."

How? Mr. Lieberman says he has made his position absolutely clear to Mr. Reid. And Mr. Reid, all agree, is a wily tactician. So does he think Mr. Lieberman, and the two or three conservative Democrats who share his inclination, will give in at the end? Or is there some artful compromise that can be seen as including and not including a public option at the same time?

Here's another possibility: Maybe Mr. Reid plans to push as far as he can with a bill including a public option, to show his party he has done all humanly possible, before yanking the public option just before the whole effort goes off a cliff. We've proven that a bill is possible, he might say then, but also that a public option isn't.
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Sen. Joe Lieberman talks to the press after a Democratic policy luncheon on Oct. 27.
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Post by racehorse » 12-07-2009 11:04 AM

http://dyn.politico.com/printstory.cfm? ... 3B00F63ADE

Chances shrink for pure public option

By: Carrie Budoff Brown

December 6, 2009 02:32 PM EST

Senate Democrats in search of a health reform compromise Sunday zeroed in on a new alternative to a government-run insurance plan — signaling that the chances a final bill will include a pure public option are diminishing.

The new idea — for the government to create a national health insurance plan similar to the Federal Employee Health Benefits Plan — seemed to gather momentum as the weekend went on, and the differences between liberals and moderates on the public option became even clearer.

The proposal would take the place of a new government insurance plan currently included in the Senate version of the bill, according to officials involved with the negotiations.

The plan would be administered by the Office of Personnel Management, which oversees the federal plan for members of Congress, and all of the insurance options would be not -for-profit ones offered by private companies.

Sen. Ben Nelson (D-Neb.), a public option opponent who is participating in the talks, said the new proposal would do away with the government insurance program in Majority Leader Harry Reid’s current bill, which allows states to opt out of a public option.

“Seems to me it would be in lieu of the public option,” Nelson said. He also said Reid’s “opt-out” idea “is no longer being talked about.”

If the Senate goes in this direction, the challenge for Reid is framing this alternative as an acceptable compromise for progressives. Politically, the idea holds appeal for moderates, who have opposed establishing a new government insurance plan, but might also satisfy liberal demands for more choice and competition for private insurers.

“The proposal under consideration can be said to provide access to the same type of insurance plans that members of Congress and federal employees get. People think of that as government health insurance; progressives could portray this in the same vein,” said a Democratic Senate aide, who spoke on the condition of anonymity to discuss the negotiations. “But moderates can simultaneously point to the fact that the government isn’t the payer and say competition was enhanced without growing the government.”

That feature — that the plan would offer policies similar to those members of Congress get — could prove a potent selling point for members of Congress to their constituents back home.

Progressive senators emerged from a three-hour negotiating session Sunday night declining to comment. Asked if the public option has been taken off the table, Sen. Russ Feingold (D-Wis.) said: “I’m not going to respond to that one.” Sen. Tom Harkin (D-Iowa) would say only that he was hopeful a deal could be reached Monday.

Aides familiar with the negotiations said the meetings are not focused solely on the public option and that senators who want the public option are seeking other concessions, including stronger regulation of the insurance industry.

There is also discussion of including a public option "fallback" provision, which would trigger a government health plan if private insurers did not choose to take part in the program — an unlikely outcome.

Jacob Hacker, a Yale University professor who originated the public option concept, posted a blog item on The New Republic website titled “You Call This a Compromise?” He said the latest crop of alternatives, including the plan modeled after the federal employees’ health program, represent “abandonment of the public option altogether.” It appears to be nothing more than a new kind of insurance exchange, which is already in the bill, he said.

And Timothy Jost, a health law expert at Washington and Lee University School of Law, wrote on POLITICO’s Arena that replicating the federal employees’ health plan “was the dumbest idea yet.” Nonprofit insurance plans currently dominate the market, and they haven’t reduced the cost of insurance, he wrote.

The negotiating group directed staff to work through the night on the proposals in preparation for what could be a key meeting Monday afternoon.

“You have people of very diverse and strong views who are making a real effort to come together,” said Sen. Chuck Schumer (D-N.Y.), a public option supporter who has become an intermediary between liberals and moderates. “But people have strong views, and we’ll have to see where people end up.”

Progressives are represented by Feingold, Harkin and Sens. Sherrod Brown (D-Ohio) and John Rockefeller (D-W.V.). The moderate side is represented by Nelson and Sens. Mary Landrieu (D-La.), Blanche Lincoln (D-Ark.), Thomas Carper (D-Del.) and Mark Pryor (D-Ark.).

Sen. Joe Lieberman (I-Conn.), a public option opponent, did not attend the meeting, but his staff was present.

The group came together only in the past few days, representing the first time in the months-long process that key liberals and moderates sat at the same table.

Earlier Sunday, President Barack Obama paid a rare weekend visit to the Senate as the talks heated up. Obama and Vice President Joe Biden called on Senate Democrats to set aside differences and pass legislation by the end of the year. “They’re doing great; they’re going to get it done,” Obama said as he departed the 45-minute closed-door meeting in the Mansfield Room.

On Sunday night, with progress being reported, the senators ordered Chinese food from Schumer’s favorite restaurant, Hunan Dynasty on Capitol Hill, and at one point, they turned on the Giants-Cowboys game. Senators later attributed raucous applause heard from the hallway to the football game, not a sudden breakthrough in the talks.

Reid said he had personally asked five moderates and five progressives to work things out on the issues that they care about, including the public option and small-business coverage. “Progress is being made, and that’s not just talk. We’ve made a lot of progress,” Reid said.

“There are still a few things we have to work out [in] the bill, and the issues are being narrowed as we speak. We’re working toward a consensus. We’re not there, but we understand how important it is that we arrive at a consensus, and we’re going to do that just as quickly as we can.”

Senate Majority Whip Dick Durbin (D-Ill.) said there are several options on the table that liberal and conservative Democrats are considering in order to strike a deal on the public insurance option in the health care debate — and that negotiations are still ongoing.

Durbin, who is a big supporter of the public option, is very much open to striking a deal.

“I’m looking for an alternative that creates competition for the health insurance companies,” he said on “Fox News Sunday.”

Reflecting on the moment, Sen. Bob Casey (D-Pa.) said that Democrats should be able to get a bill done when they have a Democratic president and a pair of congressional majorities. “We've got to get this done in order to demonstrate we can get something this substantial done, even in a difficult economy and a difficult political environment,” he said.

Reid doesn’t have much wiggle room if he expects to finish the bill by Christmas.

Under the best-case scenario, Reid could reach a tentative deal on the public option during the first half of the week and send the revised plan to the Congressional Budget Office for a cost estimate, which is likely to take several days.

Once he receives the estimate, Reid would seek firm commitments on votes, which he will want to lock in before taking the procedural steps necessary to cut off debate on the bill. Aides say the goal is to start taking those procedural steps by the end of this week.

Democrats would then need to hold together 60 senators on three procedural votes and three votes on the bill. The votes could unfold over a roughly nine-day period, ending just before the Christmas break.

Democrats remain seriously concerned about Nelson, who is considered less likely by Senate aides to vote for the bill than are Sens. Olympia Snowe (R-Maine) and Lieberman, whose interests align more closely with the caucus's. As long as the public option is sufficiently tailored to their liking, Snowe and Lieberman can likely be persuaded, aides said.

Snowe met with Obama on Saturday, and the two discussed her “trigger” proposal, under which a public option would kick in if private insurers didn’t adequately expand coverage. Snowe also met with moderate Democrats on the floor, and they plan to continue talks Monday. Snowe, however, is not part of the talks among Democratic liberals and moderates

Nelson is a tougher case. He has not only taken an uncompromising position on abortion, demanding stronger language to prohibit federal funding of abortion. He has also voted against all but one Democratic amendment so far, aside from those that received unanimous support from the body. Nelson’s voting record on the bill suggests a general dislike for key aspects of it.

Nelson’s position could become clearer after an expected vote this week on his anti-abortion amendment. Nelson has said he will not compromise, but he also signaled Friday that he wouldn’t do so until after the vote.

With Nelson as a wild card, the need to win over Snowe and Lieberman becomes all the more important — and that means progressives will be asked to make serious concessions on the public plan.

Obama’s visit came ahead of a busy time in his schedule that could make another Capitol Hill visit difficult, with a pair of trips to Europe for the Nobel Peace Prize and the Copenhagen climate summit. Then he’s scheduled to depart for Hawaii shortly before Christmas.

Despite repeated calls from lawmakers for more direction, Obama has picked his spots over the past 11 months. He has taken significant steps — a visit to the Hill, a major speech, a private meeting at the White House — only when he and his aides considered them necessary.

But given the decisions Reid needs to make in the coming days, Sunday may prove to be a pivotal moment.

Joining Obama and Biden were deputy press secretary Bill Burton, senior adviser David Axelrod, health care “czar” Nancy-Ann DeParle, HHS Secretary Kathleen Sebelius, Secretary of the Interior Ken Salazar and chief legislative liaison Phil Schiliro.

The only speakers, senators said afterward, were the president and Reid.

“We're really pretty much staying out,” said Sebelius when asked if the administration would take a side on the negotiations over the public option. “The discussions are really among the members of the Senate.”

Sen. Roland Burris (D-Ill.) said Obama said health reform "would be the greatest legislation since FDR passed Social Security."

Lieberman, who is open to supporting the bill so long as it does not include a public option, noted that Obama didn’t bring up the idea: “He didn't. I don't think he once talked about the public option. He didn't. That's what I'm saying. I thought it was interesting.”

Reid, asked about the comment, responded, “The president didn't say a lot of things. Sen. Lieberman said that to me after the meeting also, but that doesn't mean it's not an issue because the president didn't talk about it.”

But Lieberman said even the benefits of health reform legislation wouldn’t outweigh his concerns about a public option enough to vote for the bill if that provision stays in.

“No!” Lieberman told reporters. “That’s exactly what I’ve been saying to my colleagues who are pushing for the public option. This bill has so much good in it, and it does so much good — it’s deficit neutral and all the rest. Why are you insisting on getting a foot in the door for single payer?”
--
Meredith Shiner, Jake Sherman and Manu Raju contributed to this report.
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Post by racehorse » 12-07-2009 12:10 PM

http://www.nytimes.com/2009/12/06/healt ... nted=print

December 6, 2009

Senate Clears Way for Home Health Care Cuts

By ROBERT PEAR

WASHINGTON — Snowflakes swirled around the Capitol on Saturday, whipped by wintry winds, but on the Senate floor inside, a heated debate raged as Democrats and Republicans traded jabs over legislation to achieve President Obama’s goal of near-universal health insurance coverage.

By a vote of 53 to 41, the Senate on Saturday rejected a Republican effort to block cutbacks in payments to home health agencies that provide nursing care and therapy to homebound Medicare beneficiaries.

Republicans voted against the cuts, saying they would hurt some of the nation’s most vulnerable citizens. Most Democrats supported the cutbacks, saying they would eliminate waste and inefficiency in home care.

The Democrats’ health care bill would reduce projected Medicare spending on home care by $43 billion, or 13 percent, over the next 10 years. The savings would help offset the cost of subsidizing coverage for the uninsured.

Mr. Obama planned to visit Capitol Hill on Sunday to attend a meeting of the Senate Democratic caucus. The caucus is split over several major provisions of the bill, including one that would create a government health plan to compete with private insurers.

A handful of Democrats and Senator Olympia J. Snowe, Republican of Maine, met Saturday to explore ideas for a possible compromise on the public plan.

In the past, weekend sessions of Congress have dealt with momentous issues like impeachment or fiscal emergencies. But the Saturday session — the sixth day of Senate debate on the giant health care bill — felt, in some ways, like an ordinary workday, as senators debated the health care bill in public and tried to thrash out differences in private.

The Senate majority leader, Harry Reid, Democrat of Nevada, said the Senate had to meet Saturday so it could finish work on the bill before the end of the year.

“Fourteen thousand people lose their health insurance every day in America,” Mr. Reid said. “The American people don’t get weekends off from this injustice. Bankruptcy does not keep bankers’ hours. The bills don’t go away just because it’s Sunday or Saturday. The pain is still there. And so our work continues this weekend.”

Senator Bob Casey, Democrat of Pennsylvania, said: “We gather on a Saturday, which is rare. But it is entirely appropriate and, I think, essential that we spend the time on a weekend to debate this bill and get it passed.”

The Senate Republican leader, Mitch McConnell of Kentucky, said his party would not bow to pressure from Mr. Reid.

“The majority leader believes that somehow if we stay in on weekends, Republicans are going to blink,” Mr. McConnell said. “I can assure him we are not going to blink. The longer we discuss this with the American people, the more unpopular it becomes.”

Indeed, Republicans appeared to relish the debate.

“A fight not joined is a fight not enjoyed,” said Senator John McCain, Republican of Arizona.

Senator Bob Corker, Republican of Tennessee, said, “I would not want to be any other place than on the floor today talking about the most important piece of legislation we probably will deal with in our tenure here.”

Much of the debate Saturday focused on what Mr. McCain had said as the Republican presidential candidate in 2008. Democrats said it was odd to see Mr. McCain styling himself as a defender of Medicare because, in the past, he had favored deep cuts.

Mr. McCain denied that he had tried to cut Medicare benefits.

Democrats said Republicans were stalling. Republicans tried to put Democrats on the defensive.

“I don’t understand what it is that would cause my friends on the left, on the other side of the aisle, to throw seniors under the bus,” Mr. Corker said.

Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee, said, “Nobody here is trying to throw seniors under the bus.”

Mr. Baucus, a principal author of the health care bill, noted that his mother was receiving home health care and said he would not do anything to hurt beneficiaries.

“We are reducing overpayments,” Mr. Baucus said. “We are rooting out fraud. We are getting the waste out. The savings go back in Medicare and extend the solvency of the trust fund.”

But Senator Mike Johanns, Republican of Nebraska, said, “The cuts will hurt real people.”

And Senator Susan Collins, Republican of Maine, said: “The Medicare home health benefit is under attack. The impact of these cuts will ultimately fall on seniors. Home health agencies will simply not be able to afford to serve seniors living in smaller communities off rural roads.”

Four Democratic senators joined 37 Republicans in voting to block the home health cuts. The four were Evan Bayh of Indiana, Blanche Lincoln of Arkansas, Ben Nelson of Nebraska and Jim Webb of Virginia.
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Post by Cherry Kelly » 12-08-2009 12:17 PM

Don't those Dems realize that home health care is cheaper than nursing homes? Many seniors cannot afford to live in self-sufficient homes either. The home-health care is basically a regular visit to those homes where seniors continue to live in their homes, but might need to be checked on to make sure medications are being taken and other needs. Many of those seniors do not live with families or have family members living close enough to do the regular checks (checkups).

Yes there is fraud in any situation - whether it is home-health care, self-sufficient or nursing homes...
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Then supposedly some kind of compromise was made - re medicare/medicaid - AP story Monday evening.

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