House leaders say they have at least 218 votes for liberals' preferred public option in the wake of an agreement to address regional disparities in Medicare reimbursement rates, Democrats said Wednesday.
House Ways and Means Chairman Charles Rangel said there was "a general feeling" the 218 figure had been reached, referring to an overhaul that includes a public option that would pay physicians Medicare plus 5 percent and pay hospitals Medicare rates.
But a Democratic aide said leaders needed to hit a higher number to account for members who would support a "robust" public option but might object to other parts of the bill.
The agreement on how to address Medicare reimbursement rate disparities, a key concern for rural lawmakers, likely helped push Democrats over the threshold, a Democratic aide said.
"We 17 high-quality low-cost states are holding very tight on this issue, but the speaker has been kind enough to come up with compromise language that is satisfactory, I believe, to all parties," said Rep. David Wu, D-Ore. He called the agreement "a reasonable compromise between high-cost states and the high quality low-cost states."
The agreement, which members are set to announce today, would call for two Institute of Medicine studies that would determine reimbursement rates. A Democratic aide said the studies would account for a variety of factors, including geography and the demographic makeup of a particular community. The studies' recommendations would go into effect unless both chambers of Congress passed resolutions of disapproval condemning them.
The agreement is still unlikely to bring all rural Democrats to liberals' preferred public option, and leadership's decision to push for it drew fire from the Blue Dog Coalition. "For those of us in rural districts, the robust public option would be like a BTU tax vote," said Rep. Earl Pomeroy, D-N.D., referring to a 1993 vote on a tax that many freshman members believe lost them elections in 1994.
Freshmen members are also concerned about voting for an overhaul that includes elements unlikely to survive a conference with the Senate; the Senate Health, Education, Labor and Pensions Committee bill includes a public option that would require the HHS secretary to negotiate rates, many Blue Dogs' preferred course of action.
"We would prefer to not have to vote on a lot of issues that are not going to survive conference, especially the controversial ones," said Rep. Gerry Connolly, D-Va., the president of the Democratic freshmen class.
Pomeroy and other rural lawmakers prefer a public option that would require the HHS secretary to negotiate rates with providers, a plan that costs about $80 billion more than using Medicare rates. House leaders also asked CBO for a score on that version of the public option, combining it with a Medicaid expansion to bring the total cost to $895 billion, a Democratic aide said.
"I'm very pleased with the speaker's offer of alternatives. Straight negotiated rates is more expensive, but if you add this Medicaid expansion the speaker mentioned, that does offer savings," Pomeroy said.
The Blue Dogs' co-chairman, Rep. Jim Matheson, D-Utah, said fewer than 12 Blue Dogs were ready to vote for a public option based on Medicare rates. He said Blue Dogs are focused on the total cost of the bill and bringing down healthcare costs over the long term.
This article appeared in the Saturday, October 24, 2009 edition of National Journal Daily.
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