WASHINGTON - Democratic lawmakers from Washington state were hesitant to endorse the revised health care bill unveiled by their leadership Thursday. It wasn't so much because they had problems with it. Rather, they wanted to read the nearly 2,000-page bill before committing.
The exception was Rep. Norm Dicks, D-Belfair, who said, “I will be a supporter of this bill.”
The landmark legislation would extend health care to tens of millions who lack coverage, impose sweeping new restrictions on the insurance industry and create a government-run option to compete with private insurers.
Even as party leaders pointed toward a vote next week, there were fresh questions that went to the heart of their ambitious drive to remake the nation’s health care system.
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Congressional budget experts predicted the controversial government insurance option would probably cost consumers somewhat more than private coverage. At the same time, rank-and-file conservative Democrats sought additional information about the bill’s overall impact on federal health care spending.
The measure includes the top priority of Washington state’s congressional delegation – overhauling Medicare reimbursement formulas that have long punished Washington because it has one of the nation’s most efficient health care systems.
Dicks, along with Reps. Jay Inslee, D-Bainbridge Island, and Rick Larsen, D-Lake Stevens, successfully lobbied House Speaker Nancy Pelosi to include a provision requiring the Institute of Medicine, which is part of the National Academies of Science, to conduct a study of the disparities the existing formulas cause and make recommendations to the secretary of Health and Human Services. Unless Congress blocks them, the recommendations will be adopted.
“What this means for our state is a substantial increase in Medicare reimbursements for Washington physicians and medical facilities, assuring that seniors will continue to receive the care they need,” Dicks said.
Because of the low reimbursement rates in Washington state, some doctors have been refusing to treat Medicare patients, and others were leaving for states that had higher Medicare reimbursements. The problem was especially acute in rural areas.
Rather than a study, the health care reform bill adopted by the Senate Finance Committee actually includes an overhaul of the reimbursement formulas. The Finance Committee bill is expected to be at the heart of a reform bill Senate Democrat leaders are working on.
The House bill is expected to come to the floor next week. Leadership has given members more than the 72 hours they promised to read the bill before bringing it to the floor.
“My hope is we can get this through the House in the next 10 days,” Dicks said.
Democratic leaders were careful not to claim they had yet rounded up enough votes to pass the legislation. Still, the day’s events capped months of struggle and marked a major advance in their drive – and President Barack Obama’s – to accomplish an overhaul of the health care system that has eluded presidents for a half-century.
Obama called the House legislation “another critical milestone in the effort to reform our health care system.”
Dicks, who supports a so-called single-payer, entirely government-run health care system, said he was relieved the proposed bill included a public option.
“I would have preferred a more robust public option,” he said.
Larsen declined to give the bill an outright endorsement until he reads it, but he noted it included the Medicare reimbursement overhaul, a public option and provisions that will extend the life of the Medicare trust fund and close the so-called doughnut that has resulted in some seniors having to pick up the cost of a major portion of their prescription drugs.
“My initial reaction is this bill is consistent with my principles,” Larsen said.
Reps. Adam Smith, D-Tacoma, and Brian Baird, D-Vancouver, deferred comment until they have read the bill. But Smith, a moderate, had reservations about an earlier bill because it was too complicated and could be too expensive.
Washington state Republicans were quick to criticize the bill unveiled Thursday.
“Here we go again,” said Rep. Doc Hastings, R-Pasco. “It is evident, though, that this bill is just another government takeover that will result in bigger government and more spending.
“It would ration care, cut Medicare, jeopardize existing health care plans, raise taxes, penalize small businesses and restrict savings tools like health savings accounts – all without lowering costs.”
Rep. Dave Reichert, R-Auburn, said the bill was similar to one he had earlier voted against in the House Ways and Means Committee.
There was no official estimate on the total cost of the legislation, which ran to 1,990 pages. The Congressional Budget Office said the cost of additional coverage alone was slightly more $1 trillion over a decade. But that omitted other items, including billions for disease prevention programs.
To skirt budget concerns, Reichert said, the bill also doesn’t include the roughly $240 billion in increased Medicare fees Democrats want to pay doctors.
That was included in an earlier version of the bill but was stripped out and will be voted on separately.
Reichert said the public option was a mistake, and the measure would not only tax small businesses but would impose a federal sales tax on purchases of wheelchairs, pacemakers and hearing aids.
“Their ultimate goal is to have a government-run health care system,” Reichert said.
Republicans have already signaled their determination to make the health care debate a key issue in next year’s congressional elections, when all 435 House seats will be on the ballot.
But their ability to block passage in the current House is nonexistent as long as Democratic leadership can forge a consensus among the rank and file. The party holds 256 seats in the House, where 218 makes a majority.
Across the Capitol, the Democratic-controlled Senate is expected to begin debate within two weeks on a bill crafted by Majority Leader Harry Reid, D-Nev. It, too, envisions a government-run insurance option, although states could opt out, unlike the bill the House will vote on.
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The Associated Press contributed to this report.