WASHINGTON – It took 16 days, but Democratic leaders finally muscled a trillion dollars worth of legislation past the House Energy and Commerce Committee Friday after their Blue Dog conservatives abandoned a revolt against government-run health care.

Victory for House Speaker Nancy Pelosi, D-Calif., and her team came on a three-vote margin, with five Democrats joining all 23 Republicans to vote no and 31 Democrats voting yes.

Revelations of the bill’s $1.6 trillion price tag had touched off a protest among the handful of sticker-shocked committee Democrats, stalling action as the Democratic leadership cajoled its reluctant followership back into line. Even exposure to a presidential charm offensive at the White House wasn’t enough to mollify them initially, and subsequent committee sessions were twice canceled as Democratic leaders scrounged for votes.

The trick was how to reel conservatives back in without terrifying liberals, but as soon as the former were hooked, 53 of the latter signed a letter declaring their independence from the leadership and their absolute commitment to a “robust” government takeover.

With the legislation dented by bipartisan dissent and its ultimate prospects less certain than ever, House members now will spend August explaining what happened to constituents.  Many anticipate that while the House is away, Pelosi’s staff will quietly rewrite sensitive parts of the committee-passed bill, then schedule a post-Labor Day vote with nearly all further changes forbidden.

During the weeks of off-again, on-again debate in committee, Democratic leaders seemed to cringe each time their rank and file was required to vote on a Republican reform that might prove popular.  The very first such idea – an amendment by U.S. Rep. John Sullivan, R-Okla., to detect and stop duplicative spending – drew Democratic Chairman Henry Waxman’s opposition, but won anyway on a vote of 29-27.

After that shock reversal, leaders locked down the lid on the Democrats’ pressure cooker and proceeded briskly to (1) brush off a Republican physician’s proposal to bar political officials and bureaucrats from overriding doctors on patient treatment decisions; (2) enable Washington to force states and cities to offer abortion insurance to their workers; and (3) label spending for municipal playground equipment as “preventive” medicine and, as such, worthy of adding its cost to the Obama Administration’s trillion-dollar deficit.

Democrats dumped a total of 26 Republican amendments, memorably including a Brooklyn Democrat baiting another committee member to “bring it on, Chicky” during discussion of a GOP proposal to prevent a planned tax increase.

The bureaucrat-patient relationship

The question of whether government officials could order states and cities to provide insurance coverage for anything from abortions to hair plugs was outlined starkly in two questions posed by the committee’s ranking Republican, U.S. Rep. Joe Barton of Texas, to the Democrats’ staff attorney:

Barton: “Is it true that if we don’t strike this and the bill stays as is, the federal government could withhold grants from states if they didn’t comply with some of the mandated requirements for health coverage of their state employees?

Democratic counsel: “Yes.”

Barton: “Is it true under the provisions of the bill if not struck or amended that if the federal government required abortions to be covered, a state would have to do that or lose grants?

Democratic counsel: “If the secretary, acting on advice of the benefits advisory commission, had made abortion a minimum benefit for any acceptable insurance package, yes, sir. They could withhold that.”

“We can’t tell states what to do directly,” Committee Chairman Henry Waxman, D-Calif., said, explaining why withholding funding would be necessary. “We have to use whatever leverage we have over them.”  He led a 35-20 party-line vote to reject the proposal, which had been offered by U.S. Rep. Nathan Deal, R-Ga.

Hi, do you wanna play doctor?

The proposal to ban government employees from overruling doctors on matters of direct patient treatment was rejected on a vote of 23 Republicans and one Democrat in favor, 33 Democrats opposed.

“This is about the practice of medicine,” said Barton of the amendment by U.S. Rep. Phil Gingrey, R-Ga. “If I asked for a show of hands about how many people think people in Washington should tell your doctor how to practice medicine on you, I don’t think there’d be anybody who would raise a hand. I wouldn’t raise my hand. I don’t want my doctor to be told how to practice medicine on me or my family.”

The proposal’s author, an ob-gyn who practiced in Marietta, Ga., for 26 years before coming to Congress, said that doctors “should not be forced to practice under the dictates of some federal employee or political appointee who really has no medical background.”

Added U.S. Rep. Roy Blunt, R-Mo.: “I would hope that this committee would decide that the doctor-patient relationship is more important than the bureaucrat-patient relationship.”

U.S. Rep. Mike Doyle, D-Pa., responded for his side by changing the subject from bureaucrats overruling physicians to whether small companies will dump employees into a government health plan. His advice was not to worry about that because, “No. 1, it will probably be at least eight years before that can happen, and it’s up to the secretary of HHS to make that determination.”

“Well, I believe it does, sir.”

The nurse, U.S. Rep. Lois Capps, D-Calif., provided the quote of the day on Monday as she objected to her $250 million sex education amendment being mislabeled by a Democratic opponent: “Excuse me, this is not a ‘program.’ This is to establish a grant (pause, searching for just the right word) opportunity.” See?

Other frustrations ensued when she was asked if organizations receiving “evidence-based” grants would be defunded if they failed to reduce teenage pregnancy rates or achieve some other measurable goal.

U.S. Rep. Tim Murphy, R-Pa.: “Does it say somewhere in here that if an organization or state failed to reduce those issues that they would not get the grant money?”

Capps: “I would believe that would be lack of evidence.”

Murphy: “I just don’t see it in here. It doesn’t necessarily say in here that if they fail to reduce. Is it in here somewhere that I missed?”

Capps: “Page 2, line 20. Describe how the state’s proposal will address the needs of at-risk teens in the state.”

U.S. Rep. Diana DeGette, D-Colo.: “Will the gentleman yield?  Page 3, line 11, B. Evaluation, through line 20. That’s where it addresses those concerns.”

…Murphy: “Will the gentle lady be amenable to perhaps putting some wording in this that specifically says that, that if they’re not able to produce results, they don’t…”

Capps: “I believe it’s clear in the amendment, sir.”

Murphy: “It’s not in here.”

Capps: “Page 4, line 3.”

Murphy: “Page 4 now?  See, people told me it’s Page 2 and Page 3, and now it’s Page 4?”

Capps, getting ticked: “The whole amendment deals with what you’re talking about.”

Murphy: “There’s nothing in here that specifically says if they fail to meet the goals of this under the definition that they’re no longer eligible for funding.”

Capps, really ticked now: “Well, I believe it does, sir.”

Why jungle gyms make good medicine

Although the Congressional Budget Office estimated that the bill would add $239 billion to the federal deficit during the first 10 years, Waxman insisted it was “deficit-neutral” and led Democrats in rebuffing a proposal to delay some of the spending until the national deficit is under control.

Republicans had wanted to delay a burst of disease “prevention” spending for items like municipal jungle gyms and bicycle trails until Washington’s budget deficit dips below $1 trillion, but Democrats said the money must be spent. So the proposal by U.S. Rep. Lee Terry, R-Neb., to cork one fountain in the health bill was defeated 33 to 23. All Republicans voted yes; all Democrats voted no, except for four who skipped the post-midnight roll call.

“Public health and workforce” spending under the bill “can mean anything as we’ve heard from various news reports and newspaper articles from installing more jungle gyms to creating bike trails and parks,” Terry pointed out.

“This is pretty straightforward,” noted Barton. “President Obama’s budget did get below $1 trillion, and the Republican budget got well below $1 trillion, so this is a target that is defensible.”

Chairman Waxman, D-Calif., not only disagreed, he said that “the dollars we spend on prevention will be the most efficient and cost-effective investments we make in health care reform. It makes no sense to hold prevention hostage to the debate over the budget.”

Medicare for patients

Thirty-two Democrats voted no and 20 Republicans yes on the proposal by Republican U.S. Rep. Mike Burgess, an East Texas physician, to eliminate the annual Medicare cuts that force doctors to turn away patients.

No fix was required because “this bill provides a comprehensive permanent overhaul of the SGR that falls within the Paygo adjustment allowance,” clarified U.S. Rep. Bruce Braley, D-Iowa.

A quirkier but less bureaucratic stand on Medicare was taken by U.S. Rep. Anthony Weiner, D-N.Y., who attempted to abolish the nation’s primary medical program for senior citizens. His “message” amendment was intended to highlight what the tart congressman called the hypocrisy of Republican opposition to the Democrats’ government-run health care plan. On a bipartisan vote of 57-0, the Weiner farce was shrugged off as entertaining political theater. In the end, Weiner opposed his own amendment. “Mr. Weiner’s got nowhere to go but up on his next amendment,” said one congressman as the result was announced.

Democratic policy on tax cuts: No, thanks, and ‘Bring it on, Chicky’

Weiner had done better earlier. He collected astonished laughter from Republicans and actual votes from Democrats in leading opposition to a tax cut by claiming the Obama health care plan cuts plenty of taxes.

At issue was a Barton amendment to forestall a 100 percent increase in the taxes levied in the bill. The legislation’s new surtax “doubles in the year 2013 if there is a study by the Office of Management and Budget that determines if certain savings have not occurred,” Barton noted. “The effect of the Barton amendment would be that beginning 2013, only those citizens who make over $1 million would have their taxes increased by the surtax.”

Weiner said blocking the tax hike was unnecessary because “American citizens’ taxes are going to come down as a result of this bill.” When the Georgia Republican and physician, Rep. Gingrey, tried to speak, Weiner taunted, “Bring it on, Chicky.” 

Weiner’s effort to secure the double taxation succeeded on a 33-25 vote.

Illegal aliens on Medicaid

Majority Democrats scratched out a one-vote advantage as the panel voted 29-28 to kill a Republican amendment requiring that states keep illegal aliens off the public welfare program, Medicaid.

The proposal’s author, Rep. Deal, said that “the reason for the amendment is that the underlying bill would require millions of people to be automatically enrolled in Medicaid without any guarantees that these new enrollees are United States citizens or legal residents. We know that there are approximately 11-plus million individuals who are illegally in our country and… we know the verification requirements that were inserted in 2005 have proven successful.”

Health Subcommittee Chairman Frank Pallone, D-N.J., however, protested that “a lot of people” were being denied care, and said no evidence exists that illegal aliens are actually getting welfare services for which they’re ineligible.

Republicans differed, with Oregon’s Walden pointing out that his state had audited its Medicaid rolls and discovered that 3 percent of the recipients were, in fact, in the United States illegally.

Rep. Barton added that when citizenship verification requirements were first proposed, “there was a great hue and cry that people had lost their birth certificates or they were born before there were birth certificates or whatever, and they wouldn’t be able to prove it. So we added a way of documenting citizenship…and people are not being turned away if they don’t walk in with a birth certificate.”

The next day, Democratic U.S. Rep. Zack Space of Ohio followed up with what one congressman labeled “a CYA amendment” on illegal aliens that contained no provision for citizenship verification.

Good for taxpayers, not for politicians

The president, vice president and members of Congress will not have to join the public in the “public-option” government health plan, Chairman Waxman decided Thursday night.

“If this is a good plan for them, it ought to be good enough for us,” U.S. Rep. Sue Myrick, R-N.C., argued when that amendment was offered by Rep. Blunt. U.S. Rep. Steve Scalise, R-La., called it the “put-up-or-shut-up amendment.”

The only thing Democrats put up, however, was their hands to raise a procedural objection. So instead of being voted on, the Republican proposal to subject politicians right along with the public to government-run health care was tossed by the chairman.

Insurance plans exempt in wrongful death cases

Democrats spent two weeks denouncing private insurance plans, then used parliamentary procedure to bail them out when the going got tough. No vote occurred on the amendment to remove their immunity from wrongful death because Chairman Waxman ruled it “not germane to the bill.”

“Don’t be shocked when you get home this August and are asked why you extended immunity to plans, including union plans, that injure or kill people,” cautioned the author, U.S. Rep. John Shadegg, R-Ariz.

If an employee is killed or hurt because of a decision by a plan administrator, even if the decision involves willful negligence, the plan is immune from lawsuits, he said. “That employee can recover nothing for their injuries; nothing, even if there’s a wrongful death. This bill not only doesn’t fix this problem, it preserves and extends it.”

Rep. Burgess also noted that “there is an exemption that allows some people to go to the courthouse and recover damages: specifically, members of Congress.”

Dangerous, discriminatory wellness

Healthy people may cost less, as U.S. Rep. Steve Buyer, R-Ind., said, but his attempt to promote wellness ran into a Democratic one-size-must-fit-all mandate and lost on a vote of 34-24.

Making the case for employer-based wellness programs, Buyer wanted to allow employers to pay up to half of health benefit costs instead of the current limit of 20 percent.

That approach didn’t suit Democrats led by U.S. Rep. Kathy Castor, D-Fla., raised the specter of mandatory medical exams and penalties for obesity and increased premium costs, and then denounced the wellness proposal as dangerously discriminatory. “I’ll also put on the record that the administration opposes this,” she said.

Rep. Gingrey, however, wondered “how is it punitive or discriminatory when you’re not raising the premiums for those who don’t choose to participate in a wellness program?  What’s discriminatory about them paying the standard rate for the standard group health insurance policy, but rewarding others who lower the costs by their behavior?”

“We ought to encourage this kind of wellness activity, not discourage it,” Gingrey said.

Congressional-style health insurance for all: “Yes!…Pass!…No!”

Early in the debate, Rep. Weiner had an idea to give Americans the same kind of health insurance as congressmen get, but changed his mind when Republicans offered an amendment o actually do it.

Republicans had argued that the idea made too much sense not to be considered, and said they’d been hearing from constituents well before Weiner brought it up. Rep. Terry offered it and Rep. Gingrey said that people were already asking him, “‘Why can’t we have the same thing you guys have?’” He said that “we ought to give everybody in this country an opportunity to get this.”

That’s when Weiner’s mind began to change from yes to something less.  When it was time to vote on letting everybody into congressional-style health insurance, the famously loquacious Democrat had just two words left to say: “Pass” and then, “No.” His final choice among his shifting positions combined with 30 other “No” votes from Democrats on the House Energy and Commerce Committee to kill the idea he’d advocated a day earlier. The final vote was 31-28 against opening the congressional plan to everyday citizens.

Gov’t-Run Health Plan May Provide Abortion

Most Democrats managed to have it all ways on the abortion issue, at first opting to make abortions available under the government’s “public-option” health plan, then deciding to disallow them as a basic benefit, and finally reversing that decision just before midnight.

The opening salvo on abortion was fired by Rep. Capps, a nurse whose proposal created a murky accounting mechanism that effectively permitted the government’s “public option” insurance plan to contain coverage for elective abortions.

Capps argued that it continued traditional bans on federal funding of abortion services, but U.S. Rep. Bart Stupak, D-Mich., refuted that stand, saying the proposal abrogated long-standing bans.

Making abortion services not only available, but “cheaper and more affordable? That’s not a principle I can endorse,” Stupak said of the Capps amendment, which won on a 30-28 squeaker.

The panel then turned to joint proposals from Stupak and U.S. Rep. Joe Pitts, R-Pa., that were designed to prohibit the kinds of abortion services that have been consistently excluded from government sponsorship.

Stupak said he and Pitts “have been very up-front” about the proposals they were offering. The amendments were these:

1. Abortions could not be a required basic benefit of any government or private plan, which was approved 31-27. Then, in a surprise move, it was then reconsidered an hour later and reversed on a vote of 29-30, aided by the chairman’s parliamentary switcheroo and a mysterious change of heart and switch of vote by a Tennessee Democrat, U.S. Rep. Bart Gordon.  (Some days later, The Politico reported that Gordon’s spokesman explained that the congressman “legitimately misread the text of the amendment and that when it became clear to him what he was voting for, he switched his vote.”)

2. “The conscience clause, where no one should be forced to perform an abortion or help assist in an abortion no public funds for abortions,” which won on a voice vote.

3. Application in the government-run plan of the traditional “Hyde Amendment” ban on public funding for abortion, which failed, 31-27.

Sweetheart deals may help government health plan kill off competitors

Democrats decided to give their government-run health plan such a head start that it could drive private competitors out of business. On a vote of 32-23, they united to ditch Republican U.S. Rep. George Radanovich’s proposal to stop that from happening.

The Radanovich amendment sought to make certain that special tax breaks and a regulation-lite would not be available to help bureaucrats running the government health plan out-compete private insurance. If the Democrats’ goal really is more competition, “let’s make sure the playing field is fair to all competitors,” the Californian said.

Democratic Rep. Christopher Murphy of Connecticut argued that as a nonprofit, the government-run health plan is due privileged treatment. “By requiring that this plan pay state premium taxes…it would very consciously un-level the playing field,” he said.

Health Subcommittee Chairman Pallone added that denying the government plan the ability to borrow start-up money from other government agencies seemed unfair.

Dems’ $500 billion Medicare cut: ‘Don’t be scared’

Democrats turned down a Republican proposal to stop a $500 billion raid on Medicare, voting 35-23 to let the cut contained in their bill take effect. by saying no to a proposal offered by Rep. Gingrey.

“I hope every senior is listening very, very carefully,” he said. “This amendment would take all of that $500 billion and put it back where it belongs, put it into the Medicare system.”

U.S. Rep. Jan Schakowsky, D-Ill., responded that the money coming out of Medicare under her party’s legislation shouldn’t concern senior citizens. “Don’t let anybody scare you,” she said. “We will be there for you as we always have been.”
 
Gingrey said restoration of the $500 billion could help close the “doughnut hole” in the prescription drug plan, provide services like annual physicals to Medicare patients, cut deductibles and co-pays and offer catastrophic coverage.

No extra help for breast cancer patients

Breast cancer survival may be declining under government-run health care systems across the world, but Democrats say there’s nothing to worry about here, and voted against allowing American women with a risk or history of breast cancer to get specialized care under insurance that focuses on that illness if survival rates drop under the U.S. government-run plan.

The amendment to create a special option for women was “disingenuous,” said Chairman Waxman, leading a 36-22 rejection.

The proposal’s author, Arizona Republican Shadegg, said his amendment required an annual study on five-year survival rates, and if they decline, “then women could chose to pick a plan that focused on breast cancer.” Another Republican, nine-year breast cancer survivor Sue Myrick of North Carolina, said she was able “to see six doctors all told, and have three mammograms and an ultrasound before it was finally diagnosed. I knew something was wrong. In other systems, I would not have had that benefit.”

In other action:

• Democrats turned down, 35-23, a Barton amendment to deliver health care at an added cost of $2 billion a year instead of $100 billion. The proposal would have allowed the federal government to subsidize state-based “high-risk pools” to insure the uninsured. “If we can get the same bang for a lot fewer bucks, we should do it,” Barton said.
• The committee listened to a Weiner amendment that would eliminate all private health insurance and replace it with a “single-payer,” all-government system. “This is as close as we have to starting from scratch as we’ll ever have,” he said. The proposal was withdrawn when Speaker Nancy Pelosi promised that it would be offered later to the full House.

But wait, that’s not all. The 60 amendments that were still pending when the session ended will be considered in a separate bill in September, said Waxman.