CQ TODAY ONLINE NEWS
June 17, 2009 – 12:36 a.m.
Nudging Centrists Into the Health Care Corral
By Alan K. Ota, CQ Staff
Against Republican charges that they are engineering a government takeover of health care, Democrats have been trying to get party centrists on board as they compile their overhaul plans.
President Obama reached out this week to the American Medical Association, which has aligned with the GOP in the past. Senate Finance Chairman Max Baucus , D-Mont., has repeatedly emphasized that he is working with the panel’s top Republican, Charles E. Grassley of Iowa, to write a bipartisan bill.
Now, House Speaker Nancy Pelosi , whose liberal committee leaders will write health care legislation, is attempting to engage moderate Democrats whose votes she will need on the floor.
One of the California Democrat’s most significant gestures in that direction was to tap John Yarmuth of Kentucky, a former Republican now in his second term, to serve as her strategic communications adviser on health care.
Yarmuth, a former magazine publisher and radio and TV commentator, is one of a number of centrists with whom Pelosi is consulting in an effort to build consensus for a health care overhaul and to design a message that will counter GOP attacks.
Others include Dennis Cardoza of California, a member of the fiscally conservative “Blue Dogs” who attends leadership meetings, and Bruce Braley of Iowa, a vice chairman of the Democratic Congressional Campaign Committee and a leader of the new Populist Caucus.
“They are a part of the effort to build consensus in our caucus, so we can get everybody to agree,” said Majority Leader Steny H. Hoyer , D-Md. “They won’t necessarily get what they want. But they can get some variation of what they want that is good enough for them to support.”
Yarmuth said he was urging Pelosi to deliver a populist message to woo wavering Democrats. “We want competition, not socialism,” Yarmuth said. “If you take away the public option, you’ve said we trust the insurance companies to solve the problem,” he added, referring to a proposed government-run health insurance plan.
But Yarmuth is not only a media and message adviser. He is also a potential rainmaker who could help win over middle-of-the-road Democrats on key issues.
In May, Yarmuth launched his Article I leadership political action committee. Although he declines to take donations from insurers and drug companies, he has held several health-care-related fundraising events in recent weeks sponsored by providers such as the American Hospital Association and Kidney Care Partners. And in his most recent financial disclosure statement, Yarmuth listed shares of Almost Family Inc., a Louisville home health services company headed by his brother, William, valued between $1 million and $5 million.
During the last Congress, Pelosi, a progressive who represents the San Francisco area, developed priorities in tandem with liberal allies including Rosa DeLauro of Connecticut and Californians George Miller , Henry A. Waxman and Zoe Lofgren . She also worked closely with pragmatists including Rahm Emanuel of Illinois (2003-09), who is now Obama’s chief of staff.
Miller, Waxman and Charles B. Rangel of New York head the three House committees charged with writing a health care bill, but Pelosi is talking with others as she assembles support for Obama’s top legislative priority.
“She’s been trying to include more centrists like Dennis Cardoza in a liberal inner circle,” said former Majority Whip Tony Coelho, D-Calif. (1979-89). As chairman of the Partnership to Improve Patient Care, an alliance of patient and industry groups, Coelho has been pushing for a consensus health care initiative.
The Public Option
Although Pelosi has endorsed the public option, she is sounding out centrists about what they like and don’t like about emerging health care legislation.
Ron Kind , a pro-business New Democrat from Wisconsin, and Louisiana’s Charlie Melancon , a Blue Dog, were among a dozen representatives of different factions she summoned to discuss health care June 9.
Even as liberals in the Congressional Progressive Caucus have insisted on a public option as an essential stopgap for uninsured families, centrists have expressed concern about creating a new entitlement and have argued for adding safeguards to ensure that private companies remain strong competitors against any government-run plan.
Yarmuth has sided with liberals in endorsing the inclusion of a public option, but he also has suggested that the party’s liberal wing might need to give ground on its overall agenda to speed up action on health care. Pelosi, he said, might want to focus now on health care rather than on limiting carbon emissions, especially if the latter fails to gain traction.
Centrists have also argued for more generous Medicare reimbursement and funding for programs in rural areas.
“We can’t have a health care plan that is good for the nation but doesn’t meet the needs of our districts,” said Cardoza, who represents Coelho’s old district.
Pelosi has promised to ensure that health care legislation incorporates revenue-raising measures or spending cuts to offset its full cost. She has also opened a discussion about how to shape the public option and provide better care for rural constituents.
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The leaders of the Blue Dog and New Democrat coalitions discussed a common concern of both groups in a June 12 meeting — the need to provide a “level playing field” among all insurers by making clear that the public plan will not be based on Medicare reimbursement rates, will not mandate participation by doctors and hospitals and will be self-sustaining, without federal subsidies.
Kind said centrists agreed on the need for fair competition but remained divided on the best way to protect private insurers. Blue Dogs have called for a “trigger” provision that would delay the public option from taking effect until there is evidence of inadequate competition and cost containment.
New Democrats have called for a “look-back” provision that would require Congress to act on any proposals to modify the public option that are issued by a commission that would review the program after four years.
Both proposals are on the table for discussion, Hoyer said.
Yarmuth said he doubted the trigger proposal would get the support of party leaders. “It’s probably a non-starter,” he said. But he said he believed that a variation of the look-back ideas could be a part of a compromise that would win support from moderates.
The Democrats’ success, Yarmuth said, will come down to building a broad-based message: “We need to put together a message that reflects what we want to do and makes the case for the direction that the majority of the caucus thinks we ought to go in.”




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