Valley Democrats Cardoza and Costa are key to big health care vote
WASHINGTON – With a Capitol Hill showdown only days away, two San Joaquin Valley congressional Democrats remain crucial and undecided votes on a controversial health care bill.
The pressure is building on Reps. Dennis Cardoza of Atwater and Jim Costa of Fresno. In some ways, they hold the bill’s fate in their hands – as well as several political futures: the president’s, the party’s and their own.
The White House has summoned both in recent days. Television ads and Republican talking points target them.
“I have had good friends who have called me in recent weeks, who have made good arguments on both sides,” Cardoza said.
Costa went to the White House on Thursday night. A week ago, it was Cardoza’s turn. As a counterweight, corporate opponents of the health care bill have been running television ads urging viewers to tell Cardoza to vote no. Phone bank operators have been deluging both offices, also urging a no vote.
Inevitably, bargaining over one issue blends into another.
Costa said last week that he used some of his time with President Barack Obama to urge more consideration for the valley’s water and employment needs. Obama said he understood, Costa reported.
In a memo, Republican leaders identified the two Valley lawmakers as among those who would ultimately determine the success or failure of the legislation. They are both part of the Blue Dog coalition, whose members have more moderate voting records than other Democrats.
In November, Cardoza and Costa joined the majority in approving the initial House bill by a 220-215 margin.
Since then, negotiators have revised the package, but the final bill, well over 1,000 pages, isn’t expected to be available for inspection until Monday. The Valley lawmakers say they can’t commit until then.
“We’ve gotten the summaries, but we don’t know what the actual language is going to be yet,” Cardoza said.
Costa, too, stressed that “I want to see the bill in print, what we’re actually voting on,” before making a decision.
Costa and Cardoza both support elements in the health care package, including insurance coverage for those with pre-existing conditions and portability of coverage when employees change jobs. The bill’s final cost remains a potential concern for both.
Both lawmakers oppose federal funding of abortions, though they are leaving to others the details of how to write the necessary legislative language.
Because of congressional vacancies, House Speaker Nancy Pelosi needs 216 votes. No Republican is expected to vote for the health care package, leaving Democrats to pick their own way.
Politically, legislators see danger everywhere.
Failure to pass the bill would invariably brand Obama and congressional Democrats as weak or inept. That would hurt the party in November’s elections. But in conservative-leaning San Joaquin Valley districts, support for Obama and Pelosi could also be costly.
In this environment, even modest clues invite interpretation. Cardoza, for one, seemed to emphasize last week the problems of uninsured San Joaquin Valley residents and the pain of rising insurance costs.
“We have real problems with a lot of my folks not having insurance,” Cardoza said.
An estimated 28 percent of the residents of Costa’s congressional district in Fresno, Kings and Kern counties lack health insurance, according to the Physicians for a National Health Program.
An estimated 22 percent of the residents of Cardoza’s congressional district in San Joaquin, Stanislaus, Merced and Fresno counties are uninsured.
The Valley’s uninsured population is much higher than in other parts of the country.
Cardoza and Costa both cited funding for new medical schools in their votes in November. The original House bill authorized $500 million over five years for new medical schools in underserved areas.
The University of California, Merced, was an unnamed but presumed beneficiary.
The health care package to be considered next week omits the medical school funding.
Instead, Cardoza noted, the Obama administration in its fiscal 2011 budget request is seeking $100 million next year for the same purpose.
Cardoza serves on the leadership-controlled House Rules Committee, which will play a crucial behind-the-scenes role in coming days. The panel sets rules for how bills are put together and debated, and often is lambasted by Republicans for cutting off GOP alternatives.
Congressional action is expected to be concluded by next Sunday.
Rival camps ramp up efforts
Getty Images
Supporters of President Barack Obama’s health care overhaul protest Tuesday outside a hotel in Washington, D.C., where a health insurance industry group was meeting.
WASHINGTON – Thousands of liberal public-option backers and conservative tea partiers launched last-chance campaigns Tuesday in the nation’s capital to persuade Congress to pass – or reject – sweeping health care legislation.
Democratic congressional leaders conceded that they may not have the votes for final passage of the overhaul by March 26, when Congress is to break for spring recess. They’re trying to persuade party moderates and abortion foes to go along. President Barack Obama wants final votes even earlier, before his March 18 departure on an overseas trip. That appears unlikely.
Republicans launched an all-out effort to derail the bill, urging congressional candidates to hold town hall meetings, organize voters over the Internet and denounce any special deals that may be cut to grease Democrats’ votes.
“A vote for this bill opens an entirely new line of attack on House Democrats,” wrote Johnny DeStefano, deputy director of the National Republican Congressional Committee, in a memo to candidates.
The U.S. Chamber of Commerce said it will spend as much as $10 million on a television ad claiming that Obama’s plan will only worsen the bad economy and job market.
And Obama senior adviser David Axelrod, on a conference call Tuesday, told advocates of the legislation, “What happens in the next 10 days will be critical.”
Despite their divergent goals, what these camps share is an acute understanding of what happened last year after Democrats failed to pass the health care overhaul before the monthlong congressional August recess. In the boisterous town hall meetings and small-government tea party protests that followed, all sides learned that delaying a big vote until after a recess buys the opposition time, and that public demonstrations can have an impact on the political process.
“Our intent and our hope is to have no vote take place before recess,” said Mark Skoda, founder of the Memphis Tea Party and a spokesman for the “Take the Town Halls to Washington” campaign that began Tuesday.
The group’s Web site asked volunteers to travel to Washington before the two-week spring recess to lean on 66 Democratic lawmakers in the House of Representatives that they consider to be wavering on Obama’s plan: “We want to let them know there is only one vote their constituents will support: No on Obamacare.”
Organizers plan to videotape the meetings and release them to constituents.
In the pro-legislation camp, thousands of supporters of Obama’s plan – many organized by unions and some dressed in hospital gowns with tubes taped to their faces – protested outside a Washington hotel where a meeting was being held by America’s Health Insurance Plans, the trade group of health insurers.
Ten protesters crossed a police line saying they were there to make citizens’ arrests of insurance officials. Police hauled the 10 away.
At an earlier rally nearby, Howard Dean, the physician, former Vermont governor and 2004 Democratic presidential candidate, declared that Republicans are in the bag for insurance companies. He said the question for wavering Democrats is: “Are you for the insurance companies or the American people?”
Sen. Barbara Boxer, D-Calif., a supporter of the overhaul, said demonstrations do sway congressional votes.
“The more people rally, the more it shows people here they care,” she said. “It adds to the excitement. It tells you people are engaged.”
But Sen. Ben Nelson, D-Neb., a moderate, added that “you have to remember that there are those who are quiet who merit consideration.”
Republicans remain united against the legislation.
Sen. John Thune, R-S.D., said lawmakers who support Obama’s plan will be casting a vote for “higher taxes, Medicare cuts and higher premiums for most Americans. Those core elements and core features of that bill have not changed.”
Obama presses health insurers to give details online for rate hikes
Amid consumer furor over rising health insurance premiums, the Obama administration asked insurers on Thursday to post rate hikes – and the justification for them – on the Internet.
Also on Thursday, Sen. Dianne Feinstein, D-Calif., introduced legislation that would give the federal government authority to reject rate increases that insurance companies cannot justify.
The developments come as President Barack Obama intensifies his push for legislation to overhaul the country’s health care system, with escalating premiums his central talking point.
Posting rate increases online would “shine a bright light” on how premiums are set, said Health and Human Services Secretary Kathleen Sebelius.
She met Thursday with the top executives of the country’s largest health insurance firms, including the CEO of WellPoint, whose California subsidiary, Anthem Blue Cross, recently triggered a political firestorm when it raised rates by as much as 39 percent for thousands of customers.
“I’m hoping that the CEOs respond to the call for putting their information up in public,” Sebelius said. “At the very least, they owe it to consumers to justify why the rates are sky high,” Sebelius told reporters after her meeting with insurers and insurance commissioners from four states.
Insurers didn’t outright dismiss the idea, “but there were no commitments of any kind,” said UnitedHealth’s chief executive officer, Stephen Hemsley.
Angela Braly, president and CEO of WellPoint, also took part in the White House meeting, as did Aetna and Cigna executives.
The president made an appearance at the meeting, delivering a letter from an Ohio woman who says her premiums have skyrocketed.
Anthem Blue Cross recently sent letters in the mail notifying its subscribers that it planned to raise rates by as much as 39 percent.
On Thursday, The Bee contacted the office of state Insurance Commissioner and GOP gubernatorial candidate Steve Poizner to ask whether he thinks rate increases should be posted online. Poizner spokesman Darrel Ng responded with an e-mail saying public access to that information already exists in California, albeit not online.
In California, the only venues for the public to view rate filings are in San Francisco and Los Angeles, where the state Department of Insurance allows inspection of the documents.
“The fact that you have to schlep to San Francisco to see these filings is not very transparent,” said Anthony Wright, executive director of Health Access California, among those who have joined the call for greater transparency in how health insurance rates are set.
“Putting them online is a good step in California, where we have very few regulations regarding health insurance rates,” Wright said.
“I think people want to know why” rates are increasing, he said. “It informs consumers as well as policymakers and others who watch the industry. How can they raise rates without justification or even without explanation?”
The rate hikes have spurred public outcry. Politicians in California and Washington have seized on them as an argument for overhaul legislation and wider regulation of the health insurance industry.
Sebelius acknowledged that the federal government and many states, including California, have little authority to bring relief to consumers.
Sebelius called consumers “absolute sitting ducks,” who “don’t have any bargaining power” against insurance companies.
Feinstein’s legislation would give the Health and Human Services Department authority to reject or modify rate increases, according to her office. It would also establish a national Health Insurance Rate Authority.
California’s insurance commissioner, unlike commissioners in at least 25 states, does not have authority to regulate premiums.
Obama plan to fast track health overhaul faces fight in Congress
WASHINGTON – Even after President Barack Obama gave them his blessing Wednesday to push ahead hard and fast on health care, congressional Democrats remained uncertain and divided over whether they can finally pass the legislation.
Liberals and moderates both expressed concern about “reconciliation,” the fast-track procedure Obama endorsed. It strips the Senate minority of the ability to filibuster, which requires 60 of 100 senators to overcome.
“I don’t like the reconciliation idea,” said Rep. Baron Hill, D-Ind., one of the moderates. “It does give the appearance of trying to ram something through.”
Under the plan, the measure could be passed after 20 hours of debate with 51 Senate votes and 216 in the House of Representatives. Democrats control 59 Senate votes and 254 in the House.
Republicans say the reconciliation process isn’t intended to be used for big, substantive policy legislation, but rather only for deficit-reduction measures.
Obama endorsed the procedure to pass his top-priority national health care overhaul, saying that he’s willing to stake Democrats’ fortunes on it.
“I don’t know how this plays politically, but I know it’s right,” the president said in remarks from the East Room of the White House, flanked by white-coated nurses and doctors nearly a year after he began his push for a bipartisan bill.
“At stake right now is not just our ability to solve this problem, but our ability to solve any problem,” Obama said. “The American people want to know if it’s still possible for Washington to look out for their interests and their future. They are waiting for us to act. They are waiting for us to lead.”
If Democrats pass an overhaul, it’s likely that they will have to do it without a single Republican vote.
Republican senators vowed to find other procedural tactics to stall the health bill, and warned that Democrats were making a big political mistake.
“History is clear: Big legislation always requires big majorities. And this latest scheme to lure Democrats into switching their votes in the House (of Representatives) by agreeing to use reconciliation in the Senate will be met with outrage,” said Senate Minority Leader Mitch McConnell, R-Ky.
While no timetable for action was announced, lawmakers are likely to consider the legislation this month under a two-step process that will require a House vote on the version that the Senate approved on Dec. 24. The reconciliation process then would be used to make changes in that Senate version, and would need approval by both chambers.
Many liberals aren’t pleased, since the Senate bill lacks a government-run health insurance program, or public option, which the House endorsed late last year.
“The more the bill looks like the Senate version, the less likely I am to be supportive,” said Rep. Peter DeFazio, D-Ore.
Rep. Dennis Kucinich, D-Ohio, also decried the lack of a public option, saying it was eliminated “because of a backroom deal.”
Moderate Democrats also were unhappy. “I don’t think I could vote for the Senate bill,” said Rep. Walt Minnick, D-Idaho, one of 54 moderate-to-conservative Blue Dogs.
Thirty-nine House Democrats opposed the original House version, and many of them face tough re-election prospects in November in districts that voted in 2008 for Sen. John McCain, the Republican presidential candidate.
Obama never used the term “reconciliation.” However, he said that health care deserved “the same up-or-down vote” as other major pieces of legislation that passed through reconciliation during the past three decades, including a welfare overhaul, tax cuts, and the expansion of medical coverage for children and laid-off workers.
The president also said that there’s been enough debate and that several Republican ideas would be included in a final package.
“This is our proposal. This is where we’ve ended up,” Obama said. “Everything there is to say about health care has been said, and just about everyone has said it.”
To not act, he said, would embolden insurance companies, cost more Americans coverage and delay a health care overhaul for a decade or longer.
Obama offers to include GOP ideas in health bill
WASHINGTON – President Barack Obama offered Tuesday to include four Republican initiatives in his health care bill, but GOP leaders were unenthusiastic as Democrats prepared a last big push to get legislation passed.
Obama is expected to signal today how he wants Congress to proceed. By telling Republicans he wants to incorporate some of their suggestions, Obama can argue that the Democrats’ approach is bipartisan regardless of whether any Republicans vote for it in the end – and few if any were signaling Tuesday that they’re inclined to do that.
The Republican ideas Obama said he’s considering – ideas that GOP leaders offered at last week’s bipartisan health care summit – include conducting undercover investigations of health care providers that receive Medicare and Medicaid reimbursements.
Another would provide $50 million to states to pursue alternatives to medical malpractice litigation, a major Republican initiative.
Obama reiterated Tuesday that he wants a comprehensive health reform bill, not a series of incremental steps. “Piecemeal reform is not the best way” to make coverage more affordable, he said.
Congressional Democratic leaders agree, and are seriously considering using the controversial “reconciliation” process to get the bill through Congress by the end of this month. It was unclear whether Obama would recommend that approach today.
Reconciliation is a way to expedite Senate passage of legislation with 51 votes instead of the 60 usually required to shut off debate. Democrats now control 59 seats in the 100-member Senate.
Under one popular scenario being seriously discussed by Democratic leaders, the House of Representatives would pass the health care bill that the Senate adopted Dec. 24. A simple House majority, which next week would be 216 votes, would be needed to pass. Democrats control 254 of the 431 filled seats; four seats will be vacant.
In addition, both houses would take up separate reconciliation legislation that would make changes to the Senate bill sought by Obama and House Democrats. That bill also would require only simple majorities in both chambers to pass.
However, that process could create political problems.
It would require the House to vote on an $871 billion Senate bill that includes ideas many Democrats dislike, notably the lack of any government-run program, or public option. The House-passed version had a public option.
The Senate version also contains somewhat less restrictive abortion language. About 20 House Democrats are adamant that any bill contain strict limits.
The other political problem concerns how Democratic lawmakers, especially those from more conservative states and congressional districts, would explain to constituents why they voted for a process that Republicans say is simply “ramming the bill through Congress.”
“I don’t prefer reconciliation,” said Sen. Joe Lieberman, I-Conn. “This is so big a change that affects every American. This ought to be bipartisan.”