Conservative Democrats Push for Health Reform Bill Changes

Janice Simmons, for HealthLeaders Media , July 13, 2009

Democrats are working to create healthcare reform legislation that could be approved quickly within several weeks in the House and the Senate before the summer recess. However, on the way, the committees have been sidetracked by forks in the road, which have slowed them down as they discuss and evaluate how—and who—should pay for the reform legislation.

In the House, the tri-committee reform bill that was expected on Friday could be introduced as early as today, with amendments added later. The delay came when the self-described group of fiscally conservative Democrats, nicknamed the "Blue Dogs," pushed for changes in the draft bill late Thursday. Among their requests were:

  • Deficit neutrality, or finding savings within the current delivery system and "maximizing the value of our healthcare dollar before we ask the public to pay more."
  • Delivery system reform, or encouraging ways to promote innovative delivery system reforms, such as value based purchasing and the value index to realign incentives to promote high quality, efficient care.
  • Small business protections, or support efforts to address the challenges faced by small businesses.
  • Rural health equity, or addressing underlying problems and inequities that plague rural providers. A strong rural package is critical to the Blue Dogs' support, they said.

Tax on benefits
One of the House tri-committees—the House Ways and Means Committee, which is chaired by Rep. Charles Rangel (D-NY)—proposed a tax on those earning more than $350,000 per year. This would raise $540 billion over 10 years. The tax, as proposed, would begin in 2011.

Whether that is something the president would agree to remains to be seen. Appearing on CNN on Sunday, Health and Human Service Secretary Kathleen Sebelius said the president indicated that he wanted to pay for the healthcare reform through targeting healthcare savings in the system and capping itemized tax deductions in the higher income brackets.

"I think the bottom line is, it's got to be paid for," Sebelius said. "We all need to play a role."

On the Senate Finance Committee side, efforts were still continuing to find ways to pay for healthcare reform. While it seemed to be a popular idea before the July 4 break, the committee may be backing away from taxing employee health-related benefits, specifically for those in the upper tax brackets.

Also, the idea to raise taxes on sodas and sugary drinks appears to have lost momentum as well.

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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