Latest health care bill: Minnesota's House members like it and hate it

WASHINGTON, D.C. — Despite predictions by House Democrats that they will pass their new health-care reform legislation as early as next week, Minnesota's House delegation is giving the massive bill mixed reviews and at least one of its Democrats is strongly considering voting against the proposal.

The 1,990-page bill was unveiled with much fanfare and optimism by Democrats Thursday.

According to a preliminary analysis [PDF] by the Congressional Budget Office, the legislation's net cost would be $894 billion, it would cut the deficit by about $100 billion, and it would cover 96 percent of legal residents by 2019.

The House bill also now includes $20 billion in taxes on the sale of medical devices, one of Minnesota's largest industries.

While medical-device makers still consider the tax too high, it is substantially lower than the $40 billion fee included in the version of the health-care reform bill that passed out of the Senate Finance Committee.

Minnesota's U.S. senators have been working to have that fee eliminated or reduced.

The House's net estimate includes monetary penalties individuals and employers will have to pay if they don't comply with the new mandates. The CBO figures, however, leave out a number of other costs in the bill. (Go here for a breakdown).

The legislation would also launch a government-run public option that requires the government to negotiate rates with insurers like private insurance companies do. Liberals in the party had favored a plan that would have paid Medicare rates plus an additional 5 percent.

But on Thursday the Progressive Caucus indicated that while it wasn't giving up on a more "robust" plan, it was open to the negotiated-rate option.

The House bill also includes two Medicare payment studies that were key to winning some support from the Minnesota delegation. One study updates the Medicare reimbursement formula with new data and would take effect automatically. The second study, which would be subject to Congressional disapproval, develops a payment system that would reward quality of care as opposed to quantity of services.

Here's how Minnesota's House delegation reacted to the bill. (Most said their impressions were preliminary and that they needed to review the bill before making a final decision.)

Democratic Rep. Tim Walz, 1st District

"I think overall the process is moving forward," Walz said. "I think we're going to contain costs. I think places like Mayo and high quality places throughout Minnesota know that this has to happen, and I think this is good reform and good compromise.

"Of course, the part we were most concerned with was the value-based index and the change in Medicare, which I can't again stress how pleased we are that that's in there," he added. "We are comfortable, I think, with the negotiated rates on the public option.

"I am going to wait to give an unequivocal and 100 per cent answer until we read it all — until the manger's amendment and things. But I think we've negotiated transparently, openly and in good faith and told people what I need to see in this… [and] I think it meets our threshold."

Republican Rep. John Kline, 2nd District

"America's health care system needs reform. To accomplish that goal, the American people deserve a thoughtful, open, bipartisan debate about how best to bring down costs, expand access to coverage, and preserve the doctor-patient relationship," Kline said in a statement.

"Unfortunately, what Democrats are delivering is yet another government takeover of our health care system crafted behind closed doors. Like the plans before it, today's version of the legislation fails to bring down the cost of health care in a meaningful way, missing a critical opportunity to address the challenges faced by small businesses, individuals and families, and the American taxpayer… Today's proposal, like those that came before it, is a partisan power grab that fails to solve the critical challenges facing our health care system."

Republican Rep. Erik Paulsen, 3rd District

"Well, at first glance, it's like, 'new bill?' Looks like the old bill other than its twice as long and they added the $20 billion tax on medical devices, which really hurts a lot of Minnesota jobs," said Paulsen. "So, I'm concerned about that.

"These companies are trying to come up with the next best life saving technology. So, I think it's a real misguided approach because it'll raise costs for patients so I'm really concerned about that," Paulsen said.

Paulsen sent a letter to House Speaker Pelosi Thursday asking that she reconsider the tax on the medical device industry.

"This tax would negatively impact many of my constituents, both those employed in the medical technology industry and those patients who benefit from the use of medical devices," wrote Paulsen, who co-chairs the House Medical Technology Caucus. "Medical devices are the tools of modern medicine.  A tax increase on these devices is likely to be passed on in the form of higher prices, contributing to cost growth instead of encouraging the cost savings realized when new devices are developed and produced."

In an interview, Paulsen said he was also concerned about the cuts to Medicare Advantage.

"While I think this bill addressed more of the access side, it's not addressing health-care cost savings. I think we're kind of missing the opportunity."

And on the Medicare payment reform measures, Paulsen said: "Well, they have the study in there, which we worked on bipartisanly, and I think that's great. Unfortunately, I wish there was a little more meat to it."

Democratic Rep. Betty McCollum, 4th District

"I'm very excited that we have had a historical moment to make sure that everyone in America is going to be able to access affordable health care and that American families won't have to worry if they change a job, if a child is born with a pre-existing condition, or their insurance company is rescinding their insurance because the pubic option will be there as a safety net," McCollum said. "I am very, very pleased also that the geographic disparities [in Medicare payments] are addressed in this bill.

"I would have supported a more robust public option because it saves taxpayer's money, but if this is what we are going to explore first…"

McCollum added that changes could be made to the public plan in the future "if we find that we can have more savings for taxpayers."

Democratic Rep. Keith Ellison, 5th District

"I believe that a robust option, the Medicare plus five, is the best thing to do," Ellison said. "Actually, I believe single payer is the best thing to do. But if we don't have that, I think the robust public option is the best thing to do.

"It looks like it [the public option with negotiated rates] is an accommodation, but I'd like to see the proof that it saves the kind of money that a Medicare plus five would," Ellison added. "And if it doesn't, then, well, why are we doing it?

"I will say this, and I will say this repeatedly, we're doing better now than we have in 60 years working on health care. So, it really is cause to rejoice and I'm proud of the Progressive Caucus because… we're talking about which public option, not whether or not we're going to have a public option. So I feel very, very proud of the achievement of the Progressive Caucus.

"And I'm confident that we [the Progressive Caucus] are going to keep on fighting for the best we can for the American people. But let me tell you, when Social Security and Medicare were first passed, they did not cover the broad number of people that they cover today… so if we don't get all we want in this, it's not the end of the health care debate.

"I think Nancy Pelosi did everything she could do. She is a phenomenal leader, and again, you know, this thing ain't over yet… We are going to continue to push" for a public option attached to Medicare rates.

"We have yet to get the best we can get, so I am not going to settle for less, right? This thing is still in play so were not throwing up… we're still fighting."

Republican Rep. Michele Bachmann, 6th District

"I'm opposed to any legislation that attempts a sweeping government takeover of our health care system — whether they call it robust or not," Bachmann said in a statement. "What I've learned about this 2,000-page bill so far is that it includes a job-killing employer mandate, an individual mandate that requires Washington bureaucrats to define what kind of coverage is acceptable, burdensome tax increases, Medicare cuts, and a huge expansion of Medicaid that will break already strained state budgets.

"It's far too extreme and the wrong prescription for what ails our health care system.  What's more:  their claims that this bill stays under President Obama's arbitrary $900 billion price cap are based entirely on smoke and mirrors…"

"And I'm very disappointed that Republicans were not only shut out of the discussions on this important issue, but that it appears unlikely we'll even get an opportunity to try to amend this radical reform."

Democratic Rep. Collin Peterson, 7th District

"I am a pretty firm no," Peterson said. "I wish people would quit asking about the public option because it's not what the issue is. This is complete ideology run amuck. The issue is we are not reforming Medicare. We are adding more entitlements without being able to pay for the entitlements we have now."

On the Medicare-payment reform studies in the House bill, Peterson added, "There are not reforms there, it's a study."

"I mean. I have so many problems with this bill I don't even know where to start — too much government bureaucracy, not making the reforms that we need to make in the health care system overall.

"I don't think there's any way that I could support what they're doing unless they start over. That's how bad it is."

Democratic Rep. Jim Oberstar, 8th District

Oberstar said that he would support the public option with negotiated rates — and by extension the bill — only after he was confident that the Medicare payment reforms would actually work for Minnesota.

"I am not specifically confident [that I will support the bill] until I have seen the exact language on closing the [Medicare] reimbursement gap and I am waiting for in depth analysis," Oberstar said.

That analysis will include staff opinions as well as input from his district and health care providers.

Cynthia Dizikes covers Minnesota's congressional delegation and reports on issues and developments in Washington, D.C. She can be reached at cdizikes[at]minnpost[dot]com.