Missing: Reform Language, CMS Director and Bipartisanship
by: Kevin Phillips | posted July 1, 2010
“Our intent will not be to create gridlock. Oh, except maybe from time to time.”
– former Senate Majority Leader Bob Dole
I was in Washington, D.C. again last week making some Hill visits and gathering gossip. Most staffers freely admit it’s a time of gridlock – no cooperation on either side of the aisle means that even items up for a vote that would traditionally sail through unanimously are not assured of passage. If one party is for the legislation, then the other is simply against it. Fun times. Don’t expect any change of attitude before election day, November 2. Or more likely January when the 112th Congress begins and some leadership shifts (may) occur.
So what was the buzz last week on the House and Senate side? Here were the top five:
- The General swap in Afghanistan.
- The ongoing “Extender” bill debate.
- Guesstimates on how many seats the GOP will win in the House in November.
- The Kagan confirmation hearing anticipation.
- The Wall Street reform package.
That’s right, after months of healthcare dominating the agenda, it’s hardly a mention now. That’s not to say it’s completely off the map. The healthcare legislative gurus are still talking about it – and how they are going to survive fixing it.
You see, the healthcare reform bill (now law) that the Senate originally created was never supposed to become the actual law. It’s true – just ask those staff who wrote it. It was a framework, a starting point. It went just far enough that the Senate could gain the 60 votes it needed. The expectation was that the House would pass its own version. The two would meet and marry in Conference Committee where all the details would be hammered out and filled in to make a final version that could then be voted on and passed. Instead, you’ll recall, the House skipped a step and voted to pass the Senate version as is. Sure, they had a follow up “fix it” bill that made some tweaks, but the details of the main version were still largely undone.
That leaves us where we are today. The Senate bill that became law was, and is, full of blanks. Over a thousand references to “the Secretary (of HHS) shall…” without any further guidance on detail or resources. Passages that basically say “information to be filled in here later…” or “details to be provided…” Some paragraphs state facts and directions one way and then conflict in another. These blanks, ambiguities and inconsistencies are causing a bit of healthcare committee staff panic.
Over the next couple of years, there will efforts to rewrite and clarify what could literally be each paragraph of the 2,000+ page law. What’s top of mind on the list for those in House and Senate to correct? Changing the language that forces members of Congress and their staff (which is interpreted as office staff only) into the health plan options dictated by the law for the general public. It allows congressional committee staff and Administration staff, including those at all the federal departments, to stay on the federal plan. It was one of those ambiguities that didn’t get caught early on – and will soon be clarified one way or another (put all government workers on the federal plan, the choice of most in DC if they can get away with it, or put them all in the public exchange). It’s not surprising how the first fix is centered on the one that directly affects the staff.
Whether you’re for or against the healthcare reform law, we can agree the process and final result is certainly no way to run the government. And, it doesn’t make it any more efficient or productive to run your healthcare business when the parameters of the law’s details are so ill-defined for the foreseeable future.
p.s. If you’re waiting for “Repeal and Replace” to occur, stop. It’s a good campaign slogan for 2010, but won’t happen. Also, the “unconstitutional” charge by over 20 state Attorneys General, that won’t go anywhere either.
Back in April, President Obama nominated Dr. Donald Berwick to be the Administrator for CMS. As of this morning, there has been no movement on his confirmation. Despite endorsements from former CMS administrators and U.S. presidents, there is some trepidation among Hill healthcare staff on Dr. Berwick. Like most of Obama’s appointments, he has the academic credentials and requisite degrees and titles to impress. He is certainly seen as smart and qualified – some just aren’t sure he is qualified for this particular post at this juncture in reform. Insiders who have interacted with him say he isn’t well versed on Medicare and Medicaid. He also hasn’t run an organization of size before. The hope is he’ll be a strong advocate for quality and efficiency and put in place good lieutenants to oversee reform, enact policy and run their divisions.
Lastly, here is a picture of the front entrance of the Republican National Committee, a half block from the Cannon House Office Building and two blocks from the U.S. Capitol. Back in the days when I worked there, I’m certain that even we wouldn’t have gone this far.