Health Care Reform: Digging Out From “Paralyzing Snow”

The blizzard of 2010 tamped down the attendance during the annual Academy Health meeting in Washington DC February 8.

Attendance was about half of what it would have been after the paralyzing snowstorm (official weather term!) that dumped 20-30 inches in the DC metro area. Still, that’s a pretty good crowd all things considered. Health policy is clearly still a hot topic in Washington despite the blanket of snow.

The blizzard also gave HHS Secretary Kathleen Sebelius a perfect analogy to kick off a discussion of the status of health care reform during her opening keynote.

She complimented the organizers for staying the course, saying she had sympathy for those who work hard for months on end to put together a large and important endeavor—only to have 30 inches of snow fall the day before the meeting is scheduled: “Kind of the like the Massachusetts Senate election and health care reform.”

Sebelius noted the value of taking a moment to regroup, reconsider—and then made the case for pushing ahead. “I am confident there will be a comprehensive health care reform bill” signed into law this year, she predicted.

Sebelius did not extend the analogy any further, but we will. Blame the cabin fever if you must, but here is our list of nine ways that reviving health care reform is like digging out after a blizzard.

(1) Digging out is hard work: Our aching backs can testify to that, as can everyone on Capitol Hill, in the White House, and in the assorted lobbying operations on K Street as they try to figure out how to muster enough votes somewhere, somehow to get a health care bill through.

Sebelius noted that fact by repeating Obama’s comments from the State of the Union address that the Administration didn’t take on health care reform because it was easy. Republican Hill staff the second day read the most recent polling data, suggesting that the portion of the population who likes the pending bill is 15%-20% less than the portion who disapprove.

It is not going to be easy to get this done.

(2) Piecemeal Approaches Don’t Work: Plowing half a street does no one any good. (Are you listening, DC government?) Similarly, Sebelius made clear that ideas for piecemeal reform aren't going to fly. The President remains “as committed to
comprehensive reform as ever,” she said. As a practical matter, you can’t cherry-pick reform: “the pieces are too intertwined.”

For example, Sebelius said, it is disingenuous at best to support health insurance reform without also supporting some form of mandate to prevent adverse selection.

Hill staff said the same thing (at least on the Democratic side): the pieces of reform are too interdependant to tease apart.

Republicans remain game to try—but they probably won’t get their chance this year.

(3) Getting around takes fancy footwork: Lot’s of twisted ankles and bumps and bruises in DC; avoiding a spill takes the grace of a ballerina and the balance of gymnast. Same with passing a comprehensive health bill at this point.

Here is the pathway people are currently talking about:

Step 1: The House passes a bill intended to fix the Senate bill. (Under the Constitution the House must originate all spending bills.)

Step 2: The Senate passes the fix-it bill via the reconciliation process. (Only 50 votes needed, but provisions must have budgetary impact—no policy fixes allowed!)

Step 3: The House then passes the Senate comprehensive reform bill already passed by the Senate on Christmas Eve.

Step 4: The President signs the comprehensive bill first, then the fix-it bill. The order is key: that way the fix-its replace the Senate’s language, even though the fix it passes first.

Simple, right?

(4) Snow Days Can Bring People Together: There is nothing like walking down the center of Connecticut Avenue with dozens of neighbors desperately seeking an open Starbucks to build a sense of community. While we haven’t seen a similar spirit of comity follow the Massachusetts election result, it isn’t for lack of trying (or at least trying to look like you are trying). Obama’s latest initiative is to invite the Republicans to a White House summit to exchange ideas on February 25. Hey, maybe we can all get along.

(5) Sunshine Helps: That has always been DC’s default snow emergency plan. In health care reform, it means the Feb. 25 meeting will be televised. That may help, at least as Sebelius sees it. While Americans may be “sometimes disgusted” by the legislative process, most, Sebelius says, support the “common elements” of the House and Senate bills (though she didn’t elaborate on exactly what those elements are). Perhaps a televised event focused on the substance of the bills will help re-engergize reform.

Oh, and by the way, the summit is supposed to be Feb. 25, coincidentally the same day we will be discussing the impact of health care reform on business development during BIO/Windhover’s Pharmaceutical Strategic Outlook conference in New York City. We are far too humble to suggest which will be a more valuable way for you to spend your time—but its not too late to register for PSO…

(6) Goodwill Only Goes So Far: Based on DC’s experience, we now believe the Hatfield/McCoy feud was triggered when a Hatfield parked in a spot previously shoveled out by a McCoy. It gets ugly fast. Same with this summit idea. Sebelius stressed that the goal of White House meeting is not to start over on reform.

Which kind of begs the question of what is the goal. We offer one theory in The RPM Report: It is an attempt to apply a trick Obama learned on the campaign trail.

Sebelius certainly did little to undercut Republican suspicions that the goal is just to make them look bad. Obama wants to discuss ideas with the Republicans, she said, adding in almost the same breath: “It is not acceptable that half of the legislative body pushed away from the table” rather than negotiate a bipartisan bill.

Republicans, of course, see it differently, with their leadership suggesting that it is exclusion by the White House that led to an all-Democratic bill.

Sebelius did make one point that could resonate in the months ahead. “For a long time,” she observed, “the so-called public option was the issue,” with many in Congress saying they couldn’t support a bill with that included. “As far as I can tell, the public option is no longer part of the legislation,” she added, “but no one came back to the table.”

Which leads to our next point:

(7) Snow(e) Isn’t All Bad: As the path to reviving health care reform continues, it is worth remembering that there is one Republican who voted for one of the bills: Maine’s Senator Olympia Snowe voted in favor of the Finance Committee bill, though she joined all her GOP colleagues in opposing the version of the bill that came to the Senate floor. If the bipartisan revival works, it will almost have to involve Snowe.

(8) There is More Snow in the Forecast: Literally true for DC, a fact that Sebelius joked about at the end of her talk—using it to invite the assembled crowd to stay engaged on health policy in the weeks, months and years ahead. Metaphorically, we know that there are bound to be yet more wrinkles in this process before it finally ends, one way or the other.

But it will end. After all…

(9) Spring Will Come...Eventually: Right now we understand the hope is to revive the process and get a bill to the President before Easter recess.

Maybe I will be able to see my driveway by then...