The Delta Grassroots Caucus (DGC) is a broad coalition of grassroots leaders in the eight-state Delta region. DGC is also a founding partner of the Economic Equality Caucus,
which advocates for economic equality across the USA.

Rep. Ross & other Delta Leaders Play Key Role in Health Care Debate

Posted on August 03, 2009 at 11:29 AM

Health care is tremendously important for all regions of America, but even moreso in the Delta, which suffers from soaring rates of diabetes, obesity, heart disease and other maladies that are a constant burden to economic recovery and all other forms of progress. Rep. Mike Ross (AR) and other Members of Congress from the region are playing a key role in this debate, and we would like to provide some information on this issue.

Rep. Ross has received extensive national media coverage because of his leadership role with the Blue Dog Democrats, who are strategically situated to influence health care reform because they hold 52 seats in the House, as well as seven seats on the Energy and Commerce Committee, one of the crucial committees for the health care bill. Ross was the lead negotiator on behalf of the crucial Blue Dog group on Energy and Commerce Committee, which recently approved the health care bill in an action that the White House praised as a “big positive step forward that gets us even closer to comprehensive health care reform.”

At the Delta Caucus annual conference in Washington, DC on Sept. 15-16, you will have an opportunity to hear Rep. Ross (AR), Rep. Charlie Melancon (LA), Rep. Jerry Costello (IL), Rep. Travis Childers (MS), sn. Thad Cochran (MS), Sen. Mary Landrieu (LA), Sen. Blanche Lincoln (AR), and Sen. Mark Pryor (AR), among other Members of Congress as well as Obama administration officials, on these issues.

Need for a reasonable compromise: Given the controversial nature of this debate and the many points of view involved, it will be highly beneficial to arrive at a compromise that most people find acceptable. We believe that Congressman Ross is trying to work out a compromise and would encourage him to continue in that constructive role. Some people have erroneously described Rep. Ross as “opposing” health care reform. Rep. Ross actually played a key role in getting the Energy and Commerce Committee to approve the health care reform bill, with the final tally being a close 31 to 28 vote for approval. Five Democrats joined all the Republicans on the committee in voting against the bill. At the moment, the debate seems to be headed in the direction of a reasonable compromise, but there is still a long way to go.

Among the changes that led to the committee’s approval were: an agreement to cap increases in the cost of insurance that would be sold under the bill, and a provision to give the federal government authority to negotiate directly with drug companies for lower prices under Medicare. One of Rep. Ross’ major concerns was to address the problems of rural hospitals, which are under great financial stress. This concern is obviously valid and of great importance to the Delta. Ross emphasized concerns about preventing health care reform from increasing the federal deficits.

Rep. Ross is of course not the only Member from the Delta who will have an important role on health care. Rep. Marion Berry is a pharmacist and thus brings his professional expertise to the debate, and Sen. Blanche Lincoln is on the Senate Finance Committee and is playing an active role. Senators Mary Landrieu (LA), Thad Cochran (MS), Mark Pryor (AR), Claire McCaskill (MO), Rep. Jo Ann Emerson (MO), Rep. Charlie Melancon (LA), Rep. Bennie Thompson (MS), and many others from the region will play key roles. We focus here a good bit on Rep. Ross because he played a crucial role in the recent passage by the Energy and Commerce Committee and is a key leader of the Blue Dog Democrats.

TIMING ISSUES: One of the key concessions that Ross and the Blue Dogs won from Chairman Henry Waxman (CA) was a delay on a House vote on health care reform until at least September. Ross and others had contended that they would like to discuss these complex issues and listen to constituents during the August recess. The Obama administration had asked for the legislation to be voted into law by August. Provided that health care reform is completed in the fall and we do not see a series of delays that leave us with no bill by the end of the year, it makes sense that some more reflection and debate would be beneficial. In the long run it will not matter whether the bill was passed in August or September, but it is of tremendous importance to get it right when developing such a historic reform.

We should also recognize that this bill is now of phone book-sized proportions. The Members of Congress need time to actually read it and study it. We could also use some time to repudiate some of the scare tactics and nonsense that are being bandied about in certain quarters, and we will mention those below.

We might not agree with all of the positions of Rep. Ross, or the White House or of the opponents of the bill. We do appreciate the efforts of Rep. Ross, the administration and the Congressional leadership to develop a compromise and move forward with health care reform.

These are tremendously complex issues, so this message cannot hope to deal with all of them. This is just some analysis of some of the crucial issues. Here are a few key provisions of the bill:

–The bill requires insurance companies to sell coverage to everybody who seeks it, without exclusions for pre-existing medical conditions.

–The provision barring insurance companies from denying coverage to people with pre-existing conditions is one of the key parts of the bill.

–The federal government would provide subsidies to lower-income families to aid them in affording policies that would otherwise be beyond their ability to purchase.

–The bill would set up exhcnages where consumers–including those with and without subsidies–could evaluate different policies and select the one they prefer.

–The main increase in coverage does not come until 2013, after the next Presidential election.

Among the changes that led to committee approval were an increase in exemptions for small businesses required to provide health care coverage to employees by doubling the payroll threshold to $500,000. Subsidies wre reduced in the section aiding low income families to buy insurance. Overall costs were reduced by about $100 billion.

The bill allows states the option of establishing their own health care cooperatives and requiring states to pay for a portion of Medicaid expansion. The government would be required to negotiate payment rates to doctors and other health care providers, just as private insurers have to do, instead of basing it on Medicare reimbursement rates. The provision applies to any public health insurance option that would be included in the final bill.

Rep. Ross’ valid concern about rural providers: There is no question that rural providers in underserved areas like the Delta are under tremendous strain. Rep. Ross is right on target in urging greater parity in payment rates to rural providers. Ross said, “In Arkansas, private insurance companies typically reimburse 20 percent more than Medicare.” He said that without the changes regarding payment rates to rural providers, “What would have happened would be rural hospitals would be forced to close because, as we all know, they’re barely hanging on.”

Concerns about rural hospitals transcend ideological concerns about what is “liberal” and what is “conservative.” For those allegedly “liberal” urban Members of Congress who apparently show little concern for underserved rural areas, that is not a liberal position, since “liberals” are people who are supposed to be concerned about the plight of lower to middle income working people, wherever they happen to reside. We need to look at this reform to include the entire country and avoid divisions such as “urban vs. rural” or “liberal vs. conservative.” The Delta region includes New Orleans, Little Rock, Memphis, Jackson and other urban areas, so we are not exclusively concerned about smaller cities and rural areas. But concerns about the rural hospitals that are barely surviving are legitimate and ought to be recognized by everybody.

Sen. Lincoln is a member of the Senate Finance Committee and has made favorable comments about the House Blue Dogs. Lincoln was a founding member of the Blue Dogs when she served in the House of Representatives. She endorsed the Blue Dogs’ concern about assuring that health care reform does not worsen the deficits.

We would encourage Rep. Ross, Sen. Lincoln and others to keep working in a constructive way to create a bill that most people will agree with. On such a controversial set of issues, not everyone will support the reform, so the goal should be to develop as broad a majority consensus as possible.

Choice remains a key element of the plan: Among the helpful comments that Rep. Ross made on the bill were his statement that the bill assures “that a public plan will not be forced on anyone and will negotiate rates directly with providers, competing on a level playing field.” This comment is helpful in refuting some of the scare tactics that have been utilized by opponents who have denounced the bill as a socialistic “government take-over of health care.” As Rep. Ross indicated, there will not be any plans forced on anyone and individual choices will remain.

Rep. Ross has to take into consideration the many conservative elements in his district, as well as the tremendous health care needs in Arkansas and the nation. There are also some more traditional Democrats in his district as well, so he obviously has a very difficult challenge in tacking these issues, as do the other Members of Congress. He will obviously be expected to continue to apply constructive pressure to reflect his constituents. We would encourage him to see his role as modifying the bill to assure its eventual passage, and many of his comments tend to reinforce that view of his activities, such as his comment that “We have a historic opportunity to transform our health care system.”

Scare tactics and misinformation need to be repudiated: One of the most ludicrous scare tactics is a campaign on radio shows warning that the health care bill will lead to “death care,” “end-of-life rationing,” an effort “to kill Granny,” and “euthanasia.” Unfortunately, Minority Leader John Boehner (Ohio) contributed to this misinformation by staing that the bill “may start us down a treacherous path toward government-encouraged euthanasia.” These comments are distorted and erroneous.

The proposal in question would pay physicians who counsel elderly or terminally ill patients about what medical interventions they would prefer near the end of life, as well as assistance on how to prepare instructions such as living wills. Medicare would reimburse doctors for one session every five years to consult with a patient about their wishes and how to assure that their choices are honored. The counseling sessions would be voluntary.

President Obama recently answered questions about this provision by making a series of positive comments about living wills, noting that he and the First Lady have them. How did we get from a voluntary provision to promote living wills and other such thoughtful planning, to the hysterical comments about “death care” and “euthanasia?”

I recently had my parents agree to living wills, which are highly useful documents that prevent massive costs in artificially preserving life by connecting terminally ill and unconscious patients to machines, but more important is the dignity issue. My parents said they do not want to “be a vegetable kept alive by machines and tubes.”

Many thoughtful analysts of this debate see the key issue as not so much saving health care costs, but the quality of life it tends to promote. According to Tia Powell, director of the Montefiore-Einstein Center for Bioethics, extensive research has demonstrated that “The good news is if you get people in an environment that is of their choosing, where there is supportant and they have good pain control, it is very likely to extend their life.”

This provision is voluntary and expands choices. Nobody has to go to the counseling. For those who use the counseling, no one is required to agree to anything.

A possible counter-argument that is valid might be that this is a relatively less important provision of the bill, and we might not want to get caught up in a debate about what to do regarding people in a vegetative state, as in the Terri Schiavo case. That is a judgment call, and if this provision needs to be left out to assure final passage, that might be reasonable. On the other hand, if a majority of people study it and find it useful, why not include it.

There are different points of view on this. I would say encouraging actions like living wills is useful. Others might just as logically say that if we need to jettison this provision to assure overall passage, then we need to do so, because it is not at the heart of the reform package. The fundamantal reality that everybody should agree upon is that the scare tactics about efforts to “kill Granny” or provide “death care” have no place in an intelligent debate on one of the most vital issues facing America today.

We will continue to monitor the health care debate, which has such tremendous implications for the Greater Delta Region. Lee Powell, director, MDGC (202) 360-6347