As Congress attempts to transform the nation’s health care system, the support of Maine’s U.S. Sens. Susan Collins and Olympia Snowe is critical.
“When people are looking at the handful of senators who can make or break this vote, these two are clearly right there,” said Mark Brewer, a professor of political science at the University of Maine, in a recent interview.
President Obama has asked that comprehensive health care reform legislation be ready for his signature by the end of this year. That means the House and Senate must develop, debate and refine separate measures this summer and fall. The two bills must be passed in their respective houses and then merged in the contentious conference process. The resulting final legislation must be approved again by both bodies before being sent to the White House.
It’s a tall order on an ambitious timeline. Health care reform has not been attempted in any exhaustive way since a bitterly failed effort during the Clinton administration in 1993 and 1994.
Whether the reform can succeed this time is the subject of much speculation. But there is little dispute about the influence of Maine’s two moderate Republican senators. With 60 Senate votes needed to support whatever legislation emerges from the Senate Finance Committee, Collins and Snowe have a decisive role to play in ensuring its success.
“They tend to be fiscal conservatives,” he said, “but they don’t buy into the socially conservative wave of Republicans that started in the 1960s and became prominent around 2000,” making them pivotal to the passage and contents of health care reform legislation.
The 100-seat Senate currently is made up of 57 Democrats, 40 Republicans and two Independents, with one seat still open as a persistent dispute rages in Minnesota over the results of last November’s election. Though they hold a narrow majority, Senate Democrats are three votes shy of being able to override a Republican filibuster and carry politically divisive legislation on their own. That’s why Snowe and Collins played such a crucial role in the passage of Obama’s $787 billion economic stimulus bill in February — joined by Arlen Specter of Pennsylvania, who since has switched to the Democratic side of the aisle — as the only GOP lawmakers to support the measure.
And that’s why their support is seen as essential to the passage of meaningful health care reform, which, like the stimulus legislation, threatens to fracture along party lines despite broad bipartisan agreement that the nation’s current system is unacceptable.
And while the much stronger Democratic majority in the House of Representatives essentially assures passage of a liberal-leaning reform bill from that body, Maine’s Democratic representatives Michael Michaud and Chellie Pingree have strong feelings about what the package should contain.
Earlier this week, as Congress prepared to break for the weeklong July 4 recess, the four members of Maine’s congressional delegation found some time to share their national health reform activities and aspirations with the Bangor Daily News.
Snowe, ‘the Dealmaker’
Snowe serves on the powerful Senate Finance Committee, where the primary health reform legislation, including its astronomical cost, is being hammered out. Snowe also has been named to a smaller bipartisan group within the committee, charged with maintaining the momentum and focus of the reform. She frequently is referenced in national media reports as leading the contentious roundtable talks and was named “the Dealmaker” in a recent Time Magazine story about major players in the health care reform process.
This week, Snowe described activity in the Finance Committee room as “hectic” as members grapple with the complexity and interconnectedness of the U.S. health care system. The committee meets at least daily, she said, often with representatives of insurance, pharmaceutical, medical, hospital and consumer interest groups.
“We all want to do the right thing and provide universal access to health care,” Snowe said. “But we are concerned about the complexity of the legislation we’re crafting and the cost.”
Montana Democrat and Finance Committee Chairman Sen. Max Baucus aims to bring the bill in at $1 trillion or less over the next 10 years. It’s a mind-boggling price tag, but significantly lower than the estimated $1.6 trillion impact of a competing measure under development in the Health, Education, Labor and Pensions Committee, chaired by ailing Democratic Sen. Edward Kennedy of Massachusetts.
While some pieces of the health reform legislation — such as the need to more tightly regulate insurance companies and to change some physician reimbursement formulas — are falling into place, others remain elusive.
Snowe is the only Senate Republican so far to support the idea of including a “public option,” a government-run insurance program that would compete with private insurers to offer affordable coverage to the estimated 47 million Americans who currently have none.
Snowe has termed the public option — championed by most Democrats and the centerpiece of the proposal developed in Kennedy’s committee — a “last resort” solution. This week, she said the public option should be included in the legislation but only implemented if private insurers fail to provide an acceptable array of plans — including ones that offer a baseline of essential services and are affordable for lower- and middle-income Americans.
“We [lawmakers] will define affordability,” Snowe said. “There will be no wiggle room.”
One accepted corner post of the reform is increased regulation of the health insurance industry. That means, among other things, limiting or eliminating insurers’ ability to refuse coverage on the basis of an individual’s health status or pre-existing conditions, how much premiums can increase for those who use a lot of health care services, the “lifetime cap” on benefits and more.
Snowe said stronger regulation is needed to hold insurers’ feet to the fire.
“We are not depending on private insurers and hoping this will work,” Snowe said. “We intend for it to work.”
The insurance industry, which historically has resisted such regulation, has shown itself to be more amenable now — in part due to the likelihood of another prospective corner post of the reform: mandates requiring all employers to provide insurance, or all individuals to purchase it, or both. This guaranteed boom in their business means insurers are willing to swallow a degree of regulation they might have choked on in the past.
But they are lobbying hard against the public option, which, as a de facto nonprofit agency, would compete aggressively for their customers. And with the single exception of Olympia Snowe, Republicans are backing them up.
Collins: ‘wary of rushing’
Collins, too, meets daily with congressional colleagues and interest groups to discuss proposed health care reform. While she recognizes the urgency of the situation, she said this week she is not persuaded that Obama’s timeline is realistic.
“This is a big challenge. Health care affects every single person in our country and represents one sixth of our economy,” she said. “I am wary of rushing a bill through in the next month rather than making sure the decisions are well founded.”
Collins has strong reservations about the public option, referencing a recent study predicting that as many as 119 million Americans might switch from private coverage to the public plan, potentially causing the collapse of the private insurance sector.
“We want to hold on to what is good about our system and improve what isn’t working,” she said.
Collins said the health care reform bill must address a number of interconnected issues, including the need for more emphasis on wellness and disease prevention, the growing shortage of doctors and other medical providers in rural areas, changing models of reimbursement and liability, and measures to improve end-of-life care and the management of chronic illnesses such as diabetes and heart disease.
Collins said she opposes the idea of an employer mandate. “Most employers want to provide health care coverage,” she said. “If they’re not doing it, it’s because they can’t afford to.” Collins favors providing tax credits to small businesses that do offer insurance, tax credits to employees who purchase it, and subsidies to lower-income workers who need help affording coverage.
Of the estimated 47 million Americans who do not have health care coverage, Collins said, 9 million earn more than $75,000 a year and are uninsured “by choice.” Collins said she still is undecided as to whether this group should be required to carry at least catastrophic coverage so their unpaid medical bills don’t get shifted to other Americans.
A more Democratic House
In the House of Representatives, Rep. Michael Michaud of Maine’s second district said he is “not wedded to [Obama’s] time frame; I’m wedded to the idea that we do what is right for the country.” As a fiscally conservative “blue dog” Democrat, Michaud said, one of his primary concerns is how much the health care reform will cost and how it might be funded.
He is opposed to taxing employer-sponsored benefits, one idea that has been floated.
“Businesses are having a hard enough time providing coverage for their employees,” he said. “It would be going in the wrong direction to tax businesses.”
Like the No Child Left Behind education initiative endorsed by the administration of George W. Bush, the health care reform legislation runs the risk of being an unfunded mandate to the states, Michaud said. Another concern is that, by trying to please too many industry and political interest groups, the national health care reform may not amount to much.
“But we would still pat ourselves on the back and say ‘We reformed health care,’” he said with chagrin.
The newest member of Maine’s congressional delegation, Rep. Chellie Pingree, said reforming the nation’s health care system is “the number one issue” for her constituents. “When I run into old friends or complete strangers in the supermarket, they all say, ‘You’re really going to do something about health care this time, aren’t you?’” she said. “People feel they have been brought to the edge. They really want us to do something now.”
Pingree said she remains interested in a national, government-run single-payer plan — sometimes called the ‘Medicare for All’ model — but acknowledged the concept has little political support.
“Given that the insurance and pharmaceutical companies are focusing on getting rid of even the public option, we’re working just to keep that option on the table,” she said.
The more limited public option, allowing people to choose between private and public coverage, would promote negotiation with drug companies for lower prescription prices, she said, as well as providing more “transparency” about operating expenses, benefits and other financial information.
“I’m surprised any lawmaker would oppose it,” Pingree said. The House will pass legislation that includes the public option, she predicted.
With a week of summer vacation ahead, members of Congress will have a few days to cogitate on the momentous decisions ahead. After the break, they’ll be back on the fast track, trying to craft comprehensive health reform that will improve, streamline and make more equitable the nation’s health care system.