So much attention has been placed on the Senate today that we have neglected the movement on health care in the House. For the moment there hasn’t really been any. Last Friday the Speaker held a caucus where members had to publicly discuss their positions on health care and what bills they would support. Nancy Pelosi appears to still be a few votes shy of the 218 needed for a robust public option tied to Medicare + 5% rates, but she is confident that some manner of public option will easily pass her chamber. None of this has really reached a conclusion yet.

We are starting to get some details about that caucus meeting, however. House aides have begun to point out members who stated their desire to vote against ANY health care bill coming out of the House, not just a bill with a strong public option. Among the two more surprising names on that list? Steve Kagen (D-WI) and Larry Kissell (D-NC), both of whom received a decent amount of netroots support when first elected to Congress (Kagen in 2006, Kissell in 2008). Both represent swing districts and both presumably feel jittery about passing a House health care bill and feeling the wrath of conservatives back at home.

Steve Kagen’s spokesman, Jake Rubin, believes I’m mistaken. “Your source may have told you half of the story.” Rubin said that Rep. Kagen, a doctor, doesn’t support a bill unless it includes all of his 10 essential elements of health care reform. Rubin highlighted Kagen’s insistence that no discrimination in any access to health care, which for the most part has been accomplished in the bill. In fact, a good bit of these 10 essential elements are part of the House bill. Other parts are “open to interpretation,” and that will be where Rep. Kagen makes his determination on the bill, Rubin said. Rep. Kagen was part of the “Quality Care coalition” which extracted a concession from Speaker Pelosi on rural reimbursement rates for Medicare doctors and hospitals, so that may be an additional factor. “Rep. Kagen’s stand is consistent with where he was three years ago when he was elected to Congress,” Rubin said.

Others are not so sure. A House aide working for a progressive member tells me that Kagen has commented repeatedly on “value-based reimbursement,” in other words moving away from fee-for-service medicine, which tends to give doctors a financial incentive to call for more tests and more treatment, driving up costs. There are substantial pieces of delivery system reform in the bill, though perhaps not to Kagen’s specifications. “It’s unconscionable to use that as a veto,” the aide said. “Except for the public option, there’s nothing objectionable here that should cause anything in favor of reform to vote against the bill.” As the aide put it, this is something of a fig leaf, to pick the fee-for-service issue as a cover for not wanting to take a tough vote in a tough district. It’s certainly possible that this is a principled argument, and with Kagen being a former doctor he may have strong views on the subject. But there is some disconnect between such a stand, the fact that the bill includes many of these delivery system reforms, and the swing district in Wisconsin that Kagen represent. It’s certainly worth being suspicious of tangential arguments from people who claim to be supportive of reform.

As for Kissell, he’s a “fair-weather Dem at best” who is “looking for a way out” on this bill, according to the aide.

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