I don’t take Peter DeFazio’s carping about the health care bill entirely seriously. But his substantive argument – that Democratic leaders took out a Medicare reimbursement measure that would have changed geographic disparities – could shift other members of the caucus:
“Unless they put that back in, I can’t support it,” Defazio said, referring to the medicare disparity fix. “This is under active discussion. They just decided yesterday morning they’re stripping this out. The senate budget committee staff deliberated for 20 minutes and it was out and our leadership was going to accept that. But a number of us involved in the quality health care coalition said that’s unacceptable and we’re not going to support the bill unless you fix this.”
The Medicare disparity fix seeks to normalize reimbursement rates across regions. It was particularly important to people in rural areas, whose doctors don’t receive as much money in reimbursement. My assumption would be that budget-counters determined that it cost too much to include in the reconciliation bill, although the Byrd rule was also flagged as a possibility.
But if you look at who’s remaining in the whip count, a lot of those members come from rural areas. If DeFazio doesn’t carry through on his threat, those other members – who are needed to pass the bill – might.
UPDATE: As expected, DeFazio has company on this, including Reps. Jay Inslee (D-WA) and Ron Kind (D-WI). Medicare reimbursement has been a key issue throughout this process. Caucus Chair John Larson says:
“Several members have expressed concerns,” Larson said. We’re continuing to meet on that and if we can’t fix it because of parliamentary procedure, we believe that there are ways to fix it in other legislation.”
So they’re asking for a leap of faith.
UPDATE II: Here’s how Speaker Pelosi handled this in her press conference today:
Q: There are a number of Members from states—there were corrections to Medicare disparities in the House bill that have been taken out. Mr. DeFazio, for one, from Oregon says that his state is getting nothing, they are being treated unfairly, and right now he is a “no” unless that is corrected. Is there any fix possible in the reconciliation package for states that feel they are being shortchanged on Medicare money?
Speaker Pelosi. Well, without subscribing to that representation that a highly respected Member of our Congress, Mr. DeFazio, made, there are signification ways to address the disparity issue in the Senate bill. But we do want the language to be closer to what we had in the House bill because that represented a compromise between those who have a legitimate concern about the reimbursement to their states being unfair—and they are—and also aligns with that the issue of wanting quality, not quantity, of procedures—and these sort of go together, but they can be dealt with separately—and those who say, yes, but we are dealing with large populations of poor people and cultural diversity and the rest.
So in any event, both sides of that discussion, which really have the same common interests, which was to have a fair reimbursement so that doctors would be available in all of the states, we are working on that language.
Q: He clearly is not satisfied.
Speaker Pelosi. Well, the point is that this is a big coalition. We had a meeting in my office yesterday that was, I don’t know, maybe 15 Members on one side or the other. But we have reached agreement before on this, and that was the language in the House bill. And I feel comfortable about where we are heading. But we are working on that.