AUGUSTA, Maine — While they agree on the goal of health care reform, members of Maine’s congressional delegation are divided on how to achieve reform and what it should look like as Congress returns to work.
For example, Democratic Rep. Chellie Pingree hopes a strong public option is part of the final bill. She said it is needed to make sure insurance companies work with the new system, not against it.
“There needs to be a very strong patient bill of rights, something that protects seniors and closes the doughnut hole,” she said last week. The doughnut hole is the current gap in prescription drug coverage by Medicare.
A public option like the one in the House-passed bill would lose the votes of Maine’s two Republican senators. But the process that will be used to pass a final bill may not need 60 votes in the Senate, and with the Democrats with a solid majority in both chambers, the GOP may have little to say in the final bill.
“I am very concerned about the process that is being used, and its lack of transparency and accountability,” Republican Sen. Olympia Snowe said last week. “The president has called me and solicited my views on the bill, and he appears to be more involved in the negotiations this time, but we will have to wait and see what is in the final bill.”
She said how the measure will be paid for is a major concern. She also said that during the break she has been working to make sure the final bill is affordable for businesses and individuals.
“I have heard clearly from small-business owners their concern about a mandate that is not affordable,” she said. “I have had meetings around the state and there are a lot of concerns.”
It is not just Republicans who are concerned with both the process and the substance of the legislation. Rep. Michael Michaud, a Democrat, said last week that his vote for the House bill last month does not mean he will vote for a final bill that is crafted “behind closed doors” and he has several specific provisions he wants included in the final measure.
“I am working with the Ways and Means Committee and this administration to try to get Maine classified at the Boston market rates,” he said.
Michaud said the current reimbursement rates for Medicaid and Medicare hurt rural states like Maine. For example, he said, moving Maine to the Boston rates would mean nearly $100 million more a year in federal payments to Maine hospitals, reducing the shifting of costs that occur to private insurers. He said that would make all health insurance more affordable.
“I am also concerned about how this will affect small businesses and Maine families,” he said. “It will have to be deficit neutral.”
The House and Senate bills differ significantly in how they are funded. The Senate measure has a wide array of taxes on medical equipment and so-called “Cadillac” health care insurance policies. The House measure would impose higher income tax rates on the very wealthy.
“I want to see more emphasis on controlling health care costs,” Republican Sen. Susan Collins said. “There are not enough efforts to hold down the increasing costs that are a major problem. This bill needs a lot of changes before I could vote for it.”
She agreed with Snowe that the public is the loser as the Democrats have decided to craft the final bill “in secret” and not allow the full participation in the process by all lawmakers. She agreed with Michaud that changes in the Medicaid and Medicare reimbursement process could have a huge impact on Maine.
“I don’t think the way to pay for the bill is to slash Medicare, as the bill does,” she said. “There could be savings in Medicare if you implement some quality improvement measures that reward outcomes, not just volume of care, but that is not what this bill does.”
Collins said as lawmakers struggle to find ways to pay for health care reform, they need to look outside of the health care area. She said one source of billions of dollars would be to stop or reduce subsidies to farmers not to grow certain crops.
There is also disagreement on how to provide affordable insurance coverage to individuals. The House bill would create a national exchange where the self-employed could shop for coverage. The Senate bill creates statewide exchanges.
The bills also treat young adults differently. The so-called “young invincibles” are the largest uninsured group in the country. The House allows them to stay on their parents’ policies longer, while the Senate would create a high-deductible option for those under 30.
Democratic leaders in Congress have yet to announce the details of the final bill, but that could occur this week.