Capitol Hill Report: The Public Plan Food Fight

June 15, 2009


By Mike Amery, Legislative Counsel, Federal Affairs, (202) 349-4299,

The mission of the Academy is to be "indispensable to its members." One way the Academy fulfills this mission is by representing of neurology in the halls of Congress. Capitol Hill Report presents regular updates on legislative action and how the AAN ensures that the voice of neurology is heard on Capitol Hill. The Academy's legislative counsel in Washington, DC, Mike Amery, offers weekly updates on advocacy for neurology and neurologic concerns.

Update: June 17

The Senate Finance Committee was scheduled to release a health care reform bill this week and hold a markup of the bill next week. The Congressional Budget Office scored the bill at $1.6 trillion. They were hoping for a score of $1 trillion.

Because of this, the committee has delayed the markup until after the July 4th recess.

Update: June 16

President Obama’s speech was well received by the AMA House Delegates. While specific details have not been released, he said the public health plan would not be designed to lead to a single-payer health care system.

Read the president’s speech to the AMA.

I have mentioned for the last several weeks that the line in the sand on health care reform is the "Public Plan." The issue is whether the federal government will initiate an insurance option to compete against private insurance health care plans. The rhetoric got louder this week as health care reform plans come closer to being released.

First, President Obama came out strongly in favor of a public plan saying that it will lower costs and is "necessary to keep insurance companies honest."

The Senate Health, Education, Labor and Pensions Committee (HELP), chaired by Sen. Ted Kennedy (D-MA), released a draft of proposals that was immediately labeled a "partisan plan" by Senate Republicans, who, in turn, are pinning their hopes on a bill by the Senate Finance Committee. In that body, Chair Sen. Baucus (D-MT) and Ranking Member Sen. Grassley (R-IA) work much more closely across partisan lines. However, even in the Finance Committee things are falling apart in advance of the release of draft bill. Sen. Grassley said that a public option was a non-starter and led nine committee members to send a letter to the President opposing a public plan. On the Democratic side, Sen. Baucus's staff was accused in Roll Call, a Capitol Hill newspaper, of intimidating health lobbyists by threatening to shut them out of the process if they discuss the bill with Republicans!

In the US House, where the Democratic majority can act without Republican support, passage of the public plan should be easy, but even here problems are arising. The chairs of the committees of jurisdiction over health care are committed to including a public option. But just when they thought the Democratic Caucus would all come together, a group of 40 fiscally conservative Democrats (known as the "Blue Dogs") broke off by saying they wouldn't support a public plan. This reinvigorated the Republican Caucus, who all appear to be unanimous in their opposition. My conversations with three Republican House members last week made it clear to me that Republican talking points are circulating on the Hill. Paul Ryan (R-WI), Phil Gingrey (R-GA), and Tim Murphy (R-PA) each told me the exact same thing: a public plan will lead a single-payer system by driving out private insurance.

So where is medicine in this? First, the American Medical Association (AMA) was against a public plan, and now they are for it—or at least they are willing to talk about it. A New York Times article last week ("Doctors' Group Opposes Public Insurance Plan") gave the impression that the AMA was opposed to a public plan. The AMA then released a clarification, saying:

Make no mistake: Health reform that covers the uninsured is AMA's top priority this year. Every American deserves affordable, high-quality health care coverage.

Today's New York Times story creates a false impression about the AMA's position on a public plan option in health care reform legislation. The AMA opposes any public plan that forces physicians to participate, expands the fiscally-challenged Medicare program or pays Medicare rates, but the AMA is willing to consider other variations of a public plan that are currently under discussion in Congress. This includes a federally chartered co-op health plan or a level playing field option for all plans. The AMA is working to achieve meaningful health reform this year and is ready to stand behind legislation that includes coverage options that work for patients and physicians.

I wonder what the position will be after President Obama addresses the AMA House of Delegates in Chicago on Monday, June 15? We'll know more next week!

Read all of Mike Amery's reports on the Capitol Hill Report page.