Capitol Hill Report: Health Care Repeal: Easy in the House, Not in the Senate

January 25, 2011


By Mike Amery, Legislative Counsel, Federal Affairs, (202) 506-7468,

Dr. Donofrio Meets MedPAC and Capitol Hill

Before I get to the health reform repeal, I want to thank Peter Donofrio, MD, FAAN, of Nashville, TN, for coming to Washington last week to help increase awareness of the needs of cognitive specialties. The Academy is part of a coalition of cognitive specialists including Infectious Disease, Rheumatology, and Endocrinology that is discussing the elimination of consult codes by CMS and other issues impacting cognitive specialties. Dr. Donofrio, who serves as the chair of the AAN's Medical Economics and Management Committee's Coding Subcommittee, spoke before MedPAC, and spent two days on Capitol Hill meeting with key members of Congress and staff.

They Don't Ask Why in the Senate

By all accounts, being a member of the House majority is fun. If you are the Speaker of the House or a committee chair you run the show as long as you have the support of your team. Even if you are a junior backbencher from East Rural Podunk, just claim your pet issue that will bring you back after the next election and House majority leadership will make sure you get 15 minutes of fame…and success. Being a member of the House majority means that you win, almost every time.

On the other hand, being a member of the Senate is prestigious, but not so fun. Even if you are in the majority, the process is brutally slow as roadblocks are constantly thrown in front of your best ideas. That is, of course, unless you want to throw the roadblock.

Senate rules require unanimous consent of all senators before a bill moves forward. This rule allows groups or even individual senators to grind the process to a halt, even on a whim. Back in 1995, I was working as a junior legislative aide for a newly elected senator from Minnesota when one night the Senate was wrapping up business on a higher education bill of little significance (or so we thought).

It was on this night we decided to find out how the Senate rules really worked. So when a call came from the Senate cloak room (which runs the Senate floor) asking if any senators had objections on moving the bill to final passage, I told the cloak room that my senator objected. The cloak room staff didn't even ask why, as any senator has the right to object to any bill for any reason they want.

As it turned out, the bill was of great interest to the University of Minnesota and the next day the governor of Minnesota (not understanding Senate tradition, I presume) was on the phone asking why. On the other hand, the Senate majority leader was asking what my senator needed to gain his support. That objection equaled power, even if it was just a whim.

What Does This Have to Do with Health Reform?

As expected, the US House has exercised the power of the majority and passed a complete repeal of the health reform bill, even though everyone knew the vote is largely symbolic because it takes a lot more than just a House majority to repeal legislation like this.

This bill now moves to the Senate, where Democrats still remain in control. Remember that every Senator has the power to object. Republicans will do everything they can to force votes by objecting to anything and everything that tries to move forward on the Senate floor. And Democrats in turn will require votes on amendments dealing with popular provisions.

But in the end, Senate roadblocks will prevent House Republicans from getting any more than their symbolic vote of repealing health reform.

All of that said, Senate Majority Leader Harry Reid (D-NV) said he won't even schedule it for a vote. Now that is real power.

Next Steps for the House

House leadership understands that their efforts are going nowhere in the Senate. So last week they voted 253-175 to pass a resolution that would direct committees to develop smaller revisions and replacement legislation for the federal health reform law. Fourteen Democrats joined in approving the directive that includes 13 objectives for the committees to work on as they develop their replacement bills.

Some of the directives include:

  • Lowering health care premiums through increased competition and choice
  • Providing people with pre-existing conditions better access to affordable health coverage
  • Increasing the number of insured individuals
  • Providing states with "greater flexibility" to administer their Medicaid programs
  • Providing seniors with assistance on prescription drug costs
  • Overhauling medical malpractice laws
  • Banning federal funding for abortions
  • Protecting the physician-patient relationship

Details of these will be worked out in the committees and the AAN will try to help when it benefits Academy members and their patients.

Ninth Annual Palatucci Advocacy Leadership Forum

One of the highlights of the year for me is the Palatucci Advocacy Leadership Forum. I recently had the pleasure of attending this year's forum in San Diego where a new group of 30 graduates were brought into the "Palatucci family." I really appreciate the opportunity each year to meet Academy members who are passionate about advocacy and are looking for ways to get involved. It is a great program and I encourage everyone to apply.

Giffords Update.

Lastly, I thank everyone for your kind personal comments to me on the last Capitol Hill Report. Congresswoman Giffords has been transferred to Houston, TX, to TIRR Memorial Hermann and reports say she is improving daily. I hope you will continue to keep her in your prayers and wish for her speedy return to the floor of the House of Representatives.