Daily Dose

By Ceci Connolly
It may seem as though President Obama is shifting his attention to foreign affairs this week, but the administration doesn't want anyone to forget about the centerpiece of its domestic policy agenda. Senior White House adviser David Axelrod, in one of his e-mail missives to the Democratic faithful, writes Monday that Team Obama has put together a handy video summing up the president's health-care proposal.

"Four minutes -- that's all you need to learn just what you get from health insurance reform," Axelrod says. The note reprises the White House mantra of "security and stability" to urge supporters to get behind the legislative push.

"As the President says, now is the time to deliver the change we need on health care," according to the letter. "Forward this e-mail and make sure your family, friends and social networks take four minutes and watch this video."

By Ceci Connolly
The first family plans to queue up for the swine flu vaccine -- when the time comes.

President Obama says he's looking to scientific experts to prioritize who gets innoculated when in this country.

"My understanding at this point is that the high-risk populations are going to be first with the vaccine, and that means not only health-care workers, but particularly children with underlying neurological vulnerabilities," he said on CNN's "State of the Union" program Sunday.

"And so we've got to make sure that those vaccines go to them first."

Under that approach, the president said he expected his two daughters would receive the vaccine and that he "may come fairly far down the line" in prioritization.

"We want to get vaccinated. We think it's the right thing to do," he added. "We will stand in line like everybody else. And when folks say it's our turn, that's when we'll get it."

By Ceci Connolly
Fresh off his trip to Iraq, Vice President Biden will wade deep into the health-care debate next week, according to administration sources.

Biden is slated to give his "first major health policy address" Tuesday to the National Association of Insurance Commissioners and on Wednesday visits the Leisure World retirement community in Silver Spring.

On the subject of Obama and health reform, seniors have been the most skeptical age group in the nation. That's a major concern for the White House because retirees vote in large numbers, particularly in mid-term elections. Biden, who will be joined at Leisure World by Health and Human Services Secretary Kathleen Sebelius and White House health czar Nancy-Ann DeParle, plans to "talk directly to seniors about how changes in Medicare will not affect them medically and will in fact, strengthen the system," said an aide who was not authorized to be quoted.

Biden's higher profile also will also come during a week in which President Obama will turn his focus to foreign policy.

Perhaps more importantly, Biden will be reaching out to an array of lawmakers to press the case for bipartisan enactment of a bill that expands insurance coverage and holds down skyrocketing costs. After spending 36 years in the Senate, Biden's role will be less as a health policy expert and more as a peer.

By Lori Montgomery
As if health care reform weren't confusing enough.

When the chairman of the Senate Finance Committee released his long-awaited reform plan on Wednesday, his staff announced that it would cost $856 billion over the next decade. Hours later, the nonpartisan Congressional Budget Office released its preliminary analysis, saying the plan would provide coverage to about 30 million uninsured people and cost ... $774 billion over the next decade.

Normally, what the CBO says goes on cost estimates. Most participants in the health care debate, including dozens of reporters, shifted quickly to the $774 billion figure. But Finance Chairman Max Baucus (D-Mont.) is insistent about the $856 billion figure -- presumably so Democrats, who want to make the package more generous, get the message that they can't add much without sending the cost soaring over President Obama's self-imposed limit of $900 billion.

So which number is right? Depending on your point of view, they both are.

The CBO tends to focus on the cost of expanding coverage to the uninsured, then tallies up the other parts of the package to make sure the coverage expansion is paid for. In this case, $774 billion is the cost of expanding eligibility for Medicaid ($287 billion), providing subsidies to participants in the insurance exchanges ($463 billion) and giving tax credits to small businesses that offer their workers health insurance ($24 billion). (The comparable number for the House bill is nearly $1.28 trillion over 10 years.)

By the CBO's calculations, that cost would be offset by fees and taxes related to the expansion of coverage, including penalties on people who failed to buy insurance and businesses that failed to offer it, as well as a new tax on high-cost insurance policies. Those provisions would bring the net cost of Baucus's coverage model down to $500 billion over 10 years, according to the CBO. (The comparable number for the House bill is the oft-cited $1.042 trillion.)

Finally, THAT cost would be more than offset by $549 billion in other new fees and taxes ($139 billion) and the net impact of changes to other programs, particularly within Medicare ($409 billion). Subtract $500 billion from $549 billion, and the bill would be $49 billion in the black over the next 10 years, according to CBO, reducing future deficits.

Baucus takes a different approach. His estimate of $856 billion represents the sum of every provision in the bill that costs money, from expanding coverage ($774 billion) to giving Medicare doctors a one-year pay raise ($11 billion) to closing the coverage gap in the Medicare prescription drug benefit ($17 billion) to dozens of other, much tinier things. (It would take a while to figure a comparable number for the House bill.) Baucus then calculates every provision in the bill that saves money, for a total of $904 billion. Which leaves you, again, with an extra $48 billion or $49 billion to play with.

As long as we're in math class, here's a bonus extra-credit question: The House bill would increase deficits by nearly $240 billion over the next decade. What simple change would make that bill balance?

That's right, health-care fans: Remove the 10-year pay raise for Medicare doctors. If the House bill only raised their pay for one year, as Baucus does, the bill would shift pretty easily into deficit neutrality. And, despite the screaming that would emanate from the American Medical Association, some House Democrats are proposing to do just that.

But the House bill would still have big problems after 2019, when it would quickly fall into deficit again. Baucus's package of tax hikes and spending cuts, on the other hand, would grow faster than the cost of expanding coverage, making his proposal the only one so far that would keep Obama's promise not to make future deficits worse.

Class dismissed.

Reuters reports:

The White House said on Thursday it had allocated $25 million in grants to states for a pilot program that would seek to ease the impact of malpractice suits on the U.S. medical system, as President Barack Obama pushes for sweeping healthcare reform.

Obama offered the plan in a speech to Congress last week in connection with the wishes of many legislators, particularly Republicans, that medical malpractice laws be reformed as part of an overhaul.

Continue reading»

By Ben Pershing
Total spending on health-care reform ads this year will soon reach the $100-million mark, a new milestone in an advocacy advertising campaign that experts already believe to be the costliest ever.

According to the Campaign Media Analysis Group, which tracks political ads, national spending on health-care spots from all sides of the debate should crest the century mark in the next few days. And just as the reform debate has reached a crucial phase -- with Senate Finance Chairman Max Baucus (D-Mont.) releasing a bill this week that will drive the process forward -- the battle on the airwaves has escalated rapidly. The first $50 million of the year was spent over the course of about seven months, while the second $50 million has tumbled forth in roughly the last six weeks.

"In just the last 60 days, 49 different groups have aired nearly 100,000 TV commercials about federal health-care policy," Evan Tracey, CMAG's chief operating officer, wrote in an article posted Wednesday at AdAge.com. He asked: "[I]s it possible that the American media consumer is on the verge of a health-care overload?"

Television viewers this summer have been bombarded with health-care ads, and paid media on the subject pales in comparison to the amount of time devoted to it on news and other programs. This Sunday, for example, President Obama plans to go on five different talk shows for interviews that will likely focus on health care, and he will visit David Letterman's "Late Show" on Monday.

The amount spent on television ads is also only one small slice of the total being expended by all sides to influence the debate. The health sector, which includes hospitals, nursing homes and pharmaceutical companies, has spent more than $240 million so far this year on registered lobbyists. And that total doesn't count millions more expended on consultants, public relations firms and grassroots activities for which spending is difficult to track.

8 a.m. ET: At some point in the last few months, Max Baucus apparently decided to test the cliche that a true compromise should irritate everyone.

One day after Baucus released his long-awaited compromise health care measure, the most common theme in the coverage is just how unhappy all sides are with both the bill and its author. "It appears that no one is happy with ... Baucus -- and that may be the best news President Obama has had in months," the Washington Post writes. The White House gave a tepid response, but the administration is certatinly happy to have a bill that moves the process forward. And business groups and other private-sector stakeholders either responded positively or were muted in their criticism. The bill, the Associated Press reports, "gives health insurers, drug makers and large employers reasons to heave sighs of relief, sparing them the higher costs and more burdensome rules included in other Democratic-written alternatives."

The bill's price tag -- $774 billion -- is either the best or worst thing about it, depending on whom you ask. Fiscal hawks will cheer that it meets Obama's goal of expanding coverage without adding to the deficit, but many Democrats complain that it mandates individuals buy health insurance while providing inadequate subsidies to help them pay for it. Kaiser Health News writes that the question of how much people can really afford to pay for insurance is "at the heart of the current debate" and "there is not a firm consensus" among any of the players involved on the answer.

8 a.m. ET: If Budget Day on Capitol Hill is like Christmas for policy wonks, then today must surely be some lesser holiday for health-care mavens. At long last, Max Baucus will unveil his version of the reform bill, without the support of any Republicans or many radical changes from the framework he has already released.

"The time has come for action. And we will act," Baucus writes in an op-ed published in the Wall Street Journal, adding that the Finance Committee will move forward "in the next several weeks." Baucus's decision not to wait for Republican support, as Associated Press puts it, "dims the chances for a bipartisan compromise on President Barack Obama's top domestic priority." How strong were the chances for such a compromise in the first place? Beyond the basic necessity to get 60 votes in the Senate, how important is it in the broad scheme of things to pass a bill with two or three Republican votes, instead of none? Perhaps more surprising than the absence of support from Chuck Grassley and Mike Enzi is that of Olympia Snowe, though that doesn't necessarily mean she won't back a bill in the end. Baucus did say Tuesday that he thought there would be some GOP support for the measure when the Finance Committee reports it out.

The complaints came from both ends of the spectrum Tuesday, with Grassley criticizing the "artificial deadline" Baucus had imposed and Jay Rockefeller, a key liberal, declaring "The way it is now, there’s no way I can vote for the Senate package." As always, if Baucus tries to appeal more to one side, he loses support on the other. As Jonathan Cohn notes, "many of the changes Democrats seek are bound to alienate Snowe. (Among other things, improving the affordability provisions probably means raising more revenue, something Snowe doesn't seem to want.)"

By David S. Hilzenrath
As Republicans argue that Democratic health care proposals would put government bureaucrats between doctors and patients, one of the House's most liberal members is making a counter-argument: Insurance company bureaucracies are already in the way.

Rep. Dennis Kucinich, the Ohio Democrat and erstwhile presidential candidate, plans to cast a spotlight on insurance companies in hearings scheduled for Wednesday and Thursday. Kucinich chairs the House Oversight and Government Reform Subcommittee on Domestic Policy.

First he plans to air testimony about patients whose insurers refused to pay for care; then he plans to put insurance company executives in the hot seat. The witness list for Thursday includes representatives of United Healthcare, WellPoint, Aetna, Humana, and Cigna.

The lineup for Wednesday's hearing includes a woman whose father died in 2007 at age 59 after his bone marrow transplant was delayed by a dispute with BlueCross BlueShield of Montana.
William G. Ackley, who was an elementary school principal, suffered for 20 years from a form of leukemia. In April 2006, as his condition deteriorated, the insurer sent Ackley a letter saying it would not pay for the transplant because "the proposed service does not meet your policy's definition of 'Necessary.' " A peer reviewer found that under the circumstances the treatment was "investigational" -- in other words, BCBSMT Medical Director Mary Sims wrote the following month, not proven effective for his disease.

A series of appeals and denials ensued. Ackley's family asked a state regulator to get involved. Meanwhile, the National Marrow Donor Program wrote a letter to the insurer asserting that the proposed treatment was "neither investigational nor experimental" but rather was the only treatment for Ackley's disease "known to be curative."

By Paul Kane and Ben Pershing
The House has begun an hour-long debate Tuesday on a resolution rebuking Rep. Joe Wilson (R-S.C.), whose heckling of President Obama last Wednesday sparked a week's worth of controversy increasingly tinged by allegations of racism.

As the debate neared, Wilson took the chair in the House chamber usually reserved for the Republican manager of floor debate, scribbling marks down on what appeared to be a short speech. GOP aides said that they expect Wilson will address the House.

After shouting "You lie!" at Obama during his address to a joint session of Congress in the House chamber, Wilson issued a statement of apology and also called the White House to say the same. But he has steadfastly refused to apologize on the House floor, a step that Democrats, led by House Majority Leader Steny H. Hoyer (Md.) and Majority Whip James E. Clyburn (S.C.), say is necessary as a sign of respect both to the president and to the body's rules of decorum.

The resolution states: "Whereas the conduct of the Representative from South Carolina was a breach of decorum and degraded the proceedings of the joint session, to the discredit of the House: Now, therefore, be it resolved, that the House of Representatives disapproves of the behavior of the Representative from South Carolina, Mr. Wilson, during the joint session of Congress."