CSPAN/NEWSMAKERS

Host: Steve Scully

Guest: Rep. Mike Ross (D-AR), Blue Dog Health Care Task Force

Reporters: Anna Edney, David Clarke

STEVE SCULLY, HOST: Joining us on C-Span's News Markers Program for this Sunday is Congressman Mike Ross, Democrat of Arkansas, and also the Chair of the Health Care Task Force for the Blue Dog Democrats. Thanks for being with us.

And joining us for the questioning is Anna Edney. She is the Health Care Reporter with Congress Daily. Good morning to you and David Clarke of CQ Politics, also a health care reporter.

Congressman, let me begin with an open-ended question. What would it take for you to support a health care bill as it moves between different committees in the House and onto to the Senate and then the President? What are you looking at for?

MIKE ROSS, REPRESENTATIVE (D-AR), BLUE DOG HEALTH CARE TASK FORCE CHAIRMAN: That’s a good question, Steve. We – let me be clear. The conservative Democrats, known as the Blue Dog Coalition, we support health care reform.

But this is a lot different than the energy bill, the Cap and Trade Bill. There were some people that were not trying to get to a Yes. With the health care reform bill, everyone wants to gets to a Yes. Everyone acknowledges that we've got to fix health care.

So to specifically answer your question, we agree with the President that we've got to do much more to contain costs. We need to provide a greater exemption for small businesses so we don't put them out of business while at the same time ensuring that we provide coverage for the employees of small businesses.

Then we've got to address the regional and especially the rural disparities that exist in the Medicare reimbursement rates. This is not about the doctors. Although it is about some rural hospitals that are struggling to get by and I understand that as well as anyone because we lost a hospital in my home county that my grandmother was a nurse at for much of her life, back in 1995.

It's about access for the patients. I've got – I represent 150 towns, a very large rural district about half of Arkansas. In a number of those towns, doctors are no longer accepting new Medicare patients.

So once you become Medicare eligible or once you move into a community and you're on Medicare, it can be a three-month wait right now to be able to get a doctor to start seeing you as a patient on a, you know, patient-doctor basis.

You add millions of people to that equation through this so-called public option, which they, you know, contend should be based on Medicare rates, then how long will the wait be for them, six months, a year? You know its one thing to provide everybody a shiny new insurance card but it's another thing to be able to use that card to actually walk in the door and see a doctor.

So those are the big concerns we have. Obviously, there are many more. We're considering somewhere between 12 and 24 amendments to the bill as it's marked up in the House Energy and Commerce Committee. But the big one for us is, as fiscal conservatives, is containing costs. If we don't contain the costs, then no one is going to have health care in the not too distant future.

SCULLY: And as you know some of those costs outlined last Thursday by the CBO Director. David Clarke of CQ Politics with the first question.

DAVID CLARKE, CQ POLITICS, HEALTH CARE REPORTER: I want to ask you about the issue of cost in the bill. There seems to be two issues. One is how to pay for it over 10 years. And then the second, probably more importantly is how over the long-term, do you get the rate of growth of health care to go down a little bit so it doesn’t swamp the Federal budget and cause everyone's health bills to rise.

There are a lot of ideas out there about how to do it. The CBO Director said he doesn’t see many of those ideas in the health bill that’s moving through the House. What specifically would you like to see in the bill to reign in the long-term costs of health care?

ROSS: Dave, you're correct. Doug Elmendorf, the CBO Director, dropped a bomb shell Thursday when he said that this bill does not go nearly far enough at containing costs. In fact, it will increase the debt long term.

That admission by the CBO Director we believe validates what the Blue Dog Coalition has been saying about this bill for the last three months. And of course, then Senator Conrad came out and opposed the House version of the bill yesterday as well. So it wasn’t a good day for the bill.

I believe both of those validated our concerns. We've got to find ways to contain costs and quite honestly we don't have all the answers. But I'll speak to some of the ways that we believe the costs can be contained.

But I think it's important for the viewers that they understand why we got to get health care reform. I know some people tell me, you know, we've got – we're in the middle of the worse economic recession since World War II. We've got record debt, record deficits so why health care reform now.

Those are the very reasons why we do need to do the right kind of health care reform now. I know a lot of people are worried about national health care. Well, the reality is half the people in America already have it.

It's called Medicare, Medicaid, SCHIP, Veterans' health care, military retiree health care. You add those national health care programs to Social Security that consumes 40 cents out of every tax dollar today.

If we do nothing to control and contain the cost of health care because health care is growing at twice the rate of inflation, has been for many years now. If we do not contain the costs, if we do not get health care growing at the rate of inflation, that 40 cents out of every dollar to fund those national health care programs plus Social Security that I'm talking about, that will reach 100 percent of all revenue by 2040, which means we'll no longer have a Department of Defense or an army or an air force and navy and marines and coast guard. Obviously as a nation, we cannot afford to let that happen.

CLARKE: So when you're talking about the problem of the long-term costs but what do you think should be done about it. Mr. Elmendorf, one of the things he mentioned yesterday was currently the health benefits you receive through your employer are not taxed.

A lot of economists think that if you did remove that exclusion to that tax that would be one way of over the long-term reducing the cost of health care. Is that something you support?

ROSS: I think that’s a bad idea in the middle of the worse economic recession since World War II. I think that’s really getting to how you pay for it, which is a Ways and Means issue and I'm on Energy and Commerce and we deal with policy issues.

But in terms of actually trying – I don't know if we can get health care down to the rate of inflation or not, but I do believe that we can do better than it being twice the rate of inflation. For example, I think we need – you know, one of the ideas that the President's put out there is a Medipak, kind of like a super Medipak where you would take the politics, if you will, out of the medical decisions.

And have a commission with oversight from the Secretary of Health and Human Services that makes those decisions instead of having 535 members of Congress that are a constantly standing for reelection making the tough choices as it relates to the cost as well as the reimbursement rate.

So I mean I don't know if that’s something I'm for or not, I'm just saying I want to learn more about it. The President's thrown it out there. I think it should at least be on the table. This is the biggest reform of any domestic issue in my lifetime. And to try to speed this thing through Committee in five days, I think is ridiculous.

I think we need to slow it down. We need to look at every option that’s on the table. And find ways that we can really contain costs to stop the rate of inflation because it not only – not only can we never balance the Federal budget again until we get health care costs under control, but the 160 million who have health insurance today, they won't have it 10, 15, or 20 years from now.

We're already seeing the employer shifting more and more to cost to the employee and the next 10 to 15 years, depending on whose numbers you want to believe, it's going to reach a point where neither the employer nor the employee can afford it.

So this is an issue. A lot of people somewhere along the way started thinking we were talking about health care reform in terms of health care for the 48 million that do not have it. And certainly that’s something we need to address but when the President called for health care reform, I was one of 20 something members of Congress at the White House for the National Health Care Summit.

He made several things real clear. Number one this was about containing the costs and getting health care growing at a rate closer to the rate of inflation for our own Federal Government's fiscal issues that I just outlined but also so those have it today will have it tomorrow.

The second very important thing he said in kicking this off was that if you like the health insurance you’ve got today, you'll always be able to keep it and you'll always be to choose your own doctor.

I think we need to go back to the basics and back to where President Obama laid out this need for health care reform with those very important principles.

SCULLY: Anna Edney with the Congress Daily.

ANNA EDNEY, CONGRESS DAILY, HEALTH CARE REPORTER: You must have some specific ideas. What will the Blue Dog Coalition be doing on, and again Energy and Commerce Committee specifically, to be able to turn this bill around in a way that you think it should be going to bring the growth of spending down?

ROSS: Well, like I said, we're going to offer somewhere between a dozen and two dozen amendments to the bill. Some of those amendments are still being drafted. As you know the text of the bill did not come out until what, Tuesday?

And then the Managers' Amendment, which totally rewrote the bill and added 200 pages to it. It was a 1,000, now it's about 1,200, it came out just yesterday, just – what would that be – on Thursday of this week.

Our staff's been working around the clock and well into the evening trying to draft some of these amendments but we're looking specifically at waste, fraud, and abuse within the Medicare system.

We're looking specifically at the things in Medicare that are broken and that need to be fixed. And then we've got to look at chronic disease management. You know there is a company, I believe they're in South Carolina, they – all the employees got the same health insurance plan.

And yet what they did was they had a group of diabetics voluntarily participate in a chronic disease management program for diabetics. Then they had another set that didn’t.

They followed them over just a short period of time, a year or two. All had the same health care coverage. One group with a chronic disease were managed, the other one wasn’t.

They all started at $11,000 a year in health care costs, that group of diabetics. The fact is that after the pilot project, those that weren’t under some type of managed care, a coordinated care program, even though they had the same health insurance plan, those that weren’t part of that, their costs went from $11, 000 to $16,000.

Those who were, their costs went from $11,000 to $6,000. So, there's a lot of ways that we can squeeze savings out of the system while continuing to allow people the freedom to choose the plan they want, as well as be able to continue to choose their own doctor.

EDNEY: Some of those ways, specific the chronic care management, CBO has said they can't quite gauge how much would be saved from doing something like that or whether anything would be saved. How do you deal with that obstacle where you might not get a price tag on this?

ROSS: Well, that’s part of the frustrating aspect of health care reform is what the CBO will score as a savings and what they will not, but – in those areas where they do score savings, those – every area that they believe there could be a savings, every area the Administration believe there could be a savings.

All of those issues should be on the table. And we should be debate them and not rush through a five day markup just to meet some artificial deadline. I mean we've been trying to get this done since Teddy Roosevelt I understand, as it relates to health care reform.

We're very close and I think we've got a real opportunity to do it but we want to do it right and I don't understand why there's a rush to do it by August 1 when we very well can have a bill that could actually pass the House in September.

So part of what we believe is we need to slow down and take our time. Get all the facts and do it right. But the other type things that I believe that we should do is listen to the experts, the health, you know, not just CBO and although, you know, we should look at where they think there's savings but there's areas that they can't score as a savings but health care professionals, doctors hospitals, nurses, other health care providers can tell you that there will certainly be a savings in certain areas.

And so just because CBO doesn’t score it, is not the reason why we should not look at it…

SCULLY: But just to be clear, are you saying that the bill in its current form would not pass the Democrat controlled House?

ROSS: Correct. Yes, there's – number one, you’ve got the CBO Director saying that it's going to increase the debt long term. And the whole purpose for this bill was to bring health care down to the rate of inflation or closer to the rate of inflation. And to begin to bend that cost curve as it's become referred to.

This according to the CBO Director has the opposite effect. It actually increases the debt in not short-term, which some could understand it might short-term, but he's indicated it will increase the costs long-term.

You got the new Democratic members, the freshmen, who are indicating that they think it’s a bad idea to propose the kind of tax increase that’s been proposed at this time. This is not just the conservative movement that has problems with the bill.

I could tell you a number of the more progressive members of the Democratic caucus have come up to me on the floor during votes and thanked me for trying to slow this down and do it right.

So to answer your question, there are seven of us on the Energy and Commerce Committee that are Blue Dog members and we're joined at the hip on this. We've been meeting for several hours every day to work through these amendments and ways to try and get the bill to a place where we can vote for it because for the reasons I've outlined, we need health care reform. But this bill doesn’t go nearly far enough toward containing the costs.

Then in terms of the Democratic caucus as a whole, there are a number of people, I think they would be a significant number of votes short in passing it on the House floor right now. And they certainly don't have the seven votes required. You know, there are seven of us on the committee. And it's seven that vote no and doesn’t pass the committee (ph).

SCULLY: Do you have a number though? Do you have a number? You said significant, how many?

ROSS: I haven't done like a real count with all 435 members of Congress but just from discussions that I've had with various members of various political philosophies, everything from progressive to conservative to moderate, there's a lot of concern with the bill as it's currently written.

CLARKE: You mentioned one of the tax increases and one of the President's goals was to make sure that the cost of the bill, which in the House is in the neighborhood of a $1 trillion over 10 years, to make sure that that is offset and doesn’t add to the deficit.

And what the Ways and Means Committee has done is they put a surtax on upper income taxpayers that would raise about $550 billion to go toward paying for the cost of that bill. Do you support that pay for and if not, what would you put in its place?

ROSS: I don’t think we should consider any tax increase until we have first identified and implemented into the Legislation, written into the Legislation all the cost savings that we can find.

What the American people want us to do – I think the American people are willing in a fair and equitable manner to help pay for a health care plan that will insure they’ve got health care now and in the future.

But they first expect us to squeeze every ounce of savings in waste, fraud, and abuse that we can find out of the current system. Quite frankly that’s going to mean rethinking how we deliver health care.

We now pay providers to treat the sick. We need to rethink how we reimburse providers. It should be based on the value of service and the outcomes. There's a lot of things that we believe should at least be on the table for consideration.

My concern is that in this health care reform debate, we're not taking the time to debate and make decisions on the tough choices. Some of which may not be politically popular. But it's kind of like we're just throwing some more money at the problem to see if we can sugar coat it and get on down the road a ways.

This is a unique opportunity for us to really reform health care in a way that will ensure that our children, our grandchildren, and future generations actually have a health care plan that works for them and one that they can afford.

EDNEY: Have you sat down with Chairman Waxman of the Energy and Commerce Committee and shared these concerns? Has he agreed to any concessions before you offer your amendments in markup (ph)?

ROSS: We're in negotiations with Chairman Waxman. He's indicated as he recognizes he can't pass the bill out of committee without the seven Blue Dogs that are on the Energy and Commerce Committee voting for it.

He clearly understands that this is a bill we cannot support in its current form. Thursday night we spent a couple of hours with him after votes. We've had a number of meetings like that in the last few days. We've spent 45 minutes last Monday in the Oval Office with President Obama discussing our concerns, prior to that we spent a couple of hours with Speaker Pelosi on at least two different occasions.

Majority Leader Hoyer and the three committee chairs on a couple of occasions. Then specifically with Chairman Waxman, the seven, you know, Blue Dogs conservative Democrats on the Energy and Commerce Committee have spent a number of hours with him and trying to be helpful.

We're not trying to kill health care reform. We're trying to be constructive and giving us a bill that does a better job of containing the costs, reducing health care to the rate of normal inflation, and one that they can pass on the House floor.

CLARKE: I mean it seems like one of the problems here is what specifically you're going to do to address these cost concerns. And if – you’ve said you're not much in favor of the surtax to pay for the short-term costs and it didn’t sound like you're particularly supportive of taxing a health care benefits.

Why haven't the Blue Dogs come out with some specific proposals for how to pay for it both in the short-term and the long-term? I don't mean a bill necessarily but you’ve put out sort of principles that you want to see followed but why not give the Chairman and other members an idea of where you'd specifically like to do this because it seems like, unless you (ph) – you talk about hard choices but, you know, with regard to the surtax, obviously a $1 trillion over 10 years is a lot of money.

It would be difficult to cover that cost without some sort of tax increase. So, why haven't the Blue Dogs been more specific about what policies they'd like to see?

ROSS: Well, several reasons. One, we believe that we can squeeze more savings out of the current system. We don't think they have adequately done that.

SCULLY: But enough to pay for health care reform? Because that question comes up.

ROSS: It could be if we did the basic reforms that are needed to ensure that those who have insurance today have it tomorrow, to address the needs of the uninsured. You know there's a lot of things we could do different that’s being done in this bill.

I mean this bill expands Medicaid from a 100 percent of poverty to 133 percent of poverty with the Federal Government paying the extra 33 percent, not just for the next 5 or 10 years. I believe in the Senate bill, they paid over the next five years and then it's passed on to the States.

The House bill it's indefinitely that it will be funded by the Federal Government covering up to 400 percent of poverty in terms of a government subsidy to help you pay for your health insurance. The House bill has it at 400 percent of poverty.

Well, for a family of four making $88,000 a year, and very few in Arkansas do, but for a family of four making up to $88,000 a year, they're going to qualify for a government subsidy for their health insurance.

I mean my gosh, the Governor of Arkansas if he had two children still at home would qualify for a government subsidy for his health insurance. I think that could be brought down to say 300 percent of poverty, which would still cover afamily of four up to $66,000 a year in terms of providing them a subsidy to help offset the cost of their health care.

So there's a lot of items in the bill with big costs. I'm talking, you know, hundreds of billions of dollars worth of cost. That’s just two examples that total hundreds of billions of dollars I just ticked off.

Those might could be scaled back a little bit or, you know, – so that’s one way to get – but that’s just the cost of the actual bill. The bigger issue here, the bigger issue here is containing those costs so we stop health care from growing at twice the rate of inflation.

That’s what this debate originally was all about. And those are the things that we think should be done first.

Specifically to answer Dave's question, we haven't focused on the revenue side of it because the seven of us that have put the brakes on health care reform in terms of the current bill, again we're all for health care reform but in terms of the current bill, the seven of us that have put the brakes on it have put a Blue Dog conservative Democrats on the Energy and Commerce Committee, we've had our plate full just dealing with those issues that we have jurisdiction over.

When you talk about revenue items, that all falls, as you know, in the House Ways and Means Committee. We're not a member of that committee. We're focusing specifically on those items within our committee that we can, the seven of us, can have a direct impact on.

EDNEY: Is it realistic to think that Speaker Pelosi would go for a leaner bill and I'm thinking, you know, that that’s not probably not going to be the case. It looks like you'll have to take a vote when it gets to the Floor on raising taxes on the wealthy. Can you support that?

ROSS: I think – actually in Friday's – in many publications that – I remember reading on Friday in several publications Speaker Pelosi, at the insistence of some of the freshmen Democrats, is now saying that maybe we need to rethink this surtax on the rich.

So, I think we're a long way from settling on how we will get the revenue needed to pay for it. One thing is for sure, and this is what we believe, it should happen in this order. Number one, we should squeeze every penny of savings out of the current health care system that we can.

After we've done that successfully, then we need to figure out how much it's adding to the debt. And we do not need to borrow any more money from China. We've done enough of that. It took George Washington through Bill Clinton to put this country 5 trillion in debt. It took the last president to double it.

We're committed to fiscal responsibility, accountability, and common sense being restored to our Government. So we believe that it should not add a penny of new debt to our Government and at the end of the day, it's got to be paid for. That will require some difficult decisions but I think the American people, if everyone benefits from this, all 300 million people in America, if there's a shared benefit, there should also be a shared sacrifice in how we pay for it.

But before we even get to the revenue that’s required to pay for this, we've got to first squeeze every, every cent we can of savings out of the current system. I've given you several ideas of how we believe that we can do that. Medicare Part B we can remove the doughnut hole by negotiating with the drug manufacturers to bring down the high cost of medicine.

The President negotiated with one on that very issue. And yet that’s not even found in the House bill. They took a different approach. So I think – I know there's a lot of people that want to see this thing marked up and rushed to the floor for a vote before the August break.

Maybe it can happen, maybe it can't. It shouldn’t matter – we shouldn’t have an artificial deadline of when we get it done, rather we should take our time and do it right. And if we can do it right during the month of July, then that’s great. If we need additional time in order to get it done right, then we should do that because this is an issue that’s going to face everyone in America.

SCULLY: We're just about time but very quickly, is there frustration on your part with the Liberals who run the Committee, Waxman with Energy and Commerce and Rangel with Ways and Means, that they're driving a train on this.

ROSS: Well, I – there is a growing frustration, not only among conservative Blue Dog Democrats but across our caucus quite frankly, of big Items being put before us with an artificial deadline and being rushed through the committee process and onto the House Floor.

I'll tell you what the American people want. They want health care reform but they want us to slow down and get it right and actually have time to read these bills that we're voting on.

SCULLY: Congressman Mike Ross who is the Chair of the Health Care Task Force for the Blue Dog Democrats, a Democrat from Arkansas. Thank you for joining us on News Makers.

ROSS: Thanks, Steve.

(AUDIO GAP)

SCULLY: We continue the conversation with David Clarke of CQ Politics.com and Anna Edney of Congress Daily. Where is all this heading in terms of health care? Now that the Sonia Sotomayor confirmation hearings have concluded this is now front and center.

EDNEY: Well, as the Congressman was leaving, he mentioned this in the House at least all may need to start over given what CBO has said about the cost of health care, based on their bill.

And it looks like, you know, he's talking about amendments but not having anything specific quite yet. It looks like they maybe looking to the Senate Finance Committee to sort of solve this whole issue. They're the only bipartisan hope for a health care reform bill.

They're still working. They haven't come out with anything. They were delayed slightly it seemed by the Sotomayor hearings. There were a number of the negotiators particularly on the Republican side who were involved in those.

So now they’ve all been able to come back to the table and it looks like they're sort of the last best hope for anybody to get a bill that will actually do something to reduce the growth of health care spending. So I think everyone will have their eye on them and it seems including the Blue Dogs.

SCULLY: David Clarke, you kept going back to the issue of how do you pay for this? And he kept going back to waste, fraud, and abuse.

CLARKE: Right. Well, I mean that – you know, that’s the toughest question is how do you pay for it. You know it seems difficult to do without some sort of tax component. And when you talk about waste, fraud, and abuse, I mean obviously no one's against eliminating that, but it's always difficult especially when you're talking about these major massive government programs to root out all that and to really get all that savings that, you know, you could if you could eliminate all that.

So, I think, you know, I think they're going to be in a bit of a spot because the Blue Dogs sort of, you know, organizing principle is deficit reduction, being fiscally responsible. And if they want to do that and they want to make sure that this is paid for, they make have to make some concessions on the tax part.

I think that will be one of the interesting things that when the bill comes to the Floor in the House, is that in the past the Blue Dogs have taken some pretty tough stands as bills are being negotiated saying that they're wary of the bill because of its cost. But then when it came to the Floor, they’ve generally been supportive of what leadership has wanted them to do.

You know they have in fairness gotten some concessions but, you know, this is obviously probably the biggest issue that we'll see this dynamic play out. So, I think it'll be interesting to see, you know, number one what sort of concessions they get from leadership and how big those are. Then how the votes go down when they're on the Floor because it'll be a very tough vote to vote against their leadership and the President if he wants this bill.

SCULLY: And yet for both of you, we saw this in 1993 and then the Democrats losing control of the House in 1994. How much of that is in the back of their minds as they look to next year's new term elections?

EDNEY: I think it's extremely in the back of their minds because right now they want to pass this bill by August and get it to the President's desk by October so that in 2010, this is not an issue that they'll be taking a vote on.

2010 being an election year, especially these vulnerable Democrats, they're not looking to take a vote to raise taxes so close to when their constituents are going to the poll.

CLARKE: Yes, I think it's always a concern for people like Congressman Ross and the Blue Dogs. There's about 52 of them. In general the House is a little more liberal and I think there is a concern that they may, that leadership may put a bill on the floor they vote for, that they hear, you know, that they're attacked for back home by, you know, as a Republican running against them.

Then in the end, the Senate doesn’t pass a similar bill, it passes more, I guess you'd say a more moderate bill and they’re left asking well, why were we forced to take a vote that’s going to hurt us in our reelection campaigns when in the end, it was never going to be what would become law.

SCULLY: David Clarke who covers health care issues for CQ Politics.com and Anna Edney who is with Congress Daily, also a health care reporter. Thank you both for being with us today.

EDNEY: Thank you.

CLARKE: Thank you.

END.