CONGRESS
Texans had input in House health debate
Unresolved: Whether physician-owned hospitals will face growth hurdles.
By W. Gardner Selby
AMERICAN-STATESMAN STAFF
Monday, November 23, 2009
Texas members of the U.S. House mostly marched in step with colleagues when the House on Nov. 7 passed legislation to greatly expand access to health coverage, with Democrats celebrating the action as long-awaited history and Republicans insisting their ideas had been roundly ignored.
"There was never really any interest in having any Republican input into this bill," Rep. Michael Burgess, R-Denton, said last week before a Senate vote cleared the way for debate on its version of the plan after Thanksgiving. "It was going to be a Democratic product through and through."
 Lloyd Doggett helped keep public option in House bill. |
Yet members, aides and lobbyists report that Texas representatives from both parties managed to add wrinkles to the plan, a reality Burgess admitted with a wince in his voice: "I do like to think we had a little bit of influence. People in my district hate this bill so bad that I don't want them to think I was at all helpful."
Rep. Chris Van Hollen, D-Maryland, who chairs a political committee intent on re-electing Democratic House incumbents, compiled a list of elements Republicans sought that he said were reflected in the bill.
Among his examples: Republicans called for consumers to be allowed to purchase insurance from vendors in other states; the plan allows for state health insurance compacts enabling the sale of insurance across state lines. Also, Republicans advocated a tax credit for small businesses offering health coverage; the plan exempts most small businesses from having to provide coverage.
Among Texans who were slow to support the plan, Rep. Henry Cuellar, D-Laredo, committed only after House Speaker Nancy Pelosi accepted language intended to protect state tort-reform laws from being superceded by federal law.
Cuellar said last week that the state's Democratic members were pivotal in winning a provision permitting all children of the working poor to stay in a federal insurance program for 12 months, rather than six months, before having their eligibility rechecked.
"In my opinion, we (Texans) had a pretty good say-so," Cuellar said.
Burgess, who's among a handful of physicians in Congress, conceded that with the help of Democratic colleagues, he changed parts of the plan as a member of the House Committee on Energy and Commerce and its health subcommittee.
One amendment Burgess advanced with a Democratic colleague would require hospitals to disclose to patients the prices of different procedures, including how much the patients would pay out of pocket. Another, based on a proposal by Rep. Kenny Marchant, R-Coppell, would allow states to let certain individuals with extremely high lifelong drug costs for very rare conditions stay on Medicaid even if their incomes increase.
Democratic Rep. Gene Green of Houston, who worked with Burgess on the energy and commerce panel, said he made it clear he didn't want a plan that, like the Children's Health Insurance Program, would leave it up to states to chip in to participate.
"I told the speaker, I can't vote for a bill that doesn't cover everyone," he said. "Otherwise we'll end up with states like Texas, Florida and Georgia that may not participate. Why would we do that?"
"Whenever you require state buy-in, you don't get the same coverage" because Republican legislators resist such expenditures, Green said. "So I wanted something national like Medicare; that's what we have in the bill."
Austin Rep. Lloyd Doggett, a member of the House Ways and Means Committee, also is the second-highest ranking Democrat on its health subcommittee. Asked to recall a moment when he most influenced the House plan, Doggett said, "My involvement wasn't a 'moment'; it was hours, days, weeks, months."
He cited his support for eliminating lifetime limits on coverage and the right of parents to extend family coverage for their children until age 27.
Doggett also expressed pride in preserving the Medicare-like public insurance option from its inception in the subcommittee and overcoming colleagues who pushed to pay for the plan through higher payroll taxes and/or taxing employer-provided insurance.
The House plan's funding depends on Medicaid and Medicare savings, plus fees and taxes on the sale of medical devices and on individuals whose annual incomes exceed $500,000 and families with incomes of more than $1 million.
Cuellar is the only Texas member of the 52-member Blue Dog Coalition, a group of moderate and conservative Democrats who emphasized controlling costs and improving access in the health care debate.
Cuellar's tort-related amendment states that nothing in the plan "shall be construed to modify or impair state law governing legal standards or procedures used in medical malpractice cases, including the authority of a state to make or implement such a law."
Cuellar said he saw no evidence that Democratic leaders intended to weaken such laws, but Texas physicians and Republican members from Texas worried about the possibility. Cuellar said he thinks his amendment resolved those concerns.
Texans didn't always get what they wanted in the plan.
For instance, every Democrat except Doggett signed letters in October urging Pelosi to remove a restriction on doctor-owned hospitals from expanding unless they meet what critics call overly strict criteria. But the criteria — basically hurdles tied to whether hospitals are in counties where medical needs outpace available services — remained.
Bobby Hillert of the Texas Physician Hospitals Advocacy Center, which represents 67 doctor-owned facilities (including the Heart Hospital of Austin), said he expects the issue to be hashed out in House-Senate compromise talks.
Calling Texas home to more physician-owned facilities than any other state and noting that the Texas facilities employ 22,000 people, Hillert suggested that every Democratic member will ultimately have two or three "big asks" to present to Pelosi.
"I don't know that there's anything more Texas-specific than this issue," he said.
wgselby@statesman.com; 445-3644
