By Alexander Bolton - 06/17/09 08:14 PM EDT
Sen. Dianne FeinsteinDianne FeinsteinHotel lobby cheers scrutiny on Airbnb GOP platform attempts middle ground on encryption debate Week ahead: Encryption fight poised to heat up MORE (D-Calif.), who has proven critical in forging compromise on major issues in the past, says she feels cut out of negotiations to overhaul the nation’s healthcare system.
Feinstein fired off a warning Tuesday by threatening to vote against the bill if it takes tens of billions of dollars in Medicare funds away from high-cost areas such as New York and California to cover uninsured patients in low-cost and rural areas of the country.
Senators working on healthcare reform that could include a new public insurance program are considering reimbursing doctors based on the outcome of treatment instead of on quantity, which could punish populous states.
“The surest way to tank healthcare reform is to let us break down into arguments between big states and small states. That has been in every major health discussion for years and years,” said Sen. Ron WydenRon WydenThe Hill's 12:30 Report Tim Kaine backs call to boost funding for Israeli missile defense Dems push for US, EU cooperation on China's market status MORE (D-Ore.), a member of the Senate Finance Committee.
Tensions between lawmakers from big and small states are likely to heighten in the wake of a Congressional Budget Office analysis estimating that Democrats need to find $1 trillion over the next 10 years to pay for their leading healthcare reform proposal.
A split between urban and rural states could complicate talks between the Senate Finance and House Ways and Means committees, both of which are tasked with paying for healthcare reform. While Finance’s leaders come from small states, the senior Democrats on Ways and Means come from New York City, California and Michigan.
One member of the Finance Committee predicted that discussion over payments to large and small states would escalate into a major debate between Sen. Max BaucusMax BaucusGlover Park Group now lobbying for Lyft Wyden unveils business tax proposal College endowments under scrutiny MORE (D), chairman of the Finance Committee, who represents rural Montana, and Sen. Charles SchumerCharles SchumerConvention shows Democrats support fracking, activists on the fringe Dem ad blasts Indiana senate candidate on Social Security The Trail 2016: Unity at last MORE (D-N.Y.), another panel member.
Feinstein said she’s seriously worried that states like California, which is already considering cuts to public healthcare because of a state budget crisis, could be hurt by the emerging healthcare reform bill.
“All of us are very concerned. We don’t know the specifics of the plan,” said Feinstein, who does not sit on either of the Senate panels with primary jurisdiction over the issue. “This is one of the big frustrations that accompany healthcare reform for those of us not on [the Finance] committee [who represent] big states with complicated and very serious healthcare industries.”
The New York Times reported last week that lawmakers are seriously considering proposals to rein in the cost of health spending by shifting tens of billions of dollars of Medicare money away from high-cost areas to cover the uninsured in low-cost regions.
Feinstein said if leaders decide to shift billions of Medicare dollars away from California, “I can’t vote for it.”
Sen. Tom HarkinTom HarkinGrassley challenger no stranger to defying odds Clinton ally stands between Sanders and chairmanship dream Do candidates care about our health or just how much it costs? MORE (D-Iowa) said he has followed that debate and agrees with House Agriculture Committee Chairman Collin Peterson (D-Minn.) that the legislative language in that bill needs to be more equitable, considering the interests of large urban areas and more rural states. But he acknowledged those places have competing interests.
“The bigger states and the industrial states are going to have differences with Southern states and mountain states in the West,” he said. “Big differences.”
Feinstein said she would like Democratic leaders to slow down the pace of healthcare reform legislation so that she has time to meet with constituents in California to better understand how it affects them.
“I have a hard time understanding the need to push something through,” she said, warning that healthcare reform could crash and burn if lawmakers aren’t given enough time to satisfy various questions and concerns.
California’s other senator, Barbara BoxerBarbara BoxerThe Trail 2016: One large crack in the glass ceiling Dem suggests race factored into Obama Senate endorsement Obama, Biden back Kamala Harris in Calif. Senate race MORE (D), also said her state should have more of say in early discussions.
“I do feel that we do have to get more involved and I have been trying to do it via members on the committee, but I think she’s absolutely right, because whatever policy is made, we’re going to feel it more than any other state because we’re so large.”
Finance’s senior members — Baucus, ranking Republican Sen. Chuck GrassleyChuck GrassleyTop senators want details on probe of DNC breach Top Dem Senate hopefuls to skip convention Election to shape Supreme Court MORE (Iowa), Sen. Jay RockefellerJay RockefellerLobbying world Overnight Tech: Senators place holds on FCC commissioner Overnight Tech: Senate panel to vote on Dem FCC commissioner MORE (D-W.Va.) and Sen. Kent Conrad (D-N.D.) — hail from small, rural states. They will be charged with finding ways to pay for the $1 trillion-plus costs of reform.
Finance does have several junior members from populous states, including Democratic Sens. Bill NelsonBill NelsonTim Kaine backs call to boost funding for Israeli missile defense More automakers admit to equipping new cars with defective airbags GOP warming up to Cuba travel MORE (Fla.) and Robert MenendezRobert MenendezTim Kaine backs call to boost funding for Israeli missile defense GMO labeling bill advances in the Senate over Dem objections Overnight Finance: Trump threatens NAFTA withdrawal | Senate poised for crucial Puerto Rico vote | Ryan calls for UK trade deal | Senate Dems block Zika funding deal MORE (N.J.).
Sen. Debbie StabenowDebbie StabenowTim Kaine backs call to boost funding for Israeli missile defense Dems to GOP: Admit Trump is 'unfit' to be president Senate Dems push Obama for more Iran transparency MORE (D-Mich.), another member of Finance who represents a populous state, said it’s not certain how altering the reimbursement formula will affect big states. She said it is an oversimplification to characterize the proposed change to reimbursement formulas as a shift of Medicare money away from populous states.
Conrad noted that treatments at Mayo clinics cost “about half as much” as at the University of California Los Angeles and “get better outcomes.”
Mayo is headquartered in Rochester, Minn., a small city of about 100,000.
But Conrad argued that a new reimbursement scheme wouldn’t necessarily favor more rural areas. He noted that Mayo operates a successful clinic in Jacksonville, Fla., which has about 800,000 residents.