Democrats Are Schooled On the Health-Care Bill Washington Post Staff Writer
Wednesday, July 29, 2009 
From left, Speaker Nancy Pelosi, Rep. James E. Clyburn, Rep. Steny H. Hoyer and Rep. Xavier Becerra discuss the House's work on health-care legislation. (By Melina Mara -- The Washington Post)
They held the tutorial in the Capitol basement. The leadership had set aside five hours, from 4 to 9 p.m. Monday, with one break for procedural votes upstairs. For the first 2 1/2 hours, about 180 members of Congress had to do something for which they have limited affinity: Remain speechless. Sit still in a folding chair. Listen to staffers. They couldn't even ask questions but only jot them down for discussion later in the evening. They were all House Democrats, boning up on the historic and controversial health-care reform legislation that's being crafted in their chamber. The rough draft of HR 3200 ("America's Affordable Health Choices Act") was unveiled two weeks ago and runs more than 1,000 pages, not counting amendments. Last week the Democrats decided that, if they're going to try to sell this plan to their constituents, they need to have a better sense of what it says, line by line. They needed a teach-in. So their staffers led them through the bill, section by section -- from Division A, Title I, Subtitle A, Section 101 all the way through Division C, Title V, Subtitle E, Section 2541. After a couple of hours the Democrats had adopted a refrain: "No one's going to say we haven't read the bill," said Rep. C.A. Dutch Ruppersberger of Maryland, as he took a break from the closed-door gathering. "Nobody can say we haven't read it," said Rep. Lynn Woolsey of California, just minutes later. The display of studiousness struck veteran lawmakers as remarkable. "Have you ever seen members sit for two hours? There's been 120 of them that have been in there throughout," said Rep. John B. Larson of Connecticut, chairman of the House Democratic Caucus. "Having people sit there like a graduate class in a great university -- without being able to interrupt a professor -- very unusual," said Michigan's Rep. Dale E. Kildee, who has spent 33 years in Congress. Some members had a printout of the entire bill. Others followed the discussion via a 34-page summary. Rep. Dennis J. Kucinich (Ohio) took page after page of notes on a legal pad, later showing reporters the proof of his diligence. To make matters somewhat easier for members, the packet of information handed out at the door included a glossary of health-care terms, including: Capitation Comparative Effectiveness Cost Shifting Dual Eligibles The glossary spelled out such abbreviations as COBRA and DSH and EPSDT and ERISA and FEHBP and FMAP and FPL and HIPAA. Complicating matters is that legislation of this scale necessarily has many authors and is a continuously evolving document. Three House committees have cobbled together elements of the bill. The Senate, meanwhile, has two bills in the works. And any effort to make reform bipartisan will necessarily have to bring in people not invited to the tutorial -- the Republicans. No one knows what a final bill will look like. Thus, for the moment, members of Congress who hope to support it cannot tell their constituents precisely what "it" is. "It's extremely complex," said Rep. Alcee L. Hastings of Florida. "I haven't read all 1,100 pages. I have two staffers who have -- they looked like frazzled chickens last week as they were reading it." Much of the public attention has focused on such controversial elements as the creation of a government "public plan" to compete with private insurers and a "health-care surcharge" on the top 1.2 percent of earners. But the bill also includes some relatively fine-grained changes in existing policy, making it something of a grab bag of initiatives. The bill, for example, changes the Medicare reimbursement rate for nurse-midwives, waives the deductible for colorectral screening tests, and requires an upgrade of the Nursing Home Compare Web site. It allows Medicaid programs "to cover home visits by trained nurses to families with a first-time pregnant woman, or a child (under 2 years of age), who is eligible for medical assistance under this title." It changes Medicare provisions covering motorized wheelchairs and the cancer treatment known as brachytherapy. There are elements of the bill that the lay reader may find abstruse. The summary used by the House Democrats in their tutorial -- language designed to make the bill easier to understand -- describes Section 1131 of Part 2 of Subtitle B of Title I of Division B: "Incorporates a productivity adjustment into the market basket update for outpatient hospital services beginning in 2010. Sets a floor for the outpatient hospital market basket update so that the combination of the productivity adjustment and any adjustments for quality reporting cannot use the market basket update to go below zero. . . . Replaces the existing update for laboratory services of CPI minus 0.5 with an update of CPI less productivity, beginning in 2010." But the bill also acknowledges the merit of simple language. See Section 133, which, according to the summary, "requires the use of plain language in the disclosures (including the issuance of guidance as to what 'plain language' means). . . ." Monday's question-and-answer session started about 7 p.m. and lasted two hours. Participants described the questions as being all over the map. Members of the committees with jurisdiction over the bill have already had a chance to get granular on the details, but some of their colleagues on other committees are still trying to get up to speed. Rep. Christopher S. Murphy of Connecticut said there's no way to reform the health-care system with a few simple strokes. "This is a complicated problem, with a complicated solution," Murphy said. "If you're going to fix it, it's not going to come in four pages. The last Harry Potter book was 700 pages." | 
