Voter frustration with a lack of transparency in the creation of national health care legislation has prompted House Energy and Commerce Committee Chair Henry Waxman (D-CA) to join a Republican colleague in asking the White House to provide significant new information on the process by which the legislation was drafted.
The decision comes after the White House failed to respond to a written request from Rep. Michael Burgess (R-TX) on September 30, 2009 to disclose “all agreements entered into with health care stakeholders; a list of all decision-makers within the White House on such deals; and, a list of all people and groups who requested a meeting regarding health care, but were refused.”
Rep. Burgess, a physician with a particular interest in health care policy, subsequently introduced a legislative “resolution of inquiry,” which would have required the president to hand over this information. Chairman Waxman promised to work with Burgess to press the White House to voluntarily disclose significant new details.
‘Best Interest of the Public’
“Call them gentleman’s agreements, backroom negotiations, or power politics—we know they happened. What we don’t know is what was agreed to.… There is nothing inherently wrong with the President engaging on such an important topic or encouraging groups to act in the best interest of the public,” Burgess said during a committee hearing on January 27, 2010. “But we don’t know if the deals struck were in the best interest of the public. Even worse, these deals circumvented the legislative process.”
According to Burgess, early on in the health care debate the White House opened a dialogue with many health care stakeholders as policymakers attempted to earn the support of major interests with the clout to assist in passage of an overhaul or to block it. The American Medical Association provided valuable backing, as did the Pharmaceutical Research and Manufacturers of America (PhRMA), the AARP, the American Nurses Association, and others.
Burgess believes the process by which these groups decided to offer their support was far from transparent.
PhRMA Support Examined
According to research conducted by government transparency advocates at the Sunlight Foundation in Washington, DC, PhRMA elected to endorse the health care overhaul only after President Obama guaranteed he would oppose any bill that sought to reduce drugmakers’ profits beyond a negotiated bottom line.
The American Medical Association worked in favor of the bill, but at the same time received assurances from Democrat leaders they would increase reimbursement rates for physicians participating in Medicare, the Sunlight report observed. Other groups were likewise reported as receiving valuable legislative concessions in return for their endorsements.
“Every time it seemed like someone was trying to push an idea on whatever—be it reimportation [of prescription drugs] or taxing hospitals—they said, ‘no, wait a minute, that’s not part of our deal.’ And then we really saw it with the excise tax on the union plans,” Burgess said.
Numerous Deals Cut
Many deals were cut in attempts to pass the health care legislation. Language was crafted on the public option in the House to satisfy progressive Members of Congress and the interest groups that support them.
Similarly, a provision was drafted to assuage the concerns of the Conference of Catholic Bishops, and when it was adopted the Conference endorsed the legislation. That endorsement reportedly won enough votes to carry the bill to passage in the House.
Other lawmakers supported the bill only after their states received additional federal dollars for key programs. Senators Mary Landrieu (D-LA) and Ben Nelson (D-NE) came under fire in the press for withholding their votes until they received assurance of additional federal money for their states.
The blowback for Sen. Nelson about the so-called “Cornhusker Kickback” was so strong he requested the exemption he had negotiated be removed from the final bill.
‘An Ugly Process’
Burgess believes passage of the health care package was built on a series of deals with interest groups and Members of Congress. Since none of these deals was arrived at in a fully transparent fashion, the cumulative effect was enough to cause significant concern that some of these deals may have been tainted by corruption or conflicts of interest.
In an interview with Diane Sawyer on January 24, President Obama acknowledged the questionable path of the health care reform legislation, saying, “[T]he health care debate as it unfolded legitimately raised concerns not just among my opponents, but also amongst supporters that we just don’t know what’s going on.… And it’s an ugly process, and it looks like there are a bunch of backroom deals.”
Jim Waters, director of policy for the Bluegrass Institute in Bowling Green, Kentucky, said while the Waxman inquiry has the potential to unearth significant new information, it is unlikely to prevent future dealmaking of this kind.
“Moving forward, I think we have to have honesty and transparency, which isn’t business as usual. We have to know what really is being planned. It has to all be put on the table. So far, we’ve had a lot of secrecy and backdoor attempts to try to increase government involvement in health care. There’s no reason to really be optimistic about this,” said Waters.
Brian Faughnan ([email protected]), a former staffer on Capitol Hill, writes from Virginia.
Sunlight Foundation: The White House PhRMA Deal: http://blog.sunlightfoundation.com/2010/02/12/the-legacy-of-billy-tauzin-the-white-house-phrma-deal/