When President Barack Obama signed the federal health care reform bill last Tuesday, one Democratic Congressman from Wisconsin was notably absent. Rep. Ron Kind (D-La Crosse) was elsewhere. Or as his spokeswoman told the Milwaukee Journal Sentinel, “He’s just not there OK.”
Kind might be forgiven his absence considering candidate Obama’s promise during the presidential campaign to allow the American people five days to review non-emergency legislation prior to signing it. Kind was probably looking forward to attending the ceremony on Saturday.
Of course, until eight days ago there was a chance that Kind would not have been at the bill signing because he voted in opposition. Kind’s Hamlet routine leading up to the vote was well documented by the MacIver Institute. As far as Democrats were concerned when doing their whip counts, Kind was “just not there.”
Prior to the vote, Kind signaled what it would take for the Democrats to get the vote home. Kind wanted changes in the Medicare reimbursement formulas that would benefit Wisconsin. Under the Senate bill, Medicare reimbursement would change in 2013 after recommendations by the Institute of Medicine and approval of Medicare officials.
At the last minute, House Speaker Nancy Pelosi made a change to the bill to increase Medicare payments by $800 million over the next two years to hospitals and physicians in Iowa, Wisconsin, Oregon and several other states. Section 1109 provides $400 billion in additional payment to hospitals located in counties in the bottom quartile as ranked “by risk-adjusted spending per Medicare enrollee.” Section 1108 also adds $400 billion.
Politico reported on the eve of the vote Pelosi’s change brought in at least three votes for federal health care reform, including Reps. Peter DeFazio of Oregon, Bruce Braley of Iowa, and Ron Kind of Wisconsin. As many as ten members total may have changed over to the “yes”column as a result of the changed reimbursement rate.
However, some critics are already questioning whether increasing Medicare payments is a step in the right direction since the federal health care reform law is supposed to reduce the federal deficit. The law accomplishes this by reducing Medicare spending by $400 billion over the next ten years. Increasing Medicare reimbursement in the short term is certainly counter to that goal, and sets the precedent for dismantling the future reductions in Medicare called for in the law.
Stephen Zuckerman, a senior fellow and health economist at the Urban Institute, questioned why low cost hospitals in the Midwest were receiving increased reimbursement. Zuckerman, who previously testified before Congress in favor of regional disparity of Medicare reimbursement, said, “The question is whether low-cost hospitals should be rewarded with higher payments or whether high cost hospitals should be penalized with lower payments.”
But of special concern to Wisconsin’s seniors is the change to Medicare part B as a result of Section 1108. Republicans on the House Ways and Means Committee say the increased reimbursement comes at a steep cost to seniors. Part B premiums will cost seniors $100 million more. Seniors living in the areas of the increased reimbursement, including seniors in Kind’s district, will have to pay a 20% copayment on the higher reimbursement rates.
The price of Kind’s vote for the federal health care law is increased Medicare costs, a precedent in dismantling any possible deficit reduction from the law, a reimbursement policy that does not encourage lower costs, and a nice chunk out of the fixed budgets of the seniors living in Kind’s district.
With his absence from the signing ceremony, Kind’s constituents didn’t even get one of President Obama’s pens.
On the other hand, Kind’s constituents may think he saw enough of the White House before the bill passed.
By James Wigderson
Special Guest Perspective for the MacIver Institute