When congressional Republicans and the White House get ready to sit down to negotiate a balanced-budget plan, a group of conservative House Democrats could be the tail that wags the dog.
The "Blue Dog" Democrats are a group of conservative pragmatists who often look and sound more like the Republican leadership than the more liberal Democratic House leadership. The name "Blue Dogs" is a takeoff on the phrase "Yellow Dog" Democrat used to describe Southerners who would vote for a yellow dog before a Republican.
Last year, the Blue Dogs had a balanced-budget plan of their own that had the endorsement of a number of provider groups. They were never able to reach agreement with the GOP leaders on a consensus plan, but they emerged as potential dealmakers.
Now the Blue Dogs are back again, 21 members strong, and according to one of their co-chairs, Rep. Collin Peterson (D-Minn.), they will reintroduce their budget plan early next year.
More important than the details of the plan is the potential influence the Blue Dogs could wield next year. Because the Republicans lost seats in the November election giving them a slim, 19-seat majority in the House (down from more than 30 seats in the last Congress) it's possible the Blue Dogs could tip the balance of power.
"(The Blue Dogs) could be very important to the process," said Richard Pollack, executive vice president of federal relations at the American Hospital Association. "How important they are depends on whether they choose to get involved with the White House to try to influence the budget upfront or hold their votes back until the end to maximize their influence."
The AHA, VHA, Premier and other hospital groups all endorsed the Blue Dogs' plan during last year's budget negotiations. The bill would have reduced projected Medicare spending by about $158 billion over seven years. Medicare would have been opened to allow provider-sponsored organizations to enroll beneficiaries directly under favorable federal guidelines. The conservative Democrats also called for a commission to review the Medicare budget each year.
The Medicaid reforms proposed by the Blue Dogs would have retained Medicaid as a federal entitlement. Provider groups opposed the Medicaid reforms in the GOP budget plan, which would have ended the Medicaid entitlement.
The Blue Dogs seem to be making a mark already. In a recent television interview, House Minority Leader Richard Gephardt (D-Mo.) praised the group as having "set out most of the budget priorities for the Democratic Party."
According to Peterson, those priorities will include reductions in projected Medicare spending of $120 billion to
$130 billion over five years. The Medicare provisions in the new Blue Dog plan, mostly the same reforms as last year's proposal, include the PSO measure. Peterson said the Medicaid provisions are less clear, but the Blue Dogs are convinced that keeping the entitlement is necessary.
According to James Scott, president of the Premier Institute in Washington, the proposal is likely to be one that providers will again support. "I would be very, very surprised if they come up with a plan we couldn't embrace wholeheartedly," he said.