The two top Democrats in Congress apparently are tussling behind the scenes over the deal to repeal and replace the Medicare physician-payment formula, and it may be because one feels left on the sidelines.
House Minority Leader Nancy Pelosi cooked up the $200 billion-plus plan behind closed doors with House Speaker John Boehner. There appear to be sufficient votes for passage in the House, which is typically where bipartisan deals go to die.
But when the bipartisan, bicameral bills to replace the Medicare sustainable growth-rate payment formula were released Thursday, one name was conspicuously missing: Sen. Ron Wyden (D-Ore.), the ranking member of the Finance Committee, and previously one of the foremost advocates of scrapping the SGR model.
Wyden issued a written statement laying out his reasons for not backing the bill. The primary one: It only includes funding for two years of the Children's Health Insurance Program. Democrats want a four-year extension.
But Wyden's letter also suggested that the deal reached by Pelosi presents a threat to abortion rights. “There has also been talk of including an abortion policy rider—a complete nonstarter that has no place in a bill about access to care for America's seniors and children,” Wyden wrote.
That's an inflammatory accusation given the importance of abortion rights to Democratic constituencies. “He screamed abortion in a Democrat theater,” said one veteran GOP Senate staffer, who didn't want to be identified. “That was nothing but inflammatory, with the absolute goal of messing with Pelosi's process.”
At issue is a provision adding $7.2 billion in funding for community health centers to the package to avoid a funding cliff that would have arrived at the end of September. It apparently includes language barring those funds from being used to pay for abortions accept in cases of rape or incest.
Today Pelosi fired back—albeit with the restraint appropriate for an intraparty squabble. “This proposed language represents no change in current policy for CHCs and would have no operational impact at the health-center level,” Pelosi wrote in a letter to her Democratic colleagues.
The National Association of Community Health Centers backs Pelosi's assessment, saying centers have never been able to use federal dollars for abortions except under those narrow circumstances. “It has no operational impact on health centers,” said Dan Hawkins, the group's policy director.
Which raises the question: What's really going on here?
The GOP Senate staffer suggested that Wyden was doing the bidding of Senate Minority Leader Harry Reid, who may have been upset that he was frozen out of a deal that's on the verge of being enacted. “Wyden's letter is not about abortion; Wyden's letter is not even about CHIP,” the staffer said. “Wyden's letter is about the minority leader suddenly realizing we might actually do policy around here.”
The staffer thinks it's a done deal regardless of whether Democratic Senate leaders eventually sign off on it. “Pelosi's letter really upped the pressure,” the staffer said. “If it's making it through the House, it's making it through over here.”