On July 31, 2009, the House Energy and Commerce Committee voted to approve the America’s Affordable Health Choices Act of 2009 – commonly known as the House Tri-Committee bill. The Tri- Committee bill was approved by a vote of 31 – 28, with five Democrats and all 23 Republicans voting against the bill. With a bill to go to the floor of the House of Representatives for a full vote soon after Labor Day. Congress has taken an historic step toward enacting health care reform legislation and President Obama has achieved a modest victory.

The Tri-Committee bill easily won approval by the House Committees on Ways and Means and Education and Labor with votes along party lines. However, winning approval at Energy and Commerce proved much more challenging. The Tri-Committee bill met vigorous objections from fiscally conservative Democrats in the Blue Dog Coalition who have enough seats on the Energy and Commerce Committee to block approval. These objections escalated to a very public and contentious clash of ideologies that threatened to derail passage of the Tri- Committee bill by the House.

By Wednesday of last week, four members of the Blue Dog Coalition and Henry Waxman, Chairman of the Energy and Commerce Committee, had reached a compromise on key sticking points in the Tri-Committee bill. The accord was facilitated by White House Chief of Staff, Rahm Emanuel, and Director of the White House Office of Health Care Reform, Nancy-Ann DeParle. The bill that emerged from Committee on Friday supplemented the deal struck with the Blue Dog Coalition in an attempt to gain wider Democratic support. Some notable features of the Energy and Commerce Committee’s version of Tri-Committee bill, which is an attempt to appease a diverse group of, at least, Democratic interests, include:

  • A public plan option, but one which must negotiate with providers based on commercial market rates (not a mandated Medicare fee schedule).
  • A government-mandated health benefit package – with standardized comprehensive coverage – which is required to be offered by all health insurers through an exchange.
  • The elimination of pre-existing condition exclusions and underwriting guidelines that could deny coverage to some Americans.
  • A cap on increases in health insurance premiums, absent government approval.
  • Federal government subsidies to low income families to help them afford health insurance.
  • The ability of the government to negotiate directly with drug companies under Medicare Part D.

In a separate vote on an amendment to the bill, expensive biologic drugs (i.e., drugs made from living cells to fight cancer, rheumatoid arthritis and other chronic conditions) would receive 12 years of exclusivity protection before a competing lower cost generic drug could be offered in the marketplace. Although President Obama had pushed to limit exclusivity to seven years, the 12-year exclusivity protection is viewed by many as an effective way to promote competition and lower drug costs.

The House of Representatives still needs to reconcile each version of the Tri-Committee bill approved by the House Committees before a bill is ready to be voted upon by the entire House. Despite the progress made last week, passage of the House Tri-Committee bill is not a foregone conclusion. The détente between the Blue Dog Coalition and Chairman Waxman was not wide-reaching and liberal members of the House are still decrying the weakening of the public plan option. Furthermore, the Tri-Committee bill will have to pass the test of public opinion during a month-long Congressional recess that will create plenty of opportunities for comment by advocacy groups and the general public. This time soon may be known as the long hot summer for health care reform.