Magazine article Nation's Cities Weekly

Congress Turns Attention to Health Care Reform Proposals: Outcome Could Have Big Impact on Local Government Budgets

Magazine article Nation's Cities Weekly

Congress Turns Attention to Health Care Reform Proposals: Outcome Could Have Big Impact on Local Government Budgets

Article excerpt

Senate Majority Leader George Mitchell (D-Maine) kicked off the health care debate on the Senate floor last week. He warned:

"There is a crisis in American health care. It is a crisis of affordability and access to care. It must change."

Congress scrapped plans for its annual August vacation this week to focus attention on changing the national health care system--the one issue doing more to drive up the cost of government at the local, state, and federal level than any other.

The debate, covered on CSPAN and carried live by National Public Radio is, is historic. It is the first time there has been such a massive effort to change access to benefits in more than a generation. This week, the debate is expected to occur on both the House and Senate floors.

The debate will focus on a four major proposals in the House and two in the Senate. Some of the proposals have not yet even been made public. Each and every one will have a significant impact on municipal elected officials and the cities and towns they represent.

If the debate within the administration and committees so far is any guide, however, city leaders should expect little discussion of the impact of these proposals on local governments--even on the most basic of questions.

More than almost any other player, cities will be affected--as employers, as the site where many, many citizens are employed by the health care industry, and as the final providers of emergency medical services. Yet, despite the fact that state and local governments now employ more Americans than the manufacturing sector of the United States economy, few in the Congress have asked or thought about how these different proposals would treat cities. For the most part, the bills and proposals would not provide equal treatment.

So far there has been little consideration of what these bills would mean to cities, whether relief to small employers should include small cities, or whether cities and towns could continue to protect their own budgets through pooling and self-insurance. City leaders should watch this debate as it unfolds to see if their representatives answer some of the questions posed on this page.

The debates then will be important. They will be public. And both the House and Senate leadership have vowed to keep Congress in session until each House has acted.

For municipal leaders watching this debate, and watching to see if their representatives raise municipal issues to ensure they are addressed, the debate will unroll differently.

In the House, the debate will be shorter and more focused. There will be much debate and discussion about the rules governing that debate--as opposed to in the Senate where debate will not be limited. The first debate in the House will be over the proposed leadership rules setting the terms of the debate, the so-called "King of the Hill."

Bills in the House may only be taken up under debate rules set by the Rules Committee and adopted by the full House. House Democratic leaders have proposed that the House take health care up on August 15 and conclude by the 19th--with the possibility of the time frame slipping by as much as a week. They have proposed that the debate be essentially limited to four alternatives and that, using the "King of the Hill" method, the last alternative considered which receives a majority would be the winner--even if that majority is smaller or less than an earlier alternative. …

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