Al Frumin’s Bad Day

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In the middle of a meeting in the early evening Wednesday on – what else? – reconciliation, the Senate Sergeant-at-Arms Terrance Gainer interrupted proceedings to speak with the Senate Parliamentarian. Though neither man would discuss what was going on, reports soon emerged: Tea Party protesters were planning to picket the Parliamentarian’s home. It has not been an easy week for Al Frumin, who instead of going home to be with his family spent all night in the Senate ruling on Republican challenges to the Democratic health care reform reconciliation amendments.

The reconciliation process has launched the non-partisan civil servant into the public eye. Republicans have questioned his integrity (a bit ironically since the man was appointed by Trent Lott) and this morning he’s not exactly popular with Dems. Frumin ruled during the all-night vote-o-rama session that two small GOP challenges to the bill were valid. Sixteen lines of text pertaining to the student lending provisions were struck from the measure, forcing Dems to send the bill back to the House for final passage. Identical legislation must pass both chambers before it can be signed into law by the President.

The Senate is expected to wrap up reconciliation by 2pm today, sending the bill back to the House. The lower chamber invoked a rare one-day rule in order to consider the amendments asap and pass them out tonight before they leave town for the two-week Easter recess. When Obama signs the amendments into law it’ll bring an end to final chapter of the Democrats’ year-long saga to enact health care reform. It’ll also give poor Mr. Frumin a chance to go home, get some sleep and return to a life of blessed anonymity.

Senate Democrats had hoped to avoid a final lob across the Capitol by just passing a clean bill. For more than two weeks a core group of staffers from leadership, the Budget Committee and the Finance Committee have been meeting to review language that would pass the Byrd Rule sniff test – a standard that requires that all provisions be germane to the underlying budget. The Dem strategy was to hold their caucus unified against any GOP amendments – forcing Democratic senators to vote against some fairly tough stuff like prohibiting sales of Viagra to sex offenders – while carefully constructing the legislative language to avoid another House vote. They succeeded in the former but failed in the latter. Thanks to a Democratic senior aide involved in the talks here a list of some of the casualties along the way – provisions that were cut as non-germane during the crafting of the bill:

1.      Rate Review Authority – This proposal prevented the insurance industry from making unwarranted and unreasonable increases to health insurance rates.

2.      Waste, Fraud, and Abuse – Although the reconciliation bill contains significant measures aimed at reducing waste, fraud and abuse in Medicare, the original draft of the bill contained several more.  For instance, one provision enabled the Centers for Medicare & Medicaid Services to prevent fraudulent activity by providers who had previously committed tax fraud.

3.      Prescription Drug Prices – The original draft of the reconciliation bill created a new drug discount program for inpatient drugs for certain entities like community health centers and other federal grantees.

4.      Medical Malpractice – The original reconciliation bill appropriated $50 million for medical malpractice reform efforts by States.

5.      Independent Payment Advisory Board (IPAB) – IPAB was established in the Patient Protection and Affordable Care Act (PPACA) to make recommendations on reducing Medicare payments by determining the most efficient and effective ways of providing high quality health care.  The reconciliation bill contained provisions to enhance and modify IPAB, increasing its ability to save the government money.

6.      Prevention Coverage – The original draft of the reconciliation bill would have required existing group plans to cover preventive services starting 2018.

7.      Striking Tobacco Rating – The original draft of the reconciliation bill disallowed health insurers from assessing higher premium rates for tobacco users.

8.      Education – The education provisions in the original reconciliation bill were significantly revised, with several programs being scaled back or removed.