Rep. Debbie Wasserman Schultz (D-Fla.), the Democrats’ chief deputy whip in the House, said that she and other pro-abortion rights lawmakers would work to strip the amendment included in the House health bill that bars federal funding from subsidizing abortions.

“I am confident that when it comes back from the conference committee that that language won’t be there,” Wasserman Schultz said during an appearance on MSNBC. “And I think we’re all going to be working very hard, particularly the pro-choice members, to make sure that’s the case.”

House Democrats put themselves into a pickle over the weekend when they accepted an amendment, sponsored by Rep. Bart Stupak (D-Mich.), prohibiting abortion coverage, not only in the public plan being proposed in the House health reform bill, but also in the subsidized private plans found on the newly proposed insurance exchange. Stupak and other moderate Democrats want assurances that no federal funds will go to provide abortions, and they’ve hinged their support for the overall bill on the inclusion of that ban.

Liberal lawmakers in support of abortion rights, however, are also vowing to kill the overall bill unless the Stupak language is removed. One side will have to give, or the entire health reform effort goes up in flames.

Although House liberals voted for the bill with the amendment to keep the process moving forward, Rep. Diana DeGette (Colo.) said she has collected more than 40 signatures from House Democrats vowing to oppose any final bill that includes the amendment — enough to block passage.

“There’s going to be a firestorm here,” DeGette said. “Women are going to realize that a Democratic-controlled House has passed legislation that would prohibit women paying for abortions with their own funds. . . . We’re not going to let this into law.”

And the White House thought the public option was going to be the highest hurdle …

Rep. Lloyd Doggett (D-Texas)

Last week, as House Democrats took to the floor with near-unanimous praise for legislation to help the unemployed and stimulate the fragile economy, Rep. Lloyd Doggett (D-Texas) offered a wildly different message.

“This bill,” he said, “represents a textbook example of how not to deal with the economic challenges that our country faces.”

The Texas Democrat wasn’t talking about the extension of unemployment benefits at the heart of the bill, but an amendment providing the nation’s businesses — even the largest corporations — with tens-of-billions of dollars in tax rebates to stem recent losses. That provision, Doggett claimed, is less an economic stimulant than it is “a corporate giveaway” at the expense of taxpayers. It didn’t help the congressman’s mood that the Democrats’ bill allocates more than four times the funding to the business tax than it does to extending unemployment insurance.

“Today’s bill allocates $2 billion to the winner and $10 billion to the loser,” he said.

Indeed, although the jobless benefits are the centerpiece of the Democrats’ bill, they represent a mere $2.4 billion of the spending, according to the Congressional Budget Office — or just 10 percent of the $24 billion proposal. Nearly half of the money — $10.4 billion — will go toward the so-called loss carry-back extension, which will allow businesses, both large and small, to apply any losses suffered in 2008 and 2009 to income made in the previous five years, three years longer than current law allows. The result will be tax refunds topping $33 billion next year, according to the Joint Committee on Taxation.

Yet another amendment, to extend a popular $8,000 tax credit for new homebuyers, will cost $10.8 billion over a decade, JCT estimated.

Supporters of the two tax breaks — including Senate Majority Leader Harry Reid (D-Nev.) and Senate Finance Committee Chairman Max Baucus (D-Mont.), the bill sponsors — argue that they’ll help prop up businesses in the midst of the worst unemployment crisis in 26 years.

Yet an analysis of a similar bill by Mark Zandi, chief economist at Moody’s Economy.com, indicates that, in terms of bang-for-the-buck, the lopsided allocations in the stimulus bill are dubious. Indeed, for every dollar spent on the business tax rebate, just 21 cents are returned to the larger economy, according to Zandi. By contrast, the homebuyer tax credit returns 90 cents on the dollar, he found, while the unemployment extension returns $1.61.

Heidi Shierholz, economist at the liberal Economic Policy Institute, said that there’s “no economic rationale” for the business tax rebate. “For whatever reason that [provision] got in there,” she said, “it has nothing to do with stimulating the economy.”

At the start of the debate, it wasn’t in there. Indeed, when the House passed its unemployment extension bill in September, the $1.2 billion proposal stood alone. It was in the Senate, after weeks of delay over controversial amendments, that Democratic leaders decided to sweeten the pot by adding the two tax breaks. Leading up to the upper-chamber vote, Sen. Tom Harkin (D-Iowa) explained the Democrats’ position.

“The two were put together as a means of greasing the skids,” Harkin told the Huffington Post last week. “You know how things work around here. Could we have gotten UI through otherwise? Yes, we could have, but it would have taken us several days. And we don’t have that kind of time. And the minority is then able to, because of the time, demand certain things.”

Meanwhile, the nation’s unemployment rate jumped to 10.2 percent in October — the first time it’s topped 10 percent since 1983. When those who have stopped looking for work are considered, that number tops 17 percent.

Washington Post business columnist Steven Pearlstein, a Pulitzer Prize winner, said the carry-back provision, far from an effective stimulus strategy, will merely “delay the inevitable downsizing and consolidation of these industries.”

“The perverse effect,” Pearlstein wrote, “will be to reward the companies that failed to pay down debt and squirrel away cash when times were good and, by artificially keeping them alive, punish the competitors that did.”

Even some conservative economists are doubting the stimulating effect of the loss-carry back provision. Desmond Lachmann, economist at the American Enterprise Institute, said the $33 billion spent next year is simply too small, relative to the larger economy, to stimulate much growth.

“We are talking about 0.2 percent of GDP,” he said.

Doggett took a harsher angle, accusing his colleagues of rewarding the very companies that caused the recent downturn.

“This bill,” Doggett said, “now directs the Treasury to essentially write a check directly to corporations for more than $10 billion — checks to corporations that have committed fraud, checks to corporations that have no ability to create jobs because they have no employees and exist solely on paper as a fiction. It rewards some of the very corporate losers who have brought us to the brink of economic ruin.”

No matter. The House passed the bill 403 to 12, with even Doggett voting in favor. The Senate had passed the bill the day before, 98 to 0.

On Friday, President Obama signed the measure into law.

Right up until Saturday, passage was still in doubt due to resistence from conservative-leaning Democrats, who wanted stronger assurances that the proposal wouldn’t allow federal funding of abortions. Behind Rep. Bart Stupak (D-Mich.), those conservatives urged a floor vote on an amendment explicitly prohibiting such funding. They got it. And it passed 240 to 194.

That didn’t please the abortion-rights crowd — “to force insurance companies to deny a woman access to a legal procedure, would be a very disturbing step backwards,” said Rep. Earl Blumenauer (D-Ore.) just before he voted no – but it did clear the way to passage of the overall bill.

The Washington Post hits the highlights of the legislation:

Starting next year, private insurers could no longer deny anyone coverage based on preexisting conditions, place lifetime limits on coverage or abandon people when they become ill. Insurers would be required to disclose and justify proposed premium increases to regulators, and could not remove adult children younger than 27 from their parents’ family policies.

For the elderly, the group that has been most skeptical of Obama’s initiative, the House package would immediately offer discounts on prescription drugs and reduce a gap in Medicare prescription drug coverage, closing it entirely by 2019. Uninsured people who cannot get coverage could join temporary high-risk insurance pools, and unemployed workers would be permitted to keep their COBRA benefits until the public plan and insurance exchanges started in 2013.

Most Democrats — beginning with President Obama — hailed the bill’s passage as a watershed moment in the nation’s history. The proposal, Obama said, “would finally make real the promise of quality, affordable health care for the American people.”

Not all Democrats were convinced. Rep. Dennis Kucinich (D-Ohio), who voted against the measure, said it represents a giveaway to the same insurance industry that’s helped make the health care system dysfunctional. “We cannot fault the insurance companies for being what they are,” he said. “But we can fault legislation in which the government incentivizes the perpetuation, indeed the strengthening, of the for-profit health insurance industry, the very source of the problem.”

The ball is now in the Senate’s court, where lawmakers are expected to begin debate on their own enormous health reform proposal this month. That floor procedure, though, will take much longer than a single day.

Senate Majority Leader Harry Reid (D-Nev.) has asked members of the Banking Committee for their consent to move the bill directly to the Senate calender without the panel addressing it first. The move is an indication that Democratic leaders want the option to consider the bill at any time, though it doesn’t guarantee that they’ll do so.

There’s no word yet from Banking leaders if that consent has been granted. Still, the strategy is significant because if Republicans want to block the motion, they’ll have to go on the record to do so.

The legislation, sponsored by Sen. Mark Udall (D-Colo.), is designed to tackle a problem the Democrats themselves created.

The credit card reform legislation that Democrats pushed through Congress in May aims to eliminate the most abusive practices adopted by credit card issuers. It bans, for example, a number of hidden fees and prohibits companies from applying rate hikes to existing balances. Yet most of those reforms don’t take effect until late February. To beat the deadline, many companies have raised fees and rates while it’s still legal to do so.

So now Democrats, themselves responsible for delaying the reforms, are trying to get them installed more quickly. The House on Wednesday passed a bill to bump up the implementation date to Dec. 1. The Udall bill proposes the same expedited timeline.

Stay tuned…

As expected, President Barack Obama this morning signed into law a bill extending benefits for out-of-work Americans who have exhausted their unemployment checks or will do so by year’s end.

Only 45 days after the House first passed the bill.

No shocker here. America’s Health Insurance Plans has long feared the consequences to business if Congress created a public insurance plan to compete with private companies — a public plan like the one contained in the Democrats’ bill. Indeed, that seems to be the central reason for AHIP’s opposition.

“We share the concerns that providers, employers, and patients have raised about the significant disruption a new government-run plan would have on the current health care system,” AHIP President Karen Ignagni wrote in the letter. “A new government-run plan would bankrupt hospitals, dismantle employer coverage, exacerbate cost-shifting from Medicare and Medicaid, and ultimately increase the federal deficit.”

Ignagni can at least be happy that liberal Democrats have abandoned their push for a single-payer system.

Rep. Anthony Weiner has been one of the most tireless and effective advocates for health care reform. His decision not to offer his amendment on the floor was a difficult one for him, and for supporters of the measure. I believe Rep. Weiner’s choice will be enormously helpful in passing the health care reform package. His step is a correct and courageous one. I thank Rep. Weiner for it, and look forward to working with him closely. Rep. Weiner deserves a great deal of credit for helping to make quality, affordable health care more available to millions of Americans.

The decision might please Democratic leaders, but it won’t make Rep. Dennis Kucinich happy. The Ohio Democrat, who has also pushed tirelessly for single-payer health coverage, wondered yesterday how the proposal’s popularity can even be gauged without giving lawmakers the chance to vote on the measure.

“To those who want a stand-alone vote on single payer now, I want to ask this question,” Kucinich said on the House floor. “Is this a time to plant or a time to reap? What fruit will be borne from a tree that has received no light and no water in this Capitol?”

Speaker of the House Nancy Pelosi (D-Calif.) (WDCpix)

How effectively will the House health care bill cover children? Turns out, it depends on where they live.

The $894 billion health reform bill working its way toward a House vote this week would repeal the Children’s Health Insurance Program, shifting some low-income kids into Medicaid and others into private plans that would both cost more and guarantee fewer benefits. Which program the youngsters tumble into hinges, not on need, but on the state where they live – a design some advocates call “the lottery of geography.”

Image by: Matt Mahurin

Created in 1997, the state-federal CHIP partnership was designed to cover kids in families too wealthy to qualify for Medicaid but not wealthy enough to afford private insurance. States were granted broad discretion to fashion the program to fit their needs, with some carving out a separate CHIP program, some using CHIP funds to expand Medicaid eligibility, and still others opting for some combination of the two.

The House bill, which would eliminate CHIP in 2014, approaches those models very differently. While it expands Medicaid eligibility to 150 percent of poverty and shifts all kids living above that level to private plans contained on a proposed insurance marketplace, or exchange, the proposal also carves out an exception in states which augmented Medicaid in lieu of creating a separate CHIP program. In those cases, the youngsters would remain in Medicaid.

The distinction carries both coverage and cost implications. Under current law, all state Medicaid programs are required to offer a blanket system of preventative care known as the early periodic screening, diagnosis and treatment program, or EPSDT. The exchange plans, on the other hand, don’t have the same mandate. (Although states with stand-alone CHIP programs are not bound to cover EPSDT services, some of them do.)

And because states have vastly different income-eligibility levels for Medicaid and CHIP, the House bill offers no guarantee that the most vulnerable kids would receive the most robust benefits. In New Jersey, for example, Medicaid covers youngsters up to 200 percent of poverty, at which point CHIP takes over and covers kids up to 350 percent. Minnesota, by contrast, covers kids up to 275 percent of poverty under Medicaid but has no stand-alone CHIP plan.

The result? Children living at 275 percent of poverty in Minnesota would, under the House bill, still pay almost nothing for care under Medicaid — including EPSDT coverage — while families living at the same income level in New Jersey will be responsible for 22 percent of the cost of their exchange plans, without the assurance of EPSDT services.

The patchwork has led some state health departments to support the House proposal and others to oppose it.

“My members are split,” said Ann Kohler, director of the National Association of State Medicaid Directors.

Still, there are more New Jerseys out there than Minnesotas. Currently, about 5.3 million (or 72 percent) of the 7.4 million CHIP kids live in states with stand-alone CHIP programs, according to Georgetown University’s Center for Children and Families.

“They’re going to be paying a lot more out of their pockets and getting fewer benefits,” warned Alison Buist, director of child health at the Children’s Defense Fund.

Supporters of the shuffle from CHIP to private plans argue that it will increase enrollment by allowing entire families to gain coverage under the same plan. They also point out that CHIP must be reauthorized every few years, leaving the very existence of the program to the fancy of Congress. Still, the proposal to repeal CHIP has put Democrats in the uncomfortable spot of defending the elimination of a program they spent much of the last two years fighting to preserve.

Then there’s the cost issue. A recent report conducted by Watson Wyatt Worldwide, a financial consulting firm, found that most CHIP enrollees living at 175 percent of poverty pay nothing at all for their health services, while those living at 225 percent pay about 2 percent of costs. Shifted into private plans on the exchange, the researchers found, those same families would pay between 5 percent and 35 percent of health costs, respectively — a situation “greatly increasing their financial burden and leaving low-income children worse off as a result of health reform.”

Indeed, examining a similar CHIP repeal offered in the Senate, Congressional Budget Office Director Douglas Elmendorf recently noted that “some of those children would be eligible for subsidized coverage in the exchanges but would not be enrolled in an exchange plan (owing at least in part to the higher premiums and higher out-of-pocket costs that they would typically face in such a plan).”

Some House lawmakers recognize the potential problems. During the markup of health reform legislation in the Education and Labor Committee, for example, lawmakers passed an amendment — offered by Rep. Bobby Scott (D-Va.) — requiring that all exchange plans offer EPSDT services. That proposal, however, was stripped out in the final bill.

Another amendment, offered by Rep. Diana DeGette (D-Col.), would have prevented the shift from CHIP to private plans unless the White House provided certification that the private plans offered comparable benefits. That proposal passed the Energy and Commerce Committee, but was also removed in the final bill.

DeGette’s office said earlier this week that the certification language was removed “to reflect some budgetary constraints.”

Not that the end of CHIP is final. In the Senate, members of the Finance Committee last month passed an amendment to reauthorize CHIP through 2019. The sponsor of that amendment, Sen. Jay Rockefeller (D-W.Va.), is already vowing to fight for that provision all the way to the White House.

“We need to make sure children can keep their CHIP coverage and not be forced into untested private coverage,” Rockefeller said in a statement this week. “Health care reform should improve the coverage children have — not take their coverage away.”

In a little-mentioned move, Democratic leaders stripped the so-called doc-fix provision — which costs $210 billion over 10 years — out of the larger bill in order to keep costs below the magical $900 billion ceiling established by the White House earlier in the year. AMA is endorsing the idea that both would be passed simultaneously. From the letter:

Concurrent passage of [the two bills] represent a critical step in the legislative process that will enable further refinement of policies to lay a solid foundation for achieving our shared goal of assuring high-quality, affordable health care coverage for all Americans.

As a cautionary tale, the Senate tried to pass the doc fix separately last month, and it didn’t go so well.