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Watchdogs Concerned About Pork in Senate Health Reform Bill

Joe Cantlupe, for HealthLeaders Media, January 21, 2010

The Nebraska senator who gave the Democrats what they wanted on health reform now doesn't want what they want to give him in return.

After waves of protest about the potential illegality of the deal in which Nebraska was allegedly promised millions of dollars in Medicaid funds, Sen. Ben Nelson, D-NE, told Democratic leadership he "reiterates" that all states should be given "the same treatment." In other words, he told his colleagues "thanks, but no thanks."

So far, there has been no response from party leaders.

But Nelson is one of the few lawmakers refusing what many describe as "pork" projects in the healthcare reform bill, in which pet projects and favors are heaped on the Senate and House members in exchange for their votes, according to David Williams, vice president of watchdog group Citizens Against Government Waste.

"It's fascinating because whatever Congress does—whether they are working in a conference, or whatever—deals are being made," Williams says. Too often, many of the projects slip below the mass media radar because they "don't have sex appeal. "

The "giveaways"—as Citizens Against Government Waste describes them"—include:

  • $300 million in Medicaid subsidies for Louisiana. It was a favor for Sen. Mary Landrieu, D-LA, who provided one of the last remaining votes needed by Democrats in the Senate.
  • A proposed grandfather clause would allow Florida residents to get a discount in Medicare Advantage. The Tampa Tribune reported that 80,000 Floridians would be impacted by the proposed cuts—as well as thousands of other residents in New York, California, New Jersey, and Oregon.
  • A proposal would restore a Medicaid Disproportionate Share Hospital (DSH) allotment to support Hawaiian hospitals that care for significant numbers of Medicaid and uninsured patients. The proposal is expected to provide $100 million for Hawaii hospitals through 2019. The state of Hawaii will have to provide matching funds to draw down the federal money.
  • One proposal amends the Medicare Prescription Drug, Improvement and Modernization Act of 2003 so that hospitals in Michigan and Connecticut have an option to receive benefits under section 508 if it means higher payments. Section 508 corrected geographic inequities in wage index-related payments for approximately 120 hospitals, but only for a three-year period.
  • The proposal calls for Medicare coverage for individuals exposed to environmental health hazards in or around the geographic area subject to an emergency declaration as of June 17, 2009. This addition is seen to help the town of Libby, MT. According to the Washington Post, "Sen. Max Baucus, D-Mont. secured Medicare coverage for anybody exposed to asbestos—as log as they worked in a mine in Libby, Montana."

Under the Senate health bill compromise that sought Nelson's support, Nebraska was blessed with other presumed favors, according to critics. For instance, under the plan, Nebraska insurance company Mutual of Omaha would see less impact from a $10 billion-a-year industry-wide tax on health insurance providers under a deal worked out between the Senate Democrats and Nelson. There is no indication that Nelson has sought to rescind the Mutual of Omaha deal.

Already, favors that have become widely publicized have taken a life of their own, with their own special monikers, including the "Louisiana Purchase, " referring to Sen. Landrieu's vote and the "Cornhusker Kickback Working Group," regarding the Nebraska issue, according to Williams. He adds that other favors are woven through complicated legislation, such as Medicaid payment, and are barely noticed.


Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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