• WisPolitics

Monday, July 13, 2009

 12:38 PM 

'New Democrat' Kind has role in national health care reform

Western Wisconsin Congressman Ron Kind may not be a household name in health care policy. But as efforts to overhaul the nation's health care system move toward a climax this summer, sources inside and outside Congress say the moderate Democrat has quietly carved out a notable role.

Kind has co-sponsored two pieces of legislation that have a shot at being incorporated in whatever final version of health care reform is considered this year in Congress.

Kind told WisPolitics.com a bipartisan approach, rather than legislation that adheres to only the views of Democrats, works best.

"I still believe that Congress functions best when it works in a bipartisan fashion," he said. "That comes from listening."

One bill (H.R. 2502) addresses "comparative effectiveness" research -- that is, studies that compare various medical treatments in hopes of finding out which ones work most effectively and which ones should be discouraged. The measure Kind supports would establish an independent comparative effectiveness research trust fund and a board with 21 stakeholder representatives, including those from the medical profession and patients' groups, to oversee such research.

Backers of the bill see it, in part, as a way of rebutting claims by some Republicans that comparative effectiveness research -- which received $1.1 billion in this year's economic stimulus package -- is a slippery slope leading to bureaucrats deciding how a patient's ailments should be treated.

Supporters of H.R. 2502 say comparative effectiveness research is vital to the nation's future health care system -- as long as safeguards are provided.

The second bill Kind is supporting -- the Small Business Health Options Program, or SHOP, Act (H.R. 2360) -- would encourage small businesses and self-employed individuals to band together in a statewide or nationwide pool to obtain lower health insurance prices. It would also provide small business owners with a tax credit for sharing the cost of their employees' health care premiums, among other provisions.

The SHOP Act has attracted supporters ranging across the ideological spectrum, including such business groups as the National Federation of Independent Business, the National Association of Realtors and the National Restaurant Association, and such labor and liberal groups as the Service Employees International Union, Families USA and the National Partnership for Women and Families.

While Kind hardly has the clout of such key figures as Senate Finance Chairman Max Baucus, D-Mont., Senate Health, Education, Labor and Pensions Chairman Edward Kennedy, D-Mass., or House Energy and Commerce Chairman Henry Waxman, D-Calif., the seven-term Wisconsin lawmaker has influence for two distinct reasons.

Kind is a member of the House Ways and Means Subcommittee on Health, which is tasked with helping write a preliminary House version of health care legislation. However, because Kind is a junior member of that subpanel, it's arguably more important that Kind is a vice-chair of the New Democrat Coalition, a group of several dozen Democrats who have moderate-to-liberal views on domestic policy but who also maintain good ties to business.

The New Democrats -- the ideological heirs of the Democratic Leadership Coalition, which helped shape Bill Clinton's centrist approach when he first ran for president -- "are a significant group that the speaker and the key committee chairs will need to work closely with as they prepare a final bill," said Ron Pollack, the executive director of Families USA and a veteran of years of congressional skirmishing over health care policy. "The New Democrats have clearly wanted to make a mark on this legislation, and they undoubtedly will."

Robert Moffit, director of the center for health policy studies at the conservative Heritage Foundation, agreed that House moderates will play a role in whatever health care legislation emerges from Congress, even if conventional wisdom is correct in suggesting the Senate -- where lawmakers must meet a 60-vote threshold to overcome a filibuster -- will ultimately shape the bill more directly.

Moffit noted that a chunk of New Democrats, along with members of the somewhat more conservative Democratic Blue Dog Coalition, will likely provide the House Democratic leadership with the votes they'll need to pass health legislation. And if the recent 219-212 vote on cap-and-trade energy legislation is any indication, the House margin on a health care bill will likely be narrow.

"It's not so much that the House's decisions are decisive, but if you pass a bill by a close margin in the House, it strengthens the hand of moderate Democrats in the Senate," Moffit said. "If you pass the House bill by a one-vote majority, that says to moderate Democrats in the Senate that they have a real shot at shaping the final outcome."

Kind, in an interview, said the New Democrats place a high priority on overhauling the delivery system for health care. He noted the group's past efforts to advance the spread of health information technology, which received a major boost in the economic stimulus bill.

"We're for changing the incentives and reimbursements, rewarding value, not volume," Kind said. "Based on studies, there's incredible over-utilization. Thirty cents of every dollar spent on care and treatment doesn't improve patient health. That's where you go to find the savings that make wider coverage possible."

The SHOP Act provides an example of the approach Kind prefers. The bill grew out of efforts long promoted by the NFIB to allow "association health plans" -- the ability of trade and professional groups to offer their members health care plans across state lines, as corporations and unions already may do.

Despite years of aggressive lobbying by the influential small business group, it eventually became clear the legislation as written couldn't win passage. So NFIB and its allies decided to broaden their alliance by crafting what is now the SHOP Act.

The payoff from that rewrite was the support of groups like SEIU and Families USA -- and of lawmakers like Kind, who had gone so far as to sponsor alternative legislation to NFIB's association health plans bill in a previous Congress.

"On health care, Congressman Kind is a critical and welcome addition to the small-employer community," said Michelle Dimarob, NFIB's manager of legislative affairs for the House. "He does a very good job representing the needs of small business owners in affording and offering health insurance."

Observers say Kind's sensitivity to such issues stems from his Eau Claire- and La Crosse-based 3rd Congressional District, which is heavy with small businesses and small farms and for a long time was represented by GOP moderate Steve Gunderson.

La Crosse is also home to the Gundersen Lutheran Health System, which has shown interest in comparative effectiveness.

In general, Wisconsin and its lawmakers have taken an outsized role in health care policy this year. President Obama recently traveled to the perennial swing area of Green Bay to hold a health care town hall meeting, in part because studies have shown that some of the state's health systems rank high compared to the rest of the nation in controlling costs and improving patient outcomes. And two other members of the Wisconsin congressional delegation have been active on the issue -- Democratic Rep. Steve Kagen, himself a physician, and House Budget ranking GOP member Paul Ryan, who has focused attention on the price tag of overhauling the health care system.

Health care activists who have worked with Kind in Wisconsin give him high marks. Health policy is clearly "an issue that is near and dear to his heart," said Lisa Lamkins, advocacy director of AARP Wisconsin.

Robert Kraig, of the liberal group Citizen Action Wisconsin, said his group has worked extensively with Kind, including efforts to secure his support on a public option within health care reform -- a stance that separates most liberal Democrats from moderate Democrats.

"We haven't taken an official stance" on the comparative effectiveness bill or the SHOP Act, Kraig said. "But we think what he's trying to do is excellent. He's engaged and hopes to bring together a high-quality deal."

Kind also has a reputation as something of a maverick. His efforts, so far unsuccessful, to eliminate farm subsidies "have perplexed people in agriculture because dairy subsidies matter so much to his district," said Jerry Hagstrom, the ex-president of the North American Agricultural Journalists and an agriculture reporter for CongressDaily.

But Tony Coelho -- the former House Democratic whip who now chairs the Partnership to Improve Patient Care, a prime backer of the comparative effectiveness bill -- sees him as a staunch partner. "To have someone like Ron, who is considered an up-and-comer, is very significant," he said. "The New Democrats are a group of younger, aggressive members. They intend to be around for a while and want to be effective in Congress."

Members of Coelho's group run the gamut from major health care industry players (the Pharmaceutical Research and Manufacturers of America, Biotechnology Industry Organization) to medical specialty societies (cardiology, gastroenterology, urology) to patient advocacy groups (for autism, epilepsy, mental illness) and even a conservative legal group (the Washington Legal Foundation).

"We are supporters of comparative effectiveness research," Coelho said. "We just want to make sure it's done right. We don't want the government dictating to patients and doctors what kind of health care we should have. But we want the research done and to make sure that patients and doctors have it."

Michael F. Cannon, director of health policy studies at the libertarian Cato Institute, is skeptical.

"Generally speaking, whatever Congress tries to do on comparative effectiveness research is either useless or fails," Cannon said. "The reason it fails is that useful research poses a threat to the incomes of special interests. ... The government has proven it's not capable of producing a steady stream of useful research because politics always ends up winning the day."

However the health care debate plays out, some wonder whether Kind, 44, and his New Democrat colleagues will increase their clout in years to come, as the "old guard" of Democratic leaders exits the stage.

"Are the New Democrats truly a new generation of Democrats?" asked Alec Vachon, a former Republican congressional aide and an independent health care policy analyst in Washington. "As the senior guys peel off, are they going to have a different perspective, closer to that of moderate Republicans?"

In the meantime, it appears Kind will be a player in the ultimate answer to those questions.

- Louis Jacobson

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