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An interview with Rep. George Miller

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Rep. George Miller is chairman of the House Education and Labor Committee, which was one of the three committees that reported out a health-care reform bill. As such, he was one of the key players in merging the three bills together. We spoke today about the process that led to this bill, what comes next, and how Obama's big health-care speech made everything more complicated.

Walk me through the process that resulted in this bill. Who was in the room for these meetings? What were the points of contention?

Under this speaker's leadership, everybody was in the room at one time or another. When people returned from the August break, she began meeting with various groups and caucuses to ask them what they heard and thought and needed. That process continued up until yesterday afternoon. Through that, we spun out working groups to work on regional disparities, on value-based medicine, on cost. There was a lot of concern, as you know, on the deficit and long-term cost. We came down from about a trillion dollars to a little under 900 billion for the cost of coverage. This was just constant meetings and often several times with the same groups. It was really the most intense legislative process I've seen in my years here.

What happens next?

We expect to vote at the end of next week.

Will amendments be allowed?

We don't know. Those are the discussion we're having now. We will see what amendments are being suggested and whether they're necessary. I do not think there will be many, if there are. And there may be none. We haven't made that decision. But we expect to have that vote. We expect to prevail in that vote. And then we wait for the Senate to conduct its business and send it off to conference. The Senate bill is in some ways different than ours and in some ways similar.

The Senate bill finances itself through a tax on high-value health-care benefits. What are your concerns with that?

It's a question of where you set the cap. Right now, if you look at plans that many of our constituents have, this tax would hit them. There have been suggestions you could set it higher, but you get less revenue from that. We're very cognizant that this helps bend the curve, but at what price do you bend that curve, and what if businesses just begin shedding benefits? Some people say that will just go into wages, but there's no requirement for that. We want to see what the impact on families is. We're open to exploring it.

One of the issues is really what is the affordability. They're having a much more difficult time on affordability. There's an argument to be made on the benefits tax, but there are a lot of traps to be run on what checks out and how it really cuts, so there may be some blending of the two financing mechanisms. We'll sit down and see where we can reach agreement.

Did the president's decision to set a price tag of $900 billion complicate your work on affordability?

Yeah, it made things complicated. We were working off of one track and then we had to switch. We took what he said as serious, and it established a benchmark in the public's mind. It made things very complicated and that's what we've been sorting through.

Is the House bill affordable, in your mind?

I think we're close, I think we're really close. We'll get some refined numbers in the next couple of days.

Why aren't the exchanges open to everyone?

Because we're working on a system that's grown up over 60 years. The overwhelming number of people in the United States who have insurance have it through their employer. The first thing we're trying to do is integrate the people who don't have it. So we establish that for individuals in 2013, and for the smallest of small businesses. Then in 2015 we give authority to the Secretary [of Health and Human Services] to include larger and larger businesses. You have to transition it in. If everyone was eligible on the first day, you overwhelm the system. We're going to be adding 37 million people to the exchange as it is. You can't create this system and destabilize the employer-based system at the same time.

When does the president get a bill?

Before the end of the year.

Christmas Eve?

I hope before Christmas Eve!

Photo credit: Harry Hamburg/Associated Press

By Ezra Klein  |  October 29, 2009; 5:00 PM ET
Categories:  Health Reform , Interviews  
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Next: CBO scores the House bill

Comments

There isn't even a statutory definition of affordability in this bill. How can the public feel comfortable being mandated to buy insurance when waivers are left to the discretion of the Secretary of HHS? What if Karen Ignagni gets the job?

Posted by: bmull | October 29, 2009 5:17 PM | Report abuse

Truly an exciting day!

I see that Congressman Miller shares my skepticism that reduced benefits will automatically go to increased wages, especially in light of a job market that promises to be quite weak for a too-long period of time. But he also acknowledges that a tax on very expensive plans does help align incentives toward higher value health insurance and bend the cost curve. But there's no fundamental reason why a tax can't be tacked on for super-high cost plans in addition to the revenue streams in the House bill right now. Instead of capping the exclusion at $23,000 like they were thinking (which really could hit some middle class families soon), why not cap the exclusion at something like $40,000? The current House bill is a deficit reducer in 20 years, but if you add this exclusion cap on top of everything else then you ensure that you do have the incentives set up right to contain costs in the more distant future.

Posted by: reader44 | October 29, 2009 5:27 PM | Report abuse

I have a tremendous amount of respect for George Miller, so I take him at his word in most things. When someone writes about the process all this took some day, it will be one terrific book.

Posted by: LindaB1 | October 29, 2009 8:25 PM | Report abuse

Good for Miller, and Ezra, than you for interviewing him.

Miller understands that all of this needs to be phased in.

This is an extremely important message.

Posted by: mahar1 | October 29, 2009 10:03 PM | Report abuse

I just found out that Miller led the fight against Kucinich's state single payer amendment. Apparently Obama also personally intervened to see that this amendment was defeated. Disgusting Democrats.

Posted by: bmull | November 1, 2009 7:05 PM | Report abuse

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