Friday, 30 March 2012 06:47
Rocky Mountain Action Coalition
1st Quarter 2012 Meeting
Friday, 24 February 2012 10:00 am
Hazel Floyd—AUSWR CO/WY President; RMAC Member
Barbara Wilcox—AUSWR Health Care Specialist; RMAC Member
Pat Finley—AUSWR Retiree; RMAC Webmaster
Helen Domaratz—IBM Retiree; Member Congressman Jared Polis SAGE Council
John Rommelfanger—AUSWR Retiree; Sage Council Member
Judy Stenberg—National Retiree Legislative Network (NRLN) VP Legislative Affairs
RMAC Discussion Items
1. Actively Seek Out New Members
Add new members who have an interest in our issues, are
knowledgeable about these issues or are willing to do research to become
knowledgeable on these issues.
Potential members should be invited to attend a RMAC meeting as
they are identified.
2. RMAC Discussion of the NRLN Legislative Agenda
The RMAC reviewed the NRLN 2012 agenda and determined that
it was hard to understand their top priorities as so many companies are
involved each having their own priorities that make up the NRLN agenda. At this
point it was determined that the RMAC should reassess our own Legislative
Agenda going forward. The question concerning the use of NRLN documents in our
own lobbying stressing our priorities was discussed. Judy Stenberg will be
asked if the RMAC has input to the NRLN agenda and what is the RMAC role from
3. Conference Call with Judy Stenberg
Judy was asked what her expectation of the RMAC group is. Judy was
not familiar with our group and wanted to know more about our mission. As a
majority of members of the RMAC are also AUSWR members she stated that she
wanted us to continue to be part of NRLN, and pay assessments. After
discussing our mission she agreed that we should collaborate anywhere and
everywhere we can.
Judy is a member of the NRLN Executive Committee and chairs
the Legislative Affairs Committee. Some of the members of the Legislative
Affairs Committee are Kitty Kennedy (AUSWR), Will Buergey (Delta) and Bob
Martina (Lucent). The Committee operates by consensus and has made minor
changes to Legislative Agenda which is a living document that can be changed as
Judy noted that AUSWR presence is strong within the NRLN. At
one time the AUSWR had 3 Executive Board Members. Mary Ann Neuman & Judy remain
as Kitty Kennedy has resigned.
Judy identified key committees that the NRLN will continue
to lobby and they are House: Ways & Means, Ed & Labor, and
Commerce. Senate: Finance, HELP,
Judy mentioned that the Legislative committee will focus on
health issues, each person focuses on an area.
Judy has prescription drugs. She talked with one staffer about the
Generic Drug User Fee Act, GDUFA coming up this year. Thinks NRLN should
support this and that Generic drug companies should pay fees to deal with
backlog at FDA. S27 last year – End Pay for Delay. Questioned who would be good
champions for this bill? NRLN staff members Marta Bascom and Michael Calabrese
are great resources.
Judy proposed that the RMAC would help working on GDUFA. She
will send list of NRLN Legislative Committee members and topic each has. She agreed that different companies have
different priorities; for instance Kodak has Mergers & Acquisitions as
their top priority.
Judy stated that before the yearly NRLN Agenda is finalized,
a letter is sent out to all Presidents, asking for feedback. The letter did go
to Mimi Hull, AUSWR Regional President. It was stated that CO/WY Board wants to
have input next time around.
Judy asked Helen if she knew if IBM was part of NRLN. Helen answered no and that IBM doesn’t have
its own Union, it’s CWA and has no organized retiree group. Judy responded that
NRLN stepped in and helped American Airlines to create a retiree organization,
could do this for IBM retirees.
4. Post Call Discussion
RMAC will look at NRLN priorities online, the materials Judy
RMAC will consider sending her our top priorities from NRLN
RMAC members will invite others who may be interested in
RMAC will meet again March 30 at Hazel Floyd’s home at 10 am
John R will write up report.
Thursday, 15 March 2012 09:23
The New York Times
By THERESA BROWN
Published: March 14, 2012
YOU should never do this procedure without pain medicine,” the senior surgeon told a resident. “This is one of the most painful things we do.”
She wasn’t scolding, just firm, and she was telling the truth. The patient needed pleurodesis, a treatment that involves abrading the lining of the lungs in an attempt to stop fluid from collecting there. A tube inserted between the two layers of protective lung tissue drains the liquid, and then an irritant is slowly injected back into the tube. The tissue becomes inflamed and sticks together, the idea being that fluid cannot accumulate where there’s no space.
I have watched patients go through pleurodesis, and even with pain medication, they suffer. We injure them in this controlled, short-term way to prevent long-term recurrence of a much more serious problem: fluid around the lungs makes it very hard to breathe.
A lot of what we do in medicine, and especially in modern hospital care, adheres to this same formulation. We hurt people because it’s the only way we know to make them better. This is the nature of our work, which is why the growing focus on measuring “patient satisfaction” as a way to judge the quality of a hospital’s care is worrisomely off the mark.
For several years now, hospitals around the country have been independently collecting data in different categories of patient satisfaction. More recently, the Centers for Medicare and Medicaid Services developed the Hospital Consumer Assessment of Healthcare Providers and Systems survey and announced that by October 2012, Medicare reimbursements and bonuses were going to be linked in part to scores on the survey.
The survey evaluates behaviors that are integral to quality care: How good was the communication in the hospital? Were patients educated about all new medications? On discharge, were the instructions the patient received clear?
These are important questions. But implied in the proposal is a troubling misapprehension of how unpleasant a lot of actual health care is. The survey measures the “patient experience of care” to generate information important to “consumers.” Put colloquially, it evaluates hospital patients’ level of satisfaction.
The problem with this metric is that a lot of hospital care is, like pleurodesis, invasive, painful and even dehumanizing. Surgery leaves incisional pain as well as internal hurts from the removal of a gallbladder or tumor, or the repair of a broken bone. Chemotherapy weakens the immune system. We might like to say it shouldn’t be, but physical pain, and its concomitant emotional suffering, tend to be inseparable from standard care.
What’s more, recent research suggests that judging care in terms of desirable customer experiences could be expensive and may even be dangerous. A new paper by Joshua Fenton, an assistant professor at the University of California, Davis, and colleagues found that higher satisfaction scores correlated with greater use of hospital services (driving up costs), but also with increased mortality.
The paper examined patient satisfaction only with physicians, rather than hospitals, and the link between satisfaction and death is obviously uncertain. Still, the results suggest that focusing on what patients want — a certain test, a specific drug — may mean they get less of what they actually need.
In other words, evaluating hospital care in terms of its ability to offer positive experiences could easily put pressure on the system to do things it can’t, at the expense of what it should.
To evaluate the patient experience in a way that can be meaningfully translated to the public, we need to ask deeper questions, about whether our procedures accomplished what they were supposed to and whether patients did get better despite the suffering imposed by our care.
We also need to honestly assess our treatment of patients for whom curative care is no longer an option.
I had such a patient. He was an octogenarian, but spry, and he looked astoundingly healthy. He’d been sent to us with a newly diagnosed blood cancer, along with a promise from the referring hospital that we could make him well.
But we couldn’t. He was too old to tolerate the standard chemotherapy, the medical fellow on duty told him. When I came into his room a little later he said to me, with a stunned and yearning look, “Well, he made it sound like I don’t have a lot of options.” The depth of alienation, hopelessness and terror that he was feeling must have been unbearable.
The final questions on the survey ask patients to rate the hospital on a scale from worst to best, and whether they would recommend the hospital to family and friends. How would my octogenarian patient have answered? A physician in our hospital had just told him that he would die sooner than expected. Did that make us the best hospital he’d ever been in, or the worst?
Hospitals are not hotels, and although hospital patients may in some ways be informed consumers, they’re predominantly sick, needy people, depending on us, the nurses and doctors, to get them through a very tough physical time. They do not come to us for vacation, but because they need the specialized, often painful help that only we can provide. Sadly, sometimes we cannot give them the kind of help they need.
If the Centers for Medicare and Medicaid is to evaluate the patient experience and link the results to reimbursement, it needs to incorporate questions that address the complete and expected hospital experience. It’s fair and even valuable to compare hospitals on the basis of how well they maintain standards of patient engagement. But a survey focused on “satisfaction” elides the true nature of the work that hospitals do. In order to heal, we must first hurt.
A version of this op-ed appeared in print on March 15, 2012, on page A35 of the New York edition with the headline: Hospitals Aren’t Hotels.
ObamaCare's Bogus Cost Savings
Thursday, 15 March 2012 09:06
Wall Street Journal
March 14, 2012
By DANIEL P. KESSLER
As we approach the second anniversary of ObamaCare, it's worth re-examining some of the claims its proponents made about the impact of the law on health-care costs. Three of the law's most-touted cost-control measures have already been shown to be unlikely to succeed. First, the Patient Protection and Affordable Care Act was supposed to improve efficiency through the creation of Accountable Care Organizations (ACOs) and better supply-side incentives through the Medicare Shared Savings Program (MSSP). These would be a "major game-changer," according to Karen Davis, president of the Commonwealth Fund. The theory is that getting doctors and hospitals to operate under a single umbrella (the Accountable Care Organization) and share in the cost savings they achieve (the Medicare Shared Savings Program) would reduce their incentives to supply treatments that did not give good value. Neither has worked. In August 2011, the Center for Medicare and Medicaid Services announced the results of its Physician Group Practice demonstration project, the model for ACOs and the MSSP. The demo saved Medicare a little more than $100 per beneficiary per year—a bit over 1% of the average cost of an individual's services, which was described by the demonstration project's independent evaluator, North Carolina's Research Triangle Institute, as "small." Meanwhile, new research has shown that ACOs may raise costs for privately-insured individuals by increasing hospitals' and physicians' power to raise prices. The long-run trend toward the integration of hospitals and physicians in California has had exactly this effect, according to a study published in Health Affairs (April 2010) by Robert Berenson of the Urban Institute and colleagues at the nonpartisan Center for Studying Health System
Change. Second, ObamaCare created an Independent Payment Advisory Board (IPAB) that would recommend ways to reduce Medicare spending if Congress failed to accomplish this task itself. According to Peter Orszag (President Obama's former director of the Office of Management and Budget) and Ezekiel Emanuel (who was Mr. Orszag's special adviser on health policy), writing in the Aug. 12, 2010 New England Journal of Medicine, this was to be the law's "most important institutional change." Because IPAB permits an unelected body to make substantial changes to Medicare outside of the normal political process, it has stimulated substantial controversy. Closer examination
suggests that the board will be ineffective.
Some of the board's flaws—such as the exemption of hospitals from its authority until 2020—were obvious from the start. Some were more subtle. As a 2011 report from the Kaiser Family Foundation points out, the law lets Congress modify the
advisory board's recommendations as long as the changes "meet the same fiscal criteria under which the board operates." Thus Congress can meet the board's budget targets by imposing unrealistic Medicare cuts and then immediately undoing them in subsequent legislation—as it has done repeatedly with the "doc fix." In March 2011, the Congressional Budget Office revised its original analysis (delivered to Congress in March 2010) of ObamaCare, scoring IPAB as having no budgetary impact.
Third, ObamaCare mandated that health coverage sold in the law's newly created insurance exchanges must cover a package of "essential health benefits." It also required that states mandating benefits over and above those specified as essential by the federal Department of Health and Human Services reimburse individuals for the benefits' additional costs. This provision was designed to pare back the vast expansion of mandated benefits
that provider groups and other special interests have enshrined in state insurance law—and keep the essential benefits package affordable.
Despite this, in December 2011 the administration issued a bulletin allowing the states themselves to define what is an "essential benefit." In short, Health and Human Services is abdicating its power to make states pay for their decision to expand their mandates. It effectively nullifies the law's attempt to get rid of state regulations that block the sale of cost-effective insurance.
Of course, some elements of the health law still have potential. The excise tax on "Cadillac" insurance plans—those that, in 2018, cost more than $27,500 for families and $10,200 for individuals—is a start toward fixing the open-ended tax exclusion for employer-sponsored health insurance that has done so much to promote cost-unconscious care. And the Medicare payment reforms being evaluated in the law's newer demonstration
projects may have more success than those that we've seen before. But if the past is any indication of the future, voters should view election-year promises about ObamaCare lowering the cost of health care with a skeptical e
Mr. Kessler is professor of business and law at Stanford University and a senior fellow at the Hoover Institution.
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ObamaCare's Bogus Cost Savings
The evidence mounts that the health law won't make care more efficient or more affordable.
Daniel Kessler: ObamaCare's Bogus Cost Savings - WSJ.com http://online.wsj.com/article/SB1000142405297020337060457726...
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Some of the board's flaws—such as the exemption of hospitals
from its authority until 2020—were obvious from the start.
Some were more subtle. As a 2011 report from the Kaiser
Family Foundation points out, the law lets Congress modify the
advisory board's recommendations as long as the changes "meet
the same fiscal criteria under which the board operates."
Thus Congress can meet the board's budget targets by imposing
unrealistic Medicare cuts and then immediately undoing them
in subsequent legislation—as it has done repeatedly with the
"doc fix." In March 2011, the Congressional Budget Office
revised its original analysis (delivered to Congress in March
2010) of ObamaCare, scoring IPAB as having no budgetary impact.
Third, ObamaCare mandated that health coverage sold in the law's newly created insurance exchanges must
cover a package of "essential health benefits." It also required that states mandating benefits over and above
those specified as essential by the federal Department of Health and Human Services reimburse individuals for
the benefits' additional costs. This provision was designed to pare back the vast expansion of mandated benefits
that provider groups and other special interests have enshrined in state insurance law—and keep the essential
benefits package affordable.
Despite this, in December 2011 the administration issued a bulletin allowing the states themselves to define what
is an "essential benefit." In short, Health and Human Services is abdicating its power to make states pay for their
decision to expand their mandates. It effectively nullifies the law's attempt to get rid of state regulations that
block the sale of cost-effective insurance.
Of course, some elements of the health law still have potential. The excise tax on "Cadillac" insurance
plans—those that, in 2018, cost more than $27,500 for families and $10,200 for individuals—is a start toward
fixing the open-ended tax exclusion for employer-sponsored health insurance that has done so much to promote
cost-unconscious care. And the Medicare payment reforms being evaluated in the law's newer demonstration
projects may have more success than those that we've seen before.
But if the past is any indication of the future, voters should view election-year promises about ObamaCare
lowering the cost of health care with a skeptical eye.
Mr. Kessler is professor of business and law at Stanford University and a senior fellow at the Hoover
Directions for Bipartisan Medicare Reform
Thursday, 15 March 2012 08:59
New England Journal of Medicine
March 7, 2012 (10.1056/NEJMp1200914)
Before Senator Ron Wyden (D-OR) and Representative Paul Ryan (R-WI) introduced their “Bipartisan Options for the Future” on December 15, 2011, the notion that Democrats and Republicans agreed about certain aspects of Medicare might have seemed unthinkable.1 But the pairing of a liberal Democrat who has long worked on health care reforms and a fiscally conservative Republican primarily known for work on budget issues suggests that it might be possible for the parties to reach a compromise on Medicare reform. Of course, meaningful reform is not likely to occur in 2012: any significant reform probably won't happen until the public sends a clearer signal about the kinds of change it will tolerate, which won't be possible until after the fall elections. Yet some Republicans and Democrats appear to be in substantial agreement about some changes that might make Medicare more efficient, effective, and fiscally sustainable — even if none of these changes are universally accepted by either party as desirable or even tolerable.
First, there has long been discussion about raising Medicare's eligibility age from 65 to 67, as is happening with Social Security. Though still controversial among some Democrats, this policy change was put on the table by President Barack Obama as part of a compromise package. With 78 million baby boomers becoming Medicare-eligible over the next 18 years, eventually doubling the number of beneficiaries, increased spending due to population aging and greater longevity is making such a change seem more compelling.
As opponents note, however, the savings from increasing the eligibility age by 2 years probably wouldn't be large, since the youngest seniors tend to be the healthiest. Moreover, if Medicare doesn't cover them, 65- and 66-year-olds will need to continue working to get coverage from employers (which, it could be argued, would be better for them and for the economy, assuming that the economy improves enough to generate the jobs needed) or they will get subsidized coverage from the health insurance exchanges being created by the Affordable Care Act (ACA). The effect of such a change on overall spending has been debated, but the effect on federal spending is likely to be favorable.
Second, despite past controversy over the approach, Medicare has increasingly adopted policies tying benefits to income, without generating much pushback. Medicare funding is already income-related, since the program is funded by a combination of a wage tax on earned income, which as of 2013 will be levied on all other income as well, and a general-revenue contribution dominated by receipts from personal income taxes.
Over time, benefits have also become related to income. For years, low-income seniors who aren't poor enough to qualify for Medicaid have had some portion of their premiums, deductibles, and copayments covered. Both the Medicare Modernization Act and the ACA reduced subsidies for higher-income seniors.2 Since 2007, high-income seniors have received only a 25% subsidy for Part B premiums (which primarily cover physician services), rather than the 75% subsidy that other seniors receive. High-income seniors will also receive smaller subsidies for Part D, the prescription-drug benefit. Under the Wyden–Ryan proposal, the subsidy for seniors purchasing private plans or traditional Medicare would vary with income.3 This portion of the proposal has not seemed to generate much controversy.
Third, the goal of slowing Medicare's growth to achieve fiscal sustainability is driving much of the discussion about the need for reform. Because Medicare is an open-ended entitlement program, total program spending each year is the sum of spending for all covered services, rather than a set amount that Congress appropriates annually. With periodic additions to benefits, increasing costs per person, and a growing population, it's hardly surprising that Medicare spending — like the rest of health care spending — has grown much faster than the economy. But both political parties agree that this gap is unsustainable.
Medicare spending, like all health care spending, is currently growing unusually slowly, in part because of the sluggish economy and the decline in insurance coverage associated with substantial job losses since 2008. Medicare spending is projected to continue to grow slowly through 2020, owing to the ACA's reductions in reimbursement to Medicare providers. As a result, per capita Medicare spending is projected to grow by approximately 3.5% per year, about the same rate that the economy grows (a projected 3.6% per year) over the course of the decade, although total Medicare expenditures are projected to grow by 6.6% per year because of the ongoing retirement of the baby boomers.4 The Medicare actuary and others have questioned whether the reimbursement reductions will be enforced, however, given concerns about impairing access to care, and spending rates are expected to increase after the current budget period unless additional reductions in payment are implemented.
Various experts and policymakers have been converging around a targeted growth rate for Medicare spending of growth in the gross domestic product (GDP) plus 1%. The proposal from the Obama administration, the proposal from former Clinton budget director Alice Rivlin and former Senator Pete Domenici (R-NM), and now Wyden–Ryan all reference GDP plus 1% as their target growth rate.5 The question of how to achieve that rate is another story, but the occurrence of discussions among both Democrats and Republicans about strategies for ensuring a specified spending growth rate represents a fundamental move away from Medicare as an open-ended entitlement.
The Obama administration and many Democrats see the Independent Payment Advisory Board (IPAB) created by the ACA as the appropriate enforcing mechanism for Medicare. Like most previous attempts to control Medicare spending, the IPAB has been given authority to change how and how much providers are reimbursed, but the new board has unprecedented power to implement changes. The Rivlin–Domenici and Wyden–Ryan proposals use premium-support–type models that provide government subsidies to seniors for purchasing any of various health plans. Under this strategy, Medicare spending growth would be achieved by controlling subsidy growth. Whether that could be done without increasing the share of premiums that seniors must pay is hotly debated. The answer depends at least partly on whether motivating seniors to seek the best value and giving plans flexibility in organizing and delivering services can slow the growth in plan costs. By including traditional Medicare (which would be subject to the IPAB's decisions) as one of the choices offered, both Rivlin–Domenici and Wyden–Ryan may provide the elements of a future compromise.
Finally, the need to reform care delivery in Medicare may be the area of greatest agreement across the political spectrum. Even those who most celebrate Medicare's success in expanding seniors' access to care generally agree that the program provides too much uncoordinated, fragmented care to a population primarily characterized by chronic disease. There are important differences of perspective regarding how best to transform the delivery system and who should lead that transformation, but the disillusionment and frustration with the current reimbursement system could not be stronger.
There's also growing agreement that a fee-for-service system like Medicare's, which reimburses physicians for some 7000 discrete services, is inconsistent with achieving the care coordination needed by seniors with multiple chronic conditions or complex acute care needs. To me, this growing disillusionment with the incentives and rewards of fee-for-service medicine is the most surprising evolution in thinking of the past quarter century and offers the greatest promise for success in developing a replacement, whatever its parameters.
I would not minimize the challenges of reaching agreement on the appropriate design of the future delivery system, ways to achieve that design, and strategies for producing fiscal sustainability. But despite the parties' profound philosophical differences, areas of agreement are developing, even in these most partisan of times. Sometimes it's important to celebrate even these small, interim successes.
Disclosure forms provided by the author are available with the full text of this article at NEJM.org.
This article (10.1056/NEJMp1200914) was published on March 7, 2012, at NEJM.org.
Source InformationFrom Project HOPE, Bethesda, MD.
A less-centrist Finance Committee
Thursday, 15 March 2012 08:48
By JENNIFER HABERKORN and MATT DOBIAS | 3/7/12 11:38 PM EST Updated: 3/8/12
8:38 AM EST
The Senate committee responsible with oversight of Medicare and much of the health
reform law is going to look a lot different in 2013, with at least four of its
members retiring at the end of the year and others possibly facing tough
The Senate Finance Committee — arguably one of the most influential on Capitol Hill
— could look less centrist and more partisan, regardless of which party
controls the Senate after the November elections.
Democratic Sens. Kent Conrad of North Dakota and Jeff Bingaman of New Mexico and
Republican Sen. Olympia Snowe of Maine — three of the highest-ranking committee
members from both parties — all plan to retire at the end of the year. Each has
a record as a moderate, a bridge builder, or both.
Republican Sen. Jon Kyl of Arizona is leaving, too. He’s much more partisan than the other
departing senators, but he also has a deep health care policy background that
has made him a key player in deficit reduction talks and in the discussions
about replacing the broken Medicare payment formula.
The retirements mean a loss of some of the panel’s institutional knowledge on some
of the nation’s thorniest issues: Medicare, taxes, trade and the economy.
Sen. Chuck Grassley (R-Iowa), a former chairman of the committee, said he expects
the panel to be more partisan after the four retire.
“I think it would be more conservative — definitely on the Republican side,”
Grassley told POLITICO. “Maybe a little less conservative on the Democrat side.
If Sen. [Max] Baucus is the leader of it, though, he’s going to do what he can
to make sure it functions, because that’s his philosophy. And I’ll be there to
The committee had a big influence on the shaping of President Barack Obama’s health
reform law, pulling it to the center and jettisoning some liberal priorities —
including the public option — that many Democrats had wanted.
The Finance Committee is one of the most sought-after assignments on Capitol Hill,
especially with such a high-profile role in the national discussion of deficits
and entitlements — a focus that is unlikely to change much in 2013. Leaders
typically use the assignments to reward loyalty and longevity.
But Utah Sen. Orrin Hatch, the top Republican on the panel, suggested that
leadership could choose not to fill all four of the slots that will open up —
or more, depending on the election outcome.
“I don’t know what the leadership will decide to do. They may shorten the number
of people in the committee or just add some people to it,” Hatch told POLITICO.
“It depends a lot on who is in the majority next time, too.”
The idea is that it’s easier to wrangle a smaller number of people. Plus, the
committee added members in recent years, and with an even number of retirements
from both sides of the aisle, the departures could shrink its numbers without
having to push people off.
But it’s likely that each side will get to appoint at least one member.
On the Republican side, Sen. Johnny Isakson of Georgia is widely assumed to be the
next to get a prized Finance post. Sen. Rob Portman of Ohio, a former White
House budget director, is
On the Democrats’ side, Sens. Mark Begich of Alaska, Michael Bennet of Colorado
and Bob Casey of Pennsylvania are the type of pragmatists that could be tapped
to serve. And Sens. Sherrod Brown of Ohio and Sheldon Whitehouse of Rhode
Island are also thought to be in the mix, according to Hill aides and health
“Some saw Casey’s involvement in the payroll tax issue as the sort of trial run for
how he might work on Finance. He was a real constructive part of the payroll
conference,” a senior Senate aide said, noting that Begich and Bennet fit the
The model of the typical Finance member — with a few notable exceptions — is a
pragmatist and a bridge builder in the style of Bingaman, Grassley, John Kerry
and Mike Crapo.
“These are guys who want to try to get to yes, even in a politically toxic
environment,” the aide said. “I would think leadership on both sides would want
to appoint similar members moving forward.”
But the traditional pragmatist is a dying breed in the Senate, a former committee
aide said. As more and more of the across-the-aisle types leave the Senate,
their replacements have often come from more partisan ranks.
“That’s really beginning to impact the Finance Committee now,” the former aide said.
“And it affects the ability of the Finance Committee to do its job when it’s
Because committee members tend to stay put, the political mix could have a lasting
effect on legislation.
“Whoever gets appointed now will get to shape the makeup of the committee for a long
time,” the former aide said. “That’s why the change in deal makers to whoever
takes their place will matter for a long time.”
On the Republican side, the retirements put Crapo next in line behind Hatch, since
term limits prevent Grassley from serving as the committee’s top Republican
again. On the Democratic side, West Virginia Sen. Jay Rockefeller remains
behind Baucus, followed by Kerry and Ron Wyden of Oregon.
To be sure, the Senate Finance Committee hasn't been constantly busy with markups.
Over the past two congressional sessions, the panel has held only a handful of
markups - though they include a lengthy one for the Senate's health reform
package. The others included trade bills and a small tax provision.
But that may underscore the panel’s importance because many of the deficit-cutting
groups that have gathered in recent years have drawn heavily from its members.
Plus, divided government has diminished the role of every committee as party
leaders have increasingly become the ultimate brokers of legislation. And many
of the bills that hit the floor directly have Finance work in them.
As members of the committee leave, they take with them a wealth of knowledge that
doesn’t quickly translate to newer members, said Dean Rosen, a partner with the
lobbying firm Mehlman Vogel Castagnetti.
“Whenever you lose those long-serving members, regardless of their political stripes,
you’re losing a ton of experience,” he said.
Rosen added that the breadth of the Finance Committee makes it especially hard to
replace members who leave. “The jurisdiction is so broad — taxes, health,
Medicare, Medicaid, trade—that it’s difficult to replace that expertise right
away,” he said.
“My sense is, you want people who are going to be team players,” Rosen said. “I’m
sure both leaders want that, particularly because the issues involved really
have been — and will be — the most contentious politically and substantially
CLARIFICATION: This story has been updated to clarify the committee activities over the last
two congressional sessions.