This article first appeared in the St. Louis Beacon, July 13, 2009 - When it comes to the national debate over health care, everyone in Washington is a player: Whether they're a member of Congress, a lobbyist or a leader of a special-interest group.
But some are bigger players than others. And some wield their influence at different stages of what's already shaping up to be a lengthy process.
With that in mind, let's look at some of the St. Louis region's most powerful congressional figures and how they fit in -- or don't -- as Congress wrangles over what to do to increase access to health coverage, while reining in costs.
And it's a fact that it will be the elected officials in the U.S. Capitol, more than any other group, who will make the chief decisions on the changes made in the nation's complicated health-care industry, from access to delivery.
That's why so much time and money has been spent by the various special-interests most concerned about health care -- including hospitals, medical groups, insurance companies, pharmaceuticals and unions -- to lobby Congress.
The GOP's Blunt instrument
At the moment, there's little debate over who's the region's most visible figure in the national fight: It is U.S. Rep. Roy Blunt, R-Strafford, who also just happens to be running for one of the nation's most closely watched Senate seats in the 2010 elections.
Blunt heads the Health Care Solutions Group, a Republican congressional group that was formed last February (coincidentally, the same month Blunt kicked off his Senate campaign) to help influence the discussion over health care.
That spot has given Blunt a lot of attention, pro and con. He has become the national face for national House Republicans as they press their case against various Democratic health-care proposals -- particularly any sort of public options, such as the one pushed by President Barack Obama during his campaign that would allow the public to purchase health coverage through the federal system.
Blunt and the solutions group have asserted that "the Obama administration and congressional Democrats are moving full steam ahead with an expensive and dangerous government takeover of health care that could irreversibly impact the ability of families to get the care they need when they need it."
Blunt also has become the No. 1 target of the Democratic Senatorial Campaign Committee and other Democratic groups, which have put the spotlight -- issuing almost daily press releases -- on virtually every comment that Blunt has made on the topic.
That's why a Washington frenzy erupted Friday over Blunt's observations during an interview on a Columbia, Mo., radio station that "you could certainly argue that government should have never gotten into the health-care business" when it set up Medicare in 1965 to provide health insurance for the elderly, and Medicaid soon after for the poor.
Eric Schultz, communications director for the DSCC, said Friday that the comments reflect Blunt's allegiance to various special interests in the health-care industry. "Given his years as a Washington insider, and the hundreds of thousands of dollars he's received from the special interests in Washington, it's not surprising that Congressman Blunt wants to do nothing to help make health care affordable for the people of Missouri -- even as he gets his own insurance from the government," Schultz said.
Blunt or his PAC -- Rely on Your Beliefs -- has collected close to $2 million from insurance, pharmaceutical and other health-related companies since he came to Congress 12 years ago, according to the nonpartisan Center for Responsive Politics, which tracks campaign finances.
Blunt campaign spokesman Rich Chrismer said that Democrats were misrepresenting Blunt's comments and position. "Roy Blunt did not say those programs were a mistake," Chrismer said. "He was discussing the current health-care debate and discussing his belief that government would be better off organizing health care, as we did with the Medicare prescription-drug program" and not operating the programs.
Chrismer tied the attacks to the Democratic effort to help that party's likely Missouri nominee for the Senate in 2010, Missouri Secretary of State Robin Carnahan. She and Blunt are the only announced candidates for the seat now held by Sen. Christopher "Kit" Bond, R-Mo., who is retiring.
In a supporting role
The focus on Blunt has overshadowed the activities of the other regional players -- all of whom, for the moment, have lesser roles.
In the U.S. House, all five of eastern Missouri's members of Congress have participated in various activities aimed at highlighting their interest in the health care. But none sits on the chamber's key committees dealing with the issue.
The same is true in the U.S. Senate.
In general, two of the region's Republicans in the House -- Todd Akin of Town and Country and Blaine Luetkemeyer -- have taken stands generally in line with Blunt.
A spokesman for Luetkemeyer, R-St. Elizabeth, notes that he's a former small businessman. As a member of the House panel on small business, Luetkemeyer has been pressing for changes to allow small businesses to band together to purchase insurance, said press secretary Paul Sloca.
The region's third House Republican, U.S. Rep. Jo Ann Emerson of Cape Girardeau, joined the area's two Democrats -- Reps. Lacy Clay and Russ Carnahan of St. Louis -- in a forum last April that focused on health care.
Clay and Carnahan were among the early leaders of Obama's presidential campaign in Misouri and generally support many of his health-care proposals, including the need for a public option.
Carnahan is a member of the New Democrat Coalition Healthcare Task Force, a congressional group working behind the scenes. A spokesman said that he also is a cosponsor of several pieces of legislation dealing with health care, including the so-called SHOP Act to allow small businesses to pool their coverage.
Clay pointed Friday to his longstanding support for changes to expand health-care coverage for the uninsured and "transforming the system from focusing on sickness to promoting prevention and healthier lifestyles."
"Back in 2007, soon after I became a co-chair of the president's campaign, I pressed him to include two of my key priorities in his health-care reform platform: the creation of a secure, national electronic health-care records system, and a major push to close disparities in chronic diseases and conditions that afflict minorities and lower income Americans," Clay said. "I'm proud to say that both of my suggestions made it into the Obama plan."
Clay emphasized that he's a strong supporter of "an affordable public option."
Now, on to the Senate, where arguably the region's most influential player is Sen. Dick Durbin, D-Ill., a close ally of Obama and the chamber's assistant majority leader.
During an appearance this spring before St. Louis business leaders, Durbin, who's from Metro East, emphasized his opposition to proposals to tax health-care benefits for people with coverage.
At the time, the benefit-tax proposal was gaining steam on Capitol Hill. It's now generally considered to be dead among many Democrats, in part because of the opposition among labor unions.
Durbin indicated his influence again on Sunday morning, on ABC's "This Week," when the Illinois senator indicated the Senate would be cool to a House plan to pay for expanding health care coverage primary by raising taxes on the wealthy. "I think we're going to have a different approach," Durbin said. He signaled he favored a combination of tax increases and spending cuts.
Missouri's two U.S. senators - Bond and Democrat Claire McCaskill -- also will be players in the health-care debate. But neither is on the key Senate committees now drafting various proposals.
But that doesn't mean they're not trying to wield influence. McCaskill, who is close to Obama, joined Durbin in May in co-signing a letter promoting the public option to the two senators who head the two chief committees -- Sens. Ted Kennedy, D-Mass., and Max Baucus, D-Mont.
Speaking on behalf of McCaskill, a spokeswman said, “It’s clear that the status quo is not acceptable, and if we don’t reform health care, our deficits will only get worse. We need to pass a bill that does three things: provide consumer choices, bring down the overall cost of health care, and deliver better outcomes for patients.”
Meanwhile, Bond has been speaking to various groups about the importance of expanding community health centers, and "the need to keep children's health issues and small business needs in mind,'' a spokeswoman said.
Bond also has been talking a lot to Sen. Chuck Grassley, R-Ia., the GOP's point person in the Senate on health care, to emphasize his concerns, she added.
Perhaps most significantly, as far of visibility, Bond recently debated another former governor -- Democrat Howard Dean from Vermont -- on CNBC.
Such actions make clear that the most prominent congressional players could well shift as the health care debate continues.
