Bloomberg notes the NAM and Chamber of Commerce’s opposition in the article, “Business Groups Press Lawmakers to Oppose Health-Care Measure, as well as:

“The measure would drive up labor costs to the point of forcing job losses,” the National Retail Federation said in its letter. “A ‘transparent procedural ploy’ for passing the package would harm Congress’s reputation.”

Caterpillar Inc., the world’s largest maker of construction equipment, in a letter said the measure would raise its cost by $100 million in the first year.

“We can ill afford cost increases that place us at a disadvantage versus global competitors,” wrote Gregory S. Folley, vice president and chief human resources officer at Peoria, Illinois-based Caterpillar, in the March 18 letter.

More …

• Dow-Jones, “UPDATE: Groups Make Final Push To Influence Health Bill Vote“
• MarketWatch, “Pros, cons take last shot at health-care bill“

We previously posted the NAM’s key vote letter in opposition.

And, in case the thought crossed your mind, no, House leadership did not find a way to use the reconciliation process to sneak tort reform into the health care bill. Total dollars spent on medical liability reforms? Zero.

UPDATE (3:53 p.m.): Talking Points Memo reports Democratic leadership saying the widely cited memo reported in Politico is a fraud. Politico has pulled the report until it can verify its accuracy.

______________________

This leadership memo instructs House Democratic communications staff how to handle questions and criticism of the CBO scoring of the health care bill.

(Via Hot Air)

In other health care developments, the American Farm Bureau Federation has sent a letter to House members stating the organization’s strong opposition to the health care legislation. From the Farm Bureau’s news release:

In a letter sent Thursday to all members of the House, AFBF President Bob Stallman said the legislation’s “negatives of new taxes, mandates, growth in government programs and overall cost far outweigh its benefits.” Stallman said Farm Bureau strongly favors health care reform, but it must be “workable, sustainable and balanced against the overall cost of doing business.”

Stallman told lawmakers that America’s agricultural producers are trapped in a broken insurance marketplace with few options and high insurance costs. “Farmers and ranchers need market-based reform that lowers costs and increases choices for private health insurance,” Stallman wrote.

UPDATE (3:20 p.m.): Retail Industry Leaders Association opposes health care legislation. John Emling, senior vice president, is quoted in RILA’s news release.

RILA has actively supported and constructively engaged in the effort to reform America’s health care system to reduce costs and expand retailers’ ability to tailor the plans they offer to the unique needs of their employees; this legislation does neither. RILA urges members of Congress to oppose this bill, and to start over on a bill that better addresses the needs of employers and individuals alike.

Dow-Jones covers the developments, “US Business Groups Opposing Health Bill As Vote Nears.”

Today the National Association of Manufacturers sent a “Key Vote” letter to U.S. House members expressing strong opposition to the health care legislation the House is expected to act on soon. (.pdf letter)

“Key votes” are determined by a committee of representatives of member companies. A member of Congress’ votes on these issues are used to determine the member’s record on manufacturing-related issues.

Here’s is the text of the letter, signed by NAM Executive Vice President Jay Timmons:

The National Association of Manufacturers (NAM), the nation’s largest industrial trade association representing small and large manufacturers in every industrial sector and in all 50 states, urges you to oppose the Patient Protection and Affordable Care Act and related budget reconciliation legislation pending before the House.

The vast majority of American manufacturers, including 97 percent of NAM member companies, voluntarily offer health benefits not only to attract a skilled workforce, but because we believe it is the right thing to do for our employees. Our members support proposals that reduce soaring health costs, improve the efficiency of the current system and enhance the quality of care. Conversely, we oppose proposals that make it more expensive or more difficult for employers to offer health benefits.

We regret that neither the House-passed Affordable Health Care for America Act nor the Senate-passed Patient Protection and Affordable Care Act includes important policies that would lower manufacturers’ health care costs - particularly in the areas of legal liability reform, enhancing competition by allowing employers to purchase insurance across state lines, and robust delivery reform.

Subtitle E, Section 1405 in the House substitute amendment to the health care legislation is “Excise tax on medical device manufacturers”

The section states:

SEC. 4191. MEDICAL DEVICES.
(a) IN GENERAL.-There is hereby imposed on the
sale of any taxable medical device by the manufacturer,
producer, or importer a tax equal to 2.9 percent of the
price for which so sold. 

There are exemptions for eyeglasses, contact lens, hearing aids and items purchased by the general public at retail stores, things like tongue depressors. Even with the exemptions, there’s much covered under the bill’s definiion of “taxable medical device,” which “means any device (as defined in section 201(h) of the Federal Food, Drug, and CosmeticAct) intended for humans.”

From the FDA, “Is The Product a Medical Device?”

Medical Device Definition

Medical devices range from simple tongue depressors and bedpans [presumably exempt as noted above] to complex programmable pacemakers with micro-chip technology and laser surgical devices. In addition, medical devices include in vitro diagnostic products, such as general purpose lab equipment, reagents, and test kits, which may include monoclonal antibody technology. Certain electronic radiation emitting products³ with medical application and claims meet the definition of medical device. Examples include diagnostic ultrasound products, x-ray machines and medical lasers. If a product is labeled, promoted or used in a manner that meets the following definition in section 201(h) of the Federal Food Drug & Cosmetic (FD&C) Act it will be regulated by the Food and Drug Administration (FDA)⁴ as a medical device and is subject to premarketing and postmarketing regulatory controls. A device is:

• “an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is:
   
  • recognized in the official National Formulary, or the United States Pharmacopoeia, or any supplement to them,
  • intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in man or other animals, or

intended to affect the structure or any function of the body of man or other animals, and which does not achieve any of it’s primary intended purposes through chemical action within or on the body of man or other animals and which is not dependent upon being metabolized for the achievement of any of its primary intended purposes.

 Funny how health care “cost controls” so easily morph into tax increases.

New York Times columnist David Brooks, consistently friendly toward the Obama Administration and health care legislation, is as furious as we’ve seen him. From his discussion with Gail Collins, “Is Passing the Health Care Bill Really a Bad Idea?”

Deem and pass? Are you kidding me? Is this what the Revolutionary War was fought for? Is this what the boys on Normandy beach were trying to defend? Is this where we thought we would end up when Obama was speaking so beautifully in Iowa or promising to put away childish things?

Yes, I know Republicans have used the deem and pass technique. It was terrible then. But those were smallish items. This is the largest piece of legislation in a generation and Pelosi wants to pass it without a vote. It’s unbelievable that people even talk about this with a straight face. Do they really think the American people are going to stand for this? Do they think it will really fool anybody if a Democratic House member goes back to his district and says, “I didn’t vote for the bill. I just voted for the amendments.” Do they think all of America is insane?

Investor’s Business Daily editorial, “Health Care Fraud“:

Health Reform: What did it take for Congress to schedule a vote on its awful health care reform package? Not much, just a phony low-ball “score” on what the plan would cost from the Congressional Budget Office.

By presenting the CBO with incomplete, inaccurate and misleading data, the Democrats in Congress were finally able to come up with a cost score they like: $940 billion.

Grace Marie Turner of the Galen Institute, writing at Critical Condition, National Review Online’s health care blog, “A Shell Game of Tax Increases and Medicare Cuts“:

The revisions to the Senate health-overhaul bill released today would require future Congresses to increase taxes and cut Medicare even more deeply than required by the Senate bill if the advertised deficit reduction numbers are to be achieved.

That was the conclusion of four budget experts who talked with journalists on a conference call this afternoon sponsored by the Galen Institute.

“The numbers simply aren’t plausible,” said Douglas Holtz-Eakin, former director of the Congressional Budget Office and president of the American Action Forum, during the call.

The CBO estimates that the latest version of health-reform legislation released today would reduce the deficit by about $130 billion over the next ten years. “Even at face value, that is a very small net deficit reduction that amounts to only a few weeks of federal spending at current rates,” Holtz-Eakin said.

Sitting here in Washington, one could think the entire nation is obsessively following the health care debate, shouting at the TV for interrupting House whip counts with that stupid March Madness.

But people do have other things on their mind, and you don’t even have to travel to flood-threatened Fårgo to realize that. The corners of 13th and F Street NW are close enough.

The lead headlines in the newspaper boxes indicate differing interests. Yes, health care, but also escalators and Sunday’s pro-immigration march on Washington.

• Washington Post, “House unveils $940 billion health accord”
• Washington Times, “Democrats make final reform push“
• El Tiempo Latino, “Llega el dia de la marcha” — The day of the march arrives.
• Washington Hispanic, “Immigrantes salen a las calles” — Immigrants take to the streets.
• USA TODAY, “Upsets Rattle the Brackets” — Hoya Saxa?
• Washington Examiner, “Death by iPod” — It’s dangerous to jog and bike when wearing headphones.
• The Express, “Broken Down and Fed Up” — Washington Post’s commuter tabloid highlights Metro’s infuriating escalator breakdowns.

The Spanish-language newspapers have been promoting Sunday’s immigration march on Washington for quite a while, but other D.C.-based media have paid little attention.

From Fox News, “Democrats Post Health Care Bill Online, Starting 72-Hour Clock“:

The updated health care reform bill has been posted online, starting the clock on a 72-hour window before the House can vote on it. 

Click here to see the proposed changes to the bill, as well as the original Senate package. 

President Obama pledged in an interview with Fox News on Wednesday that the final provisions of the health care plan would be “posted for many days before this thing passes” to give the public a chance to review it. 

The earliest the House could vote on the latest health bill is Sunday. 

You know, for a health care bill, there’s sure a lot of nationalization of the student loan program. From the substitute amendment:

TITLE II-EDUCATION AND HEALTH
Subtitle A-Education
Sec. 2001. Short title; references.
PART I-INVESTING IN STUDENTS AND FAMILIES
Sec. 2101. Federal Pell Grants.
Sec. 2102. Student financial assistance.
Sec. 2103. College access challenge grant program.
Sec. 2104. Investment in historically black colleges and universities and minority-serving institutions.
PART II-STUDENT LOAN REFORM
Sec. 2201. Termination of Federal Family Education Loan appropriations.
Sec. 2202. Termination of Federal loan insurance program.
Sec. 2203. Termination of applicable interest rates.
Sec. 2204. Termination of Federal payments to reduce student interest costs.
Sec. 2205. Termination of FFEL PLUS Loans.
Sec. 2206. Federal Consolidation Loans.
Sec. 2207. Termination of Unsubsidized Stafford Loans for middle-income borrowers.
Sec. 2208. Termination of special allowances.
Sec. 2209. Origination of Direct Loans at institutions outside the United States.
Sec. 2210. Conforming amendments.
Sec. 2211. Terms and conditions of loans.
Sec. 2212. Contracts; mandatory funds.
Sec. 2213. Agreements with State-owned banks.
Sec. 2214. Income-based repayment. 

In a discussion with  member companies earlier this week, National Association of Manufacturers President John Engler criticized the pending health care legislation for its lack of costs saving, dismissing the claims it helps reduce the budget deficit.

There isn’t a person on this call, there isn’t a person I come across, whose balance sheet wouldn’t look pretty good if they could take 10 years of revenue and set against that only six years of expenses. That’s how this is being handled in the Congress, when they say we’re making money and reducing the deficit.

Who wouldn’t? Ten years of revenue, six years of expenses - of course you look good. But the piper will have to be paid.

The remarks remain on point with the release of new Congressional Budget Office scoring on the latest version of health care legislation, presumably the one that the House will vote on this weekend. Ed Morrissey at HotAir.com reacts to the budget gimmickry, citing the $940 billion in gross payouts:

This is why they’re delaying the start of the program, of course. If it kicked in right away, the decade-long estimate would obviously be well into the trillions. So they simply stalled it for four years, incurring just $17 billion in costs — or 1.8 percent of the total 10-year estimate — through 2013 so that wavering Democrats could go back to their districts and tell baldfaced lies to their constituents about the pricetag. A perfect ending to this travesty.

As for the process gimmickry, in an interview with Hugh Hewitt, Stanford Law School professor and former Appeals Court Judge Michael McConnell explains why the “Slaughter” legislative approach of “deem and pass” cannot be squared with the U.S. Constitution, Article I, Section 7. As McConnell wrote in a Wall Street Journal op-ed:

It may be clever, but it is not constitutional. To become law—hence eligible for amendment via reconciliation—the Senate health-care bill must actually be signed into law. The Constitution speaks directly to how that is done. According to Article I, Section 7, in order for a “Bill” to “become a Law,” it “shall have passed the House of Representatives and the Senate” and be “presented to the President of the United States” for signature or veto. Unless a bill actually has “passed” both Houses, it cannot be presented to the president and cannot become a law. 

Unconstitutional and built on budgetary deceit: The health care legislation certainly doesn’t deserve the term “reform.”

John Engler, president of the National Association of Manufacturers, spoke via conference call with NAM members Tuesday from small- and medium-sized manufacturers, one of a series of quarterly webinars used to bring folks up to date on Washington activities.

On health care, the boss had lots to say. We’ve transcribed some of his comments, with only light editing:

Our priorities at the NAM are unchanged. We came to the health care debate in good faith, saying, “Look, it’s time we have health care reform because we need to reduce health care costs, and we ought to respect all the employer plans that are out there.”

The NAM membership, mostly everybody, provides health insurance to their employees, so we were in the category of “doing the right thing.” Now we’re in the category of “no good deed goes unpunished.”

Our priorities are the same:

• Let’s maximize for manufacturers the widest possible set of opportunities and choices to have different options, some of those very much more affordable than what we have today.
• Let’s improve for the entire system and reform the way we deliver health-care services.
• Let’s increase the transparency on the costs and the quality of that health care, regardless of who’s providing it.

We’ve long been at the manufacturers part of employer-based coalitions, which have sought to educate members of Congress and the public on what we think are the significant economic consequences of what’s being proposed up on the Hill.

A hot, new round-up of health care coverage gleaned from reading The Washington Post on the commute into work.

• “House Democrats’ tactic for health bill is debated“: “An obscure parliamentary maneuver favored by House Speaker Nancy Pelosi (D-Calif.) suddenly ignited Tuesday as the latest tinder in the year-long partisan strife over reshaping the nation’s health-care system, triggering debate over the strategy’s legitimacy and political wisdom.” A thorough report, although disappointing that the editors dropped the incendiary language after the first paragraph. No Democrats “burning with a passion” to enact health care, no Republicans “inflamed” by the tactics, no voters doing a “slow burn.” We’ll try to fix the oversight.
• “House Democrats scramble to ensure adequate deficit reduction in health bill”: “Congressional Democrats rushing to push President Obama’s health-care initiative to final passage this week hit a new snag Tuesday, as the final piece of the package was held up by concerns that it would do too little to reduce the nation’s budget deficit.” That’s not red ink, those are the rosy red cheeks of the little children, warmed by the fires of reform.
• “Republicans criticize Democrats’ plan to overhaul student lending “Republicans assailed a proposed overhaul of student lending Tuesday as a ‘government takeover,’ a ‘job killer’ and an ‘outrage,’ seeking to rally opposition to a Democratic measure that would cut private lenders out of the federal loan market. The measure is expected to be merged this week with a health-care bill and could come to a vote in the House by Saturday.” Feeding the flames of discontent, because the health care bill just didn’t do enough.
• “Rushing health reform could be a death wish“: “As Democrats consider shoving health-care reform through the House with a process known as ‘deem and pass,’ it is helpful to return to square one and ask: What, again, is the rush?”

Spring fever?