The Washington Post reported yesterday that in mid-December, a group of Republican senators and representatives held closed door meetings during which they crafted new language to save HMOs $22 billion over 10 years. Democrats were excluded from both meetings and not permitted to alter or remove the new language before Senate approval on 21 December.

The House of Representatives has not yet voted on the final bill. The Congressional Budget Office estimates the changes to the approved legislation would save private HMOs $22 billion over the ten years during which the budget reduction measure will apply.

The savings come from cuts to Medicare rules that would reimburse HMOs $26 billion less over ten years. The cuts leave only $4 billion in savings for the taxpayer. The pro-HMO move came after intense lobbying efforts by representatives of private HMOs, and makes the Medicare reimbursement provisions of the legislation 84.6% less effective at reducing expenditures.

The Post reports the cuts came during "private negotiations involving House Ways and Means Chairman Bill Thomas (R-Calif.), Senate Finance Committee Chairman Charles E. Grassley (R-Iowa) and the staffs of those committees as well as the House Energy and Commerce Committee."

The article also observes that members of Congress from both major parties have raised objections to the growing practice of using closed-door sessions to decide such issues, going on to report:

"More than ever, Republican congressional lawmakers and leaders are making vital decisions, involving far-reaching policies and billions of dollars, without the public —or even congressional Democrats— present."

In light of the recent scandal involving the guilty plea of lobbyist Jack Abramoff, the Republican party is already under severe and mounting pressure to institute reforms and demonstrate its opposition to even the "appearance of impropriety", which many in the party believe these methods too easily project.

The problem is easy to identify, according to certain lawmakers. Republican Sen. John McCain who has introduced anti-corruption legislation in the past, says "earmarking" money for distribution to specific projects invites corruption and must be banned. Democratic Sen. Barack Obama, who helped introduce Democratic recommendations for lobbying reforms, told NBC's Meet the Press program reforms must address "very particular problems of this administration and this Congress".

• Washington Post: "Closed-Door Deal Makes $22 Billion Difference"

Thomas Jefferson, letter to Edward Carrington
"If once they [the people] become inattentive to the public affairs, you and I, and Congress, and Assemblies, judges and governors shall all become wolves. It seems to be the law of our general nature, in spite of individual exceptions..."