The White House is signalling that they plan to run against Republican obstructionism. If they make this a big issue, it will be a death sentence in the midterm. This dumb strategy should be shut down before it brings down the party.
Only 26% of Americans even know the filibuster takes 60 votes to overcome. Only 32% realize the Senate health care bill did not get any Republican support. If they don't know that a bill as big as health care reform was passed on a partisan basis, they will never know that about any other bill.
American's don't care about or pay attention to procedure or whip counts. They don't know how Congress works, and the more they learn about how it works the more they hate the people in it. What they know is that the Democrats control everything and are doing nothing. Democrats will be blamed for failing to govern this time around--not Republicans. When Republicans controlled fewer seats in the Senate, they were able to get what they wanted done. No one remembers Republicans whining about how they only had a 55-seat majority.
Running on how the mean old 41 Republicans won't let the most powerful man in the country do anything sounds childish, petty, and, frankly, like an extremely lame excuse. It makes Democrats look impotent. If you try to tell some person in middle America that Democrats couldn't pass X because they have only 59 votes in the Senate, instead of 60, they will either laugh at you, call you a liar, or think you a corrupt crook making very pathetic excuses.
Endorsing this "we can't do anything with just 59 votes" myth will send a clear signal to the American people that it really does not matter who the vote for because electing Democrats still leaves the Republican party in charge.
Whining about non-constitutional procedural rules is not "changing the way Washington works"--it is everything people hate about Washington.
Running on what you have done for the American people might get people to the polls. Running on what you plan to accomplish for the American people next year if they are kind enough to re-elect you might get people to the polls. Running a campaign simply whining about how a tiny minority of mean Republicans in the Senate can use arcane Senate procedures to prevent you from ever delivering on any campaign promise ever will not get people to the polls.
If you make an issue about Republicans' abuse of the filibuster, you better also be out there demanding the filibuster is eliminated. Never complain about something unless you are talking about how to fix it. That is the difference between being a weak, wimpy, complainer and a tough leader who knows how to fight. No one wants to vote for wimpy complainers who spend all day whining about how the other team refuses to play nice.
Obama Asks Republican Senators To Put Their Jobs In Jeopardy For The Benefit Of Democrats
In his State of the Union address, President Obama clearly laid out the logical reason why his push for bipartisanship is inherently doomed.
Obama admits that the Republicans have developed a brilliant political strategy of obstructionism. It has badly hurt Democrats and helped get Republicans elected. After acknowledging that just saying "no" is a very smart move, Obama asks and weirdly expects Republicans to change. Why would they ever give up a working strategy that had enabled them to win a Senate seat in Massachusetts?
This is not an issue of leadership, or just “short-term politics.” Senators are professional politicians. This is their job, their life, and often their passion. Giving up the great political strategy of just saying "no" would endanger their livelihood.
So, when Obama asks Republicans to be bipartisan, he is asking them to make a very bad personal, political, and professional choice. Working with Democrats would require Republicans to give up a working political strategy. It would increase the chance that these same Republican senators would loss their jobs. It would also help Obama and the Democrats look good, more centrist, and very effective. The result of helping Democrats look good would probably be to prolong the amount of time Republicans spend in the minority.
Obama acknowledges that it would be very stupid for Republican to work with Democrats. Even after saying that being bipartisan would put Republican senators' jobs in jeopardy, he honestly expects them to want to work with him.
As long as Republicans have every incentive not to work with Democrats, Democrats must stop chasing bipartisanship. No one should every expect politicians to work against their own re-election to help pass the opposing party's agenda. Until it directly benefits Republican senators to work with Democrats (something that does not appear to happen anytime soon), bipartisanship is logically doomed to fail. Until that happens, the refusal of Democrats to move popular legislation with Republican support plays right into the Republican strategy, and only encourages them to be less cooperative.
[I]f the Republican leadership is going to insist that sixty votes in the Senate are required to do any business at all in this town, then the responsibility to govern is now yours as well. Just saying no to everything may be good short-term politics, but it’s not leadership.
Obama admits that the Republicans have developed a brilliant political strategy of obstructionism. It has badly hurt Democrats and helped get Republicans elected. After acknowledging that just saying "no" is a very smart move, Obama asks and weirdly expects Republicans to change. Why would they ever give up a working strategy that had enabled them to win a Senate seat in Massachusetts?
This is not an issue of leadership, or just “short-term politics.” Senators are professional politicians. This is their job, their life, and often their passion. Giving up the great political strategy of just saying "no" would endanger their livelihood.
So, when Obama asks Republicans to be bipartisan, he is asking them to make a very bad personal, political, and professional choice. Working with Democrats would require Republicans to give up a working political strategy. It would increase the chance that these same Republican senators would loss their jobs. It would also help Obama and the Democrats look good, more centrist, and very effective. The result of helping Democrats look good would probably be to prolong the amount of time Republicans spend in the minority.
Obama acknowledges that it would be very stupid for Republican to work with Democrats. Even after saying that being bipartisan would put Republican senators' jobs in jeopardy, he honestly expects them to want to work with him.
As long as Republicans have every incentive not to work with Democrats, Democrats must stop chasing bipartisanship. No one should every expect politicians to work against their own re-election to help pass the opposing party's agenda. Until it directly benefits Republican senators to work with Democrats (something that does not appear to happen anytime soon), bipartisanship is logically doomed to fail. Until that happens, the refusal of Democrats to move popular legislation with Republican support plays right into the Republican strategy, and only encourages them to be less cooperative.
Only 32% Of Americans Know The Senate Bill Did Not Get Bipartisan Support
A new Pew survey should throw cold water on the logic behind the Democrats' desire to to get bipartisan support for anything. The survey finds that only a thirf of Americans (32%) were actually aware that no Republican senators voted for health care reform (29% thought Republicans in the Senate had voted for the bill, while 39% said they don't know).
Health care reform has been one of the biggest and longest debates over a piece of legislation in years. Republicans spent a lot of time trying to hammer home the message that they did not support this bill, and Democrats were “ramming this bill through” on a purely partisan basis. Even with all that, the vast majority of Americans are still unaware that health care reform was passed in the Senate with only Democratic votes. Roughly a third of Americans incorrectly thought the bill did get Republican votes. If people don't know that health care reform failed to get bipartisan support, there is no other piece of legislation they are ever likely to be better informed about.
The low information level of the voters points to the the inherent problem with Obama's insider strategy and obsession with Republican buy-in. Most Americans just don't understand or pay attention to legislative procedure or vote counts. Only 26% of people surveyed even knew that it required 60 votes in the Senate to break a filibuster. An essentially, statically equal number (25%) of people think it only requires 51 votes.
What a large number of Americans only hear or pay attention to is the really big news. Not that Republican senator X cosponsered such-and-such a bill, or 11 Republicans voted to on a procedural motion to end debate. What they hear is that a “very big, important bill was signed into law” or “a very big, important proposal from the President failed.” What people hear about is results, not vote tallies or procedure. What they don't want to hear is a lecture on how Democrats failed because Washington is broken. They know that, and that is why they elected the guy who promised to change it.
Health care reform has been one of the biggest and longest debates over a piece of legislation in years. Republicans spent a lot of time trying to hammer home the message that they did not support this bill, and Democrats were “ramming this bill through” on a purely partisan basis. Even with all that, the vast majority of Americans are still unaware that health care reform was passed in the Senate with only Democratic votes. Roughly a third of Americans incorrectly thought the bill did get Republican votes. If people don't know that health care reform failed to get bipartisan support, there is no other piece of legislation they are ever likely to be better informed about.
The low information level of the voters points to the the inherent problem with Obama's insider strategy and obsession with Republican buy-in. Most Americans just don't understand or pay attention to legislative procedure or vote counts. Only 26% of people surveyed even knew that it required 60 votes in the Senate to break a filibuster. An essentially, statically equal number (25%) of people think it only requires 51 votes.
What a large number of Americans only hear or pay attention to is the really big news. Not that Republican senator X cosponsered such-and-such a bill, or 11 Republicans voted to on a procedural motion to end debate. What they hear is that a “very big, important bill was signed into law” or “a very big, important proposal from the President failed.” What people hear about is results, not vote tallies or procedure. What they don't want to hear is a lecture on how Democrats failed because Washington is broken. They know that, and that is why they elected the guy who promised to change it.
Dissecting Obama's Health Care Statement
In last night's State of the Union address, Obama only touched on health care reform briefly. He made it clear he wants something done, but left Democrats scratching their heads about what the path forward should be. Some thoughts:
The fact that Obama mentioned pre-existing conditions is an indication that he may still push for a comprehensive bill, and has not already decided to go for something much more scaled down.
This is not just a problem of Obama failing to sell health care reform. It is true that Obama could have done more to try to market reform, but an inherent problem with the Senate bill is that it is full of unpopular ideas--ideas Obama personally campaigned against.
People don't want a tax on their benefits or a mandate forcing them to buy private insurance. Many people do want to keep the coverage they currently have, and will not be able to do that under the Senate bill because the excise tax is designed to force your employer to change your policy. Obama should know these ideas are politically toxic because he won by running against both of them.
Obama spent all year fighting to protect ideas he claimed to be against on the campaign trail, yet he did nothing to advance, and often tried to stop, very popular ideas he campaigned on like the public option, drug re-importation, and direct Medicare drug price negotiations. Obama's many flip-flops on health care played an important role in people's cynicism about reform. Blaming Congress and communication strategies may feel good, but it ignores a big part of the problem.
The fact that he said, "the plan we’ve proposed" could be a sign that Obama would support the House passing the Senate bill, with or without a reconciliation sidecar.
Obama's "let me know" line does leave open the door to a completely new bill. It could be a new bipartisan bill, or even a new pure reconciliation bill.
To Obama's suggestion for better ideas, I think the proper response is to quote Peterr “I’ll give it to you in two words, Mr. President: Public. Option.”
I would also like to submit a three word answer: "Medicare for all," and a one word answer, Pete Stark's: “Americare”
This is the most painfully frustrating part of this entire health care reform effort. Obama not only refuses to point out that progressives have better ideas about health care reform, but he pretends that these progressive ideas don't even exist at all. This is bad policy and bad politics.
If Obama did not reflexively lurch right every time Republicans came up with some new crazy lie about reform, people would be less inclined to believe the lies. The logic goes, if Democrats drop end-of-life counseling quickly because Republicans called it “death panels,” then they probably really were death panels. Why else would Democrats drop the idea so quickly?
Finally, if Obama had made a point of showing how much further to the left the vast majority of Democrats wanted health care reform to be, it would have made it easier for him to explain to the American people that the Senate bill is very much a right-of-center reform package. By never acknowledging that a large percent of the country was far to the left of Obama on this issue, he let the Republicans define his plan as extreme. Hint for Obama: if you pretend everyone to your left does not exist, then, by default, you can never be seen as a "centrist" like you crave.
Now let’s be clear – I did not choose to tackle this issue to get some legislative victory under my belt. And by now it should be fairly obvious that I didn’t take on health care because it was good politics.
I took on health care because of the stories I’ve heard from Americans with pre-existing conditions whose lives depend on getting coverage; patients who’ve been denied coverage; and families – even those with insurance – who are just one illness away from financial ruin.
The fact that Obama mentioned pre-existing conditions is an indication that he may still push for a comprehensive bill, and has not already decided to go for something much more scaled down.
After nearly a century of trying, we are closer than ever to bringing more security to the lives of so many Americans. The approach we’ve taken would protect every American from the worst practices of the insurance industry. It would give small businesses and uninsured Americans a chance to choose an affordable health care plan in a competitive market. It would require every insurance plan to cover preventive care. And by the way, I want to acknowledge our First Lady, Michelle Obama, who this year is creating a national movement to tackle the epidemic of childhood obesity and make our kids healthier.
Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan. It would reduce costs and premiums for millions of families and businesses. And according to the Congressional Budget Office – the independent organization that both parties have cited as the official scorekeeper for Congress – our approach would bring down the deficit by as much as $1 trillion over the next two decades.
Still, this is a complex issue, and the longer it was debated, the more skeptical people became. I take my share of the blame for not explaining it more clearly to the American people. And I know that with all the lobbying and horse-trading, this process left most Americans wondering what’s in it for them.
This is not just a problem of Obama failing to sell health care reform. It is true that Obama could have done more to try to market reform, but an inherent problem with the Senate bill is that it is full of unpopular ideas--ideas Obama personally campaigned against.
People don't want a tax on their benefits or a mandate forcing them to buy private insurance. Many people do want to keep the coverage they currently have, and will not be able to do that under the Senate bill because the excise tax is designed to force your employer to change your policy. Obama should know these ideas are politically toxic because he won by running against both of them.
Obama spent all year fighting to protect ideas he claimed to be against on the campaign trail, yet he did nothing to advance, and often tried to stop, very popular ideas he campaigned on like the public option, drug re-importation, and direct Medicare drug price negotiations. Obama's many flip-flops on health care played an important role in people's cynicism about reform. Blaming Congress and communication strategies may feel good, but it ignores a big part of the problem.
But I also know this problem is not going away. By the time I’m finished speaking tonight, more Americans will have lost their health insurance. Millions will lose it this year. Our deficit will grow. Premiums will go up. Patients will be denied the care they need. Small business owners will continue to drop coverage altogether. I will not walk away from these Americans, and neither should the people in this chamber.
As temperatures cool, I want everyone to take another look at the plan we’ve proposed.
The fact that he said, "the plan we’ve proposed" could be a sign that Obama would support the House passing the Senate bill, with or without a reconciliation sidecar.
There’s a reason why many doctors, nurses, and health care experts who know our system best consider this approach a vast improvement over the status quo. But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know. Here’s what I ask of Congress, though: Do not walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people.
Obama's "let me know" line does leave open the door to a completely new bill. It could be a new bipartisan bill, or even a new pure reconciliation bill.
To Obama's suggestion for better ideas, I think the proper response is to quote Peterr “I’ll give it to you in two words, Mr. President: Public. Option.”
I would also like to submit a three word answer: "Medicare for all," and a one word answer, Pete Stark's: “Americare”
This is the most painfully frustrating part of this entire health care reform effort. Obama not only refuses to point out that progressives have better ideas about health care reform, but he pretends that these progressive ideas don't even exist at all. This is bad policy and bad politics.
If Obama did not reflexively lurch right every time Republicans came up with some new crazy lie about reform, people would be less inclined to believe the lies. The logic goes, if Democrats drop end-of-life counseling quickly because Republicans called it “death panels,” then they probably really were death panels. Why else would Democrats drop the idea so quickly?
Finally, if Obama had made a point of showing how much further to the left the vast majority of Democrats wanted health care reform to be, it would have made it easier for him to explain to the American people that the Senate bill is very much a right-of-center reform package. By never acknowledging that a large percent of the country was far to the left of Obama on this issue, he let the Republicans define his plan as extreme. Hint for Obama: if you pretend everyone to your left does not exist, then, by default, you can never be seen as a "centrist" like you crave.
As With SCHIP, Major Health Care Reform Is Possible Through Reconciliation
Finally, everyone is starting to admit that real health care reform was always possible using reconciliation. After months of telling the "dirty hippies" they simply don't understand the complex nature of the Senate, the loss of one Democratic Senate seat seems to have changed everyone's tune. The Center on Budget and Policy Priorities has a new paper showing that the use of reconciliation for major health care reform is not outside the tradition of the Senate--or the realm of possibility. After all, the SCHIP program was a major expansion of health insurance coverage passed in a reconciliation measure:
Months ago, now, we could have passed a health care bill that was more progressive, more cost effective, and likely much more popular. We could have done something like SCHIP for everyone or a major expansion of Medicaid and Medicare. Instead, those months were wasted to maintain the stupid 60th-vote myth, losing the Democrats a seat in the Senate, and further destabilizing that institution--and, I'd argue, our country.
Congress also has used reconciliation in the past to establish entirely new health coverage programs or to substantially expand existing ones.This public acknowledgment from left-leaning think tanks that using reconciliation to pass health care reform is more than possible would have been helpful back in September, when it became clear that their would be no real bipartisan legislation. It would have also been helpful during the months of negotiations when progressives were told that they must keep giving into Joe Lieberman's insane demands because we must “get 60 votes for anything.” At the very least, strong validation that reconciliation was a good option would have empowered progressives in the negotiations.
- Children’s Health Insurance Program. Reconciliation legislation enacted in 1997 created the Children’s Health Insurance Program, which now provides subsidized coverage to 7 million children.
- Medicare Advantage. The 1997 reconciliation law also established the Medicare+Choice program, now termed Medicare Advantage. The Medicare Advantage program currently serves 10.4 million Medicare beneficiaries.
- Continuation of Employer-Sponsored Coverage. The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 established new rules under which workers leaving employment with a firm that offers health insurance can remain enrolled in the employer’s health plan for a specified period of time if the worker pays the premiums. COBRA also makes continuation of coverage available to spouses and children of workers upon the death of the worker, loss of dependent status, or other specified circumstances.
Months ago, now, we could have passed a health care bill that was more progressive, more cost effective, and likely much more popular. We could have done something like SCHIP for everyone or a major expansion of Medicaid and Medicare. Instead, those months were wasted to maintain the stupid 60th-vote myth, losing the Democrats a seat in the Senate, and further destabilizing that institution--and, I'd argue, our country.
Reps. Jared Polis And Chellie Pingree Push To Bring Back Public Option
Two freshman Democratic Representatives ,Jared Polis (CO2) and Chellie Pringree (ME1), are pushing hard to include a public option in any reconciliation measure meant to fix the current Senate bill. Polis and Pingree are currently circulating a letter in support of the public option, and are looking for signatures from their colleagues. From the Huffington Post:
It is good to see that at least two Democratic House members can read simple polling data. The public option is extremely popular, while the individual mandate in the Senate bill, which forces people to buy only private insurance, is incredibly unpopular. Fortunately, the addition of a public option even makes the unpopular individual mandate much more palatable to regular Americans.
No New Taxes?
What is very interesting about the letter is that Polis is one of the two authors. Throughout the health care debate, Polis was mainly known for taking the lead against the House's surtax on the wealthy.
It is possible that Polis's strong push for the public option right now might have a lot to due with its ability to save the bill money. It is rumored the current plan is to use reconciliation to raise taxes on the wealthy to pay for the union deal on the excise tax. A move that would be political suicide for Democrats.
Any health care reconciliation measure this year must reduce the deficit to some extent, so any change to the very unpopular excise tax must be paid for. One option is new taxes or increases elsewhere; the other is to pay for the changes with popular cost savings provisions like a public option, Medicaid expansion, and/or Medicare buy-in. Clearly, the latter is what Polis should prefer personally, as it would be the smart choice politically for all Democrats. Sometimes good policy makes for good politics.
"It is very likely that the public option could have passed the Senate, if brought up under majority-vote 'budget reconciliation' rules," reads the letter. "While there were valid reasons stated for not using reconciliation before, especially given that some important provisions of health care reform wouldn't qualify under the reconciliation rules, those reasons no longer exist."
[...]
"There's enthusiasm that if a majority of senators are on board with it, then we should go for it," he said. "I think the inclusion of the public option would make that route much more attractive to House Democrats."
Health care reform became less popular, Polis argued, when the public option was taken out but the requirement to buy private insurance or pay a fine remained.
It is good to see that at least two Democratic House members can read simple polling data. The public option is extremely popular, while the individual mandate in the Senate bill, which forces people to buy only private insurance, is incredibly unpopular. Fortunately, the addition of a public option even makes the unpopular individual mandate much more palatable to regular Americans.
No New Taxes?
What is very interesting about the letter is that Polis is one of the two authors. Throughout the health care debate, Polis was mainly known for taking the lead against the House's surtax on the wealthy.
It is possible that Polis's strong push for the public option right now might have a lot to due with its ability to save the bill money. It is rumored the current plan is to use reconciliation to raise taxes on the wealthy to pay for the union deal on the excise tax. A move that would be political suicide for Democrats.
Any health care reconciliation measure this year must reduce the deficit to some extent, so any change to the very unpopular excise tax must be paid for. One option is new taxes or increases elsewhere; the other is to pay for the changes with popular cost savings provisions like a public option, Medicaid expansion, and/or Medicare buy-in. Clearly, the latter is what Polis should prefer personally, as it would be the smart choice politically for all Democrats. Sometimes good policy makes for good politics.
Message to Unions: Don’t Bargain for a Temporary “Fix” - Push to Eliminate the Excise Tax
Before Scott Brown's win in Massachusetts, Democrats were still foolishly trying to pass health care reform while adhering to the insane 60-vote myth in the Senate. Under this scenario, while I'm disappointed that union leaders could only secure some small improvements to the excise tax and a special carve out for their members, I can understand the necessity of their action. But with the push for a reconciliation sidecar, the political landscape has completely changed. With any deal now only needing a simple majority in the Senate, labor unions should push for a complete elimination of the excise tax, or at least a much more better fix.
The Senate bill’s so-called “Cadillac” tax on employer-provided insurance is both terrible politics and bad policy. Let’s leave aside the extremely faulty, free market economagic claims that the excise tax will magically control health care costs, and focus on its terrible design. It is not even properly designed to do its stated function of taxing generous insurance packages; instead, it just blindly taxes expensive insurance.
The excise tax is, most importantly, a political nightmare for Democrats. It is incredibly unpopular. It is also a direct violation of Obama's campaign pledges not to tax people's health care and let people keep the insurance they have now. Voting for it could be very politically damaging to House Democrats.
Realizing the new political math involved in using reconciliation, labor unions should not try to resurrect some outdated deal they made earlier. Their negotiation position and power has changed dramatically vis-a-vis the Senate.
The reconciliation sidecar strategy already faces an uphill battle. It should only be used to make reform more popular, not less. A deal on the excise tax that exempts negotiated contracts can easily be painted by Republicans as another secret deal to benefit a special interest. It is these special deals and giveaways that have so damaged the health care reform brand. It tarnishes both Democrats and labor unions. That is not what labor or House Dems should want.
If labor unions and House Democrats are unable to completely eliminate the excise tax, they should be able to at least find a much better fix. They can redesign the excise tax to protect union workers, but in a more broad-based manner. For example, having the tax only hit people making over, say, half-a-million a year is one solution. This will provide union members with the same or greater level of protection from the excise tax without Republicans being able to attack it as a deal just for “special interests.”
This change would also have the benefit of making the general idea of the excise tax much more popular for House members. Additionally, it could make labor unions more popular (or at least not cause them to take a big hit in popularity) by allowing organized labor to say that they, in an act of solidarity, fought to make sure every working class American got the same protections from the tax that the unions did.
When something does not work--and this current, corrupt, Rahm Emanuel-driven, insider game, health care strategy hasn't--the right thing to do is a course correction. Don't plow full steam ahead with the exact same strategy. Reconciliation sidecar should not be used to make only the minimum changes to the Senate bill thought necessary to get a “deal.” This shows a tone-deafness to the vox populi, if not a penchant for political suicide. Reconciliation should be seen as a great opportunity to make the bill more popular, and show the American people that Democrats have listened to their complaints.
The Senate bill’s so-called “Cadillac” tax on employer-provided insurance is both terrible politics and bad policy. Let’s leave aside the extremely faulty, free market economagic claims that the excise tax will magically control health care costs, and focus on its terrible design. It is not even properly designed to do its stated function of taxing generous insurance packages; instead, it just blindly taxes expensive insurance.
The excise tax is, most importantly, a political nightmare for Democrats. It is incredibly unpopular. It is also a direct violation of Obama's campaign pledges not to tax people's health care and let people keep the insurance they have now. Voting for it could be very politically damaging to House Democrats.
Realizing the new political math involved in using reconciliation, labor unions should not try to resurrect some outdated deal they made earlier. Their negotiation position and power has changed dramatically vis-a-vis the Senate.
The reconciliation sidecar strategy already faces an uphill battle. It should only be used to make reform more popular, not less. A deal on the excise tax that exempts negotiated contracts can easily be painted by Republicans as another secret deal to benefit a special interest. It is these special deals and giveaways that have so damaged the health care reform brand. It tarnishes both Democrats and labor unions. That is not what labor or House Dems should want.
If labor unions and House Democrats are unable to completely eliminate the excise tax, they should be able to at least find a much better fix. They can redesign the excise tax to protect union workers, but in a more broad-based manner. For example, having the tax only hit people making over, say, half-a-million a year is one solution. This will provide union members with the same or greater level of protection from the excise tax without Republicans being able to attack it as a deal just for “special interests.”
This change would also have the benefit of making the general idea of the excise tax much more popular for House members. Additionally, it could make labor unions more popular (or at least not cause them to take a big hit in popularity) by allowing organized labor to say that they, in an act of solidarity, fought to make sure every working class American got the same protections from the tax that the unions did.
When something does not work--and this current, corrupt, Rahm Emanuel-driven, insider game, health care strategy hasn't--the right thing to do is a course correction. Don't plow full steam ahead with the exact same strategy. Reconciliation sidecar should not be used to make only the minimum changes to the Senate bill thought necessary to get a “deal.” This shows a tone-deafness to the vox populi, if not a penchant for political suicide. Reconciliation should be seen as a great opportunity to make the bill more popular, and show the American people that Democrats have listened to their complaints.
51% Of Self-Identified Republicans In Swing Districts Favor A Public Option
Public option remains popular with even 51% of self identified Republicans in swing districts favoring the idea.
Instead of putting the public option back in the bill it looks like they are going with a political suicide pact of tax increases, Medicare cuts, and giveaways to unions.
Conservative Senate Democrats come out against reconciliation sidecar strategy, no one should really care because they are not need that is the join of reconciliation. This move puts the conservative Democrats on the side of demanding the "cornhusker kickback."
Instead of putting the public option back in the bill it looks like they are going with a political suicide pact of tax increases, Medicare cuts, and giveaways to unions.
Conservative Senate Democrats come out against reconciliation sidecar strategy, no one should really care because they are not need that is the join of reconciliation. This move puts the conservative Democrats on the side of demanding the "cornhusker kickback."
Tax Increases, Medicare Cuts, And Special Give-Aways To Unions: Are Democrats Actively Trying To Lose The House?
Nancy Pelosi and Harry Reid are working on a set of “fixes” to the Senate bill that they hope to pass using reconciliation as part of their "sidecar" strategy. Instead of going for a strong set of popular proposals that could possibly convince some Americans to support reform, the leaders' stated goal is to change the unpopular Senate bill as little as possible. They have decided to pursue a “fix” to the Senate bill with a reconciliation measure containing an incredibly stupid bundle of politically toxic ideas.
According to Politico, the potential reconciliation measure contains six major components:
There will also be some other small, technical fixes and, ideally, a national exchange instead of state-based exchanges. The national exchange could easily run afoul of the Byrd rule, and might not be possible.
Before Democrats try this, I want them to think long and hard. Their “fix” to a very unpopular health care bill is an additional bill that Republicans will easily attack as being more tax increases, more cuts to Medicare, and more backroom deals to give special tax breaks for unions. Even if I agree with these general policy changes, they are not a "fix," they are political death wish.
If Democrats plan to use the reconciliation sidecar strategy, they should use it only for very popular ideas. For example, they can add popular cost control ideas like a public option, Medicare buy-in, or drug re-importation to pay for fixing or eliminating the excise tax. Tax increase are unpopular; this is American politics 101.
When I first proposed the sidecar strategy, I joked that the Democrats would completely mess it up by using the reconciliation sidecar to raise taxes so that they could give a special tax deal to unions, making the Senate health care bill even more unpopular than it already is. It appears my joke was dead on.
I must ask the Democratic leadership if they are actively trying to lose control of the House in 2010? Do they want House Speaker Eric Cantor? It really seems like they are actually trying to do everything they can think of to make sure that they destroy their brand before the midterms. Raising taxes, Medicare cuts, and special union deals--Democrats might just as well have added death panels to the bill because I bet those might poll slightly better than this combo. Have fun explaining to the American people why you thought it was a better idea to raise taxes instead of controlling costs by giving people the choice of a public option.
Democrats really should rethink the politics of this move before it advances any further. The same unpopular bill with only some small unpopular, easily attacked tweaks around the edges is an awful political path forward for health care reform.
According to Politico, the potential reconciliation measure contains six major components:
- An increase in the Medicare payroll tax for the rich
- More cuts to Medicare Advantage
- The special excise tax deal for unions
- Small increases in affordability tax credits
- A fix for the Nebraska Medicaid deal
- Closing the Medicare Part D donut hole by 2019
There will also be some other small, technical fixes and, ideally, a national exchange instead of state-based exchanges. The national exchange could easily run afoul of the Byrd rule, and might not be possible.
Before Democrats try this, I want them to think long and hard. Their “fix” to a very unpopular health care bill is an additional bill that Republicans will easily attack as being more tax increases, more cuts to Medicare, and more backroom deals to give special tax breaks for unions. Even if I agree with these general policy changes, they are not a "fix," they are political death wish.
If Democrats plan to use the reconciliation sidecar strategy, they should use it only for very popular ideas. For example, they can add popular cost control ideas like a public option, Medicare buy-in, or drug re-importation to pay for fixing or eliminating the excise tax. Tax increase are unpopular; this is American politics 101.
When I first proposed the sidecar strategy, I joked that the Democrats would completely mess it up by using the reconciliation sidecar to raise taxes so that they could give a special tax deal to unions, making the Senate health care bill even more unpopular than it already is. It appears my joke was dead on.
I must ask the Democratic leadership if they are actively trying to lose control of the House in 2010? Do they want House Speaker Eric Cantor? It really seems like they are actually trying to do everything they can think of to make sure that they destroy their brand before the midterms. Raising taxes, Medicare cuts, and special union deals--Democrats might just as well have added death panels to the bill because I bet those might poll slightly better than this combo. Have fun explaining to the American people why you thought it was a better idea to raise taxes instead of controlling costs by giving people the choice of a public option.
Democrats really should rethink the politics of this move before it advances any further. The same unpopular bill with only some small unpopular, easily attacked tweaks around the edges is an awful political path forward for health care reform.
Obama Might Not Be So Helpful in the Swing Districts
According to retiring Rep. Marion Berry, Obama promises Democrats that 2010 will not be a repeat of 1994 because Obama is personally popular. This should maybe not give Democrats in swing districts much comfort given Obama's job approval numbers in contested districts.
While Obama still has decent national job approval numbers, that does not matter in congressional races. Each seat is fought for, district by district, and in many swing districts, Obama's job approval numbers are dismal. In the four likely swing districts in the FDL/SurveyUSA polls, Obama's job approval numbers never went above 42% (IN-09 38%, NY-01 42%, OH-01 42%, AR-02 33%). It was only in Ohio's first district that Obama's job approval number was slightly above the likely vote for the Democratic incumbent, Steve Driehaus, and that probably speaks more to how bad both politicians are polling in the district than Obama's relative popularity.
Obama's high national approval ratings may be an indication of his almost unshakably high job approval ratings with some groups, like African Americans, young voters, and people living in large cities, but not a sign of broad, geographic support important for many House races. After all, a new Gallup study did find that Obama has the most polarized first year job approval rate on record. Part of this is a growing ideological uniformity within the party and Obama's very high job approval ratings among self-identified Democrats.
Obama may turn out to be a difficult political tool for House Democrats to use. His strong national job approval could be hiding very serious job disapproval rates in individual swing districts, or, at least, sections of swing districts.
“I’ve been doing that with this White House, and they just don’t seem to give it any credibility at all,” Berry said. “They just kept telling us how good it was going to be. The president himself, when that was brought up in one group, said, ‘Well, the big difference here and in ’94 was you’ve got me.’ We’re going to see how much difference that makes now.”
While Obama still has decent national job approval numbers, that does not matter in congressional races. Each seat is fought for, district by district, and in many swing districts, Obama's job approval numbers are dismal. In the four likely swing districts in the FDL/SurveyUSA polls, Obama's job approval numbers never went above 42% (IN-09 38%, NY-01 42%, OH-01 42%, AR-02 33%). It was only in Ohio's first district that Obama's job approval number was slightly above the likely vote for the Democratic incumbent, Steve Driehaus, and that probably speaks more to how bad both politicians are polling in the district than Obama's relative popularity.
Obama's high national approval ratings may be an indication of his almost unshakably high job approval ratings with some groups, like African Americans, young voters, and people living in large cities, but not a sign of broad, geographic support important for many House races. After all, a new Gallup study did find that Obama has the most polarized first year job approval rate on record. Part of this is a growing ideological uniformity within the party and Obama's very high job approval ratings among self-identified Democrats.
Obama may turn out to be a difficult political tool for House Democrats to use. His strong national job approval could be hiding very serious job disapproval rates in individual swing districts, or, at least, sections of swing districts.
Reconciliation-Only Option Two: Just End Medical Bankruptcy
There are two legitimate paths to passing health care reform that use reconciliation. One is a reconciliation sidecar, and the other is a brand new bill using only reconciliation. This reconciliation-only option appears to have the support of DCCC chairman Chris Van Hollen, who thinks the Senate bill is politically toxic. If Democrats go this reconciliation-only route, a politically smart move would be to go big, but go very focused. Make sure the bill at least addresses the single biggest problem with our health care system: medical bankruptcy. It would be very possible to use reconciliation to pass simple measures that could prevent all medical bankruptcy in this country.
The fact that if people get really sick they can go bankrupt or can't afford needed medical care is the worst moral problem with our health care system. Things like rescission or refusal to cover based on pre-existing conditions are disgusting practices by private insurance, but the main reason they are so terrible is because they can cause medical bankruptcy or create unmanageably tough financial choices because of medical cost.
Reconciliation could be used to create a new program, or use the existing Medicaid and Medicare programs, as a form of universal catastrophic insurance. Simply write the bill so that if any American without insurance gets seriously ill and is forced to spend a large percentage of their income (say over 12%) on health care in a year, they will (after spending that amount) automatically be covered by Medicaid or Medicare. This idea is modeled after a similar, near-universal catastrophic insurance program in Singapore called Medishield. For example, if a family without insurance makes $45,000 a year and has a child who needs chemotherapy that costs $50,000, after the family spends $5,400 (12% of their income) on medical costs, the family is automatically covered by Medicaid or the new program.
The threshold could be a percent of income like the example above, some level of medically induced poverty, or a mixture of the two. One's level of medically induced poverty would be your total income minus the cost of an extreme medical emergency. If medical costs cause your effective income to go below a certain threshold (say 185% of federal poverty level), you are automatically enrolled on Medicaid. So, for a family of four making $50,000 a year spending $9,200 on medical costs, sending their effective income below $40,792 (185% of FPL), they are automatically enrolled in Medicaid. But if that family of four was making $70,000, they would need to spend $29,200 before automatically being enrolled in Medicaid.
To prevent insurance companies from gaming the system, there would need to be some form of a ban on rescission or annual and lifetime limits. Even if, due to the Byrd rule, an outright ban would be impossible through reconciliation, it should still be possible to use a special free-rider tax on insurance companies that sell policies with annual or lifetime limits to effectively end the practice. The plus side to this is it would give the government a financial incentive to make sure insurance companies are not ripping off their customers.
If it were up to me, I would use reconciliation to create Medicare for all. Given that Medicare for all is unlikely, I would strongly back using reconciliation for a large expansion of Medicaid, SCHIP, and Medicare that deals with the bulk of the uninsured. But if Democrats are afraid of the complexity of even that solution, they still need to achieve something big with health care. I think just ending medical bankruptcy by creating, through reconciliation, a universal catastrophic insurance program would be a politically smart solution, and the most "scaled down" reform we could get without it looking like a full retreat and an epic failure.
Ending medical bankruptcy polls very well. The program would extremely easy to explain, and would be focused enough to address a major fear. "If an American gets very sick in this country, we will make sure they will not go bankrupt and lose their home as a result." If Democrats had spent the past year focused on simple and direct ways to solve our health care problems, instead of a corrupt Rube Goldberg plan to enrich the insurance and drug companies, maybe they would not be in such terrible political shape right now.
The fact that if people get really sick they can go bankrupt or can't afford needed medical care is the worst moral problem with our health care system. Things like rescission or refusal to cover based on pre-existing conditions are disgusting practices by private insurance, but the main reason they are so terrible is because they can cause medical bankruptcy or create unmanageably tough financial choices because of medical cost.
Reconciliation could be used to create a new program, or use the existing Medicaid and Medicare programs, as a form of universal catastrophic insurance. Simply write the bill so that if any American without insurance gets seriously ill and is forced to spend a large percentage of their income (say over 12%) on health care in a year, they will (after spending that amount) automatically be covered by Medicaid or Medicare. This idea is modeled after a similar, near-universal catastrophic insurance program in Singapore called Medishield. For example, if a family without insurance makes $45,000 a year and has a child who needs chemotherapy that costs $50,000, after the family spends $5,400 (12% of their income) on medical costs, the family is automatically covered by Medicaid or the new program.
The threshold could be a percent of income like the example above, some level of medically induced poverty, or a mixture of the two. One's level of medically induced poverty would be your total income minus the cost of an extreme medical emergency. If medical costs cause your effective income to go below a certain threshold (say 185% of federal poverty level), you are automatically enrolled on Medicaid. So, for a family of four making $50,000 a year spending $9,200 on medical costs, sending their effective income below $40,792 (185% of FPL), they are automatically enrolled in Medicaid. But if that family of four was making $70,000, they would need to spend $29,200 before automatically being enrolled in Medicaid.
To prevent insurance companies from gaming the system, there would need to be some form of a ban on rescission or annual and lifetime limits. Even if, due to the Byrd rule, an outright ban would be impossible through reconciliation, it should still be possible to use a special free-rider tax on insurance companies that sell policies with annual or lifetime limits to effectively end the practice. The plus side to this is it would give the government a financial incentive to make sure insurance companies are not ripping off their customers.
If it were up to me, I would use reconciliation to create Medicare for all. Given that Medicare for all is unlikely, I would strongly back using reconciliation for a large expansion of Medicaid, SCHIP, and Medicare that deals with the bulk of the uninsured. But if Democrats are afraid of the complexity of even that solution, they still need to achieve something big with health care. I think just ending medical bankruptcy by creating, through reconciliation, a universal catastrophic insurance program would be a politically smart solution, and the most "scaled down" reform we could get without it looking like a full retreat and an epic failure.
Ending medical bankruptcy polls very well. The program would extremely easy to explain, and would be focused enough to address a major fear. "If an American gets very sick in this country, we will make sure they will not go bankrupt and lose their home as a result." If Democrats had spent the past year focused on simple and direct ways to solve our health care problems, instead of a corrupt Rube Goldberg plan to enrich the insurance and drug companies, maybe they would not be in such terrible political shape right now.
“Some Elements Of The Bill Are Popular” - The Foolish Mantra That Won’t Save House Democrats
I have heard a dangerous mantra being repeated by the Senate bill apologists in many different forms. The goal of the consistently uttered mantra seems to be to trick those inside the Washington bubble that the Senate health care bill is, in fact, secretly popular, but the American people are too dumb to realize it. The message in defense of the legislation basically boils down to, “when people hear that X is in the bill, they like the bill more.” Usually the X is some very popular element like tax credits for small businesses, or banning coverage denial based on pre-existing conditions.
Yes, the Senate bill does contain some popular provisions and good ideas. Democrats should not take too much comfort in the fact that they wrote a 2,000 page bill and some how managed not to make every single page terribly unpopular. The problem is that legislation is normally not judged by a handful of its most popular sections, but is often judged by its most egregious. This is especially true when the onset of the bill is delayed so people can’t actually feel the good stuff, but can still hear about the bad stuff. Legislation is like a chain, only as strong as its weakest link.
It is true that when people hear about how the Senate bill will ban rescission, ban discrimination based on pre-existing conditions, expand Medicaid, help close the Medicare Part D donut hole, and/or provide small businesses with tax credits, they tend to be more supportive of the bill. But it is equally true that when people hear about the mandate forcing people to buy private health insurance, the excise tax on employer-provided health insurance benefits, special money for Nebraska, the secret deal with PhRMA to stop drug re-importation, or the delay of benefits till 2014, they become dramatically less supportive of the bill.
Democrats can try to run on the popular stuff--which will not kick in until 2014--but the Republicans will be able to run against the unpopular stuff. Plus, the Republicans will probably say, “We would have happily voted for those popular provisions if the Democrats did not put them in a bill with so many corrupt deals.” While I think this will be dishonest on the part of Republicans, it will still make for a great campaign talking point.
Doubling down on an awful bet by simply passing the Senate bill in the House as is would be a terrible idea. That bill already cost Democrats a Senate seat in Massachusetts. Chris Van Hollen, the head of the DCCC, knows voting for the bill as is would be toxic for House members in 2010.
Cold Political Calculation
Democratic House members should ignore this insane mantra for the bill apologists and make a cold political calculation. Democrats wasted all year working on health care reform so they need to deliver something big to prove they can govern. Equally important the Senate bill as it currently stands is pure poison filled with terrible provisions. The bill is unpopular and House members need to at least pretend they are responding to the anger. So, Democratic House members have only two solutions:
Either strategy should work. Policy-wise, both routes could produce a decent health care reform package if Democrats choose to use reconciliation smartly. For pure political reasons, I lean towards very expansive reconciliation sidecar strategy because the Senate Democrats already voted on their bill.
House Democrats can prove they are relevant, take credit for the very popular provisions in the reconciliation measures, and blame all the problems on the broken Senate. Conservative Senate Democrats can blame whoever they want. I recommend trying to make an argument that uncompromising Republicans just force the Democrats to go it alone, and only moderate Democrats can move things to the center.
Ignore The Mantra
The Senate bill is unpopular and full of easy political targets for Republicans. It will not magically get more popular by just passing it now. Passing it “as is” in the House will prove that House Democrats are a worthless rubber-stamp, and make them look deaf to the will of the people. It is a death sentence.
House Democrats need to show they are listening by demanding some popular changes, like including a public option. The public option is popular, makes the individual mandate more tolerable, and is a sign that Democrats stood up to the unpopular insurance companies. Even if the changes are relatively small, House members need something to point to so they can say, "we heard you."
Yes, the Senate bill does contain some popular provisions and good ideas. Democrats should not take too much comfort in the fact that they wrote a 2,000 page bill and some how managed not to make every single page terribly unpopular. The problem is that legislation is normally not judged by a handful of its most popular sections, but is often judged by its most egregious. This is especially true when the onset of the bill is delayed so people can’t actually feel the good stuff, but can still hear about the bad stuff. Legislation is like a chain, only as strong as its weakest link.
It is true that when people hear about how the Senate bill will ban rescission, ban discrimination based on pre-existing conditions, expand Medicaid, help close the Medicare Part D donut hole, and/or provide small businesses with tax credits, they tend to be more supportive of the bill. But it is equally true that when people hear about the mandate forcing people to buy private health insurance, the excise tax on employer-provided health insurance benefits, special money for Nebraska, the secret deal with PhRMA to stop drug re-importation, or the delay of benefits till 2014, they become dramatically less supportive of the bill.
Democrats can try to run on the popular stuff--which will not kick in until 2014--but the Republicans will be able to run against the unpopular stuff. Plus, the Republicans will probably say, “We would have happily voted for those popular provisions if the Democrats did not put them in a bill with so many corrupt deals.” While I think this will be dishonest on the part of Republicans, it will still make for a great campaign talking point.
Doubling down on an awful bet by simply passing the Senate bill in the House as is would be a terrible idea. That bill already cost Democrats a Senate seat in Massachusetts. Chris Van Hollen, the head of the DCCC, knows voting for the bill as is would be toxic for House members in 2010.
Cold Political Calculation
Democratic House members should ignore this insane mantra for the bill apologists and make a cold political calculation. Democrats wasted all year working on health care reform so they need to deliver something big to prove they can govern. Equally important the Senate bill as it currently stands is pure poison filled with terrible provisions. The bill is unpopular and House members need to at least pretend they are responding to the anger. So, Democratic House members have only two solutions:
- Quickly pass a simple, clean, and easy to explain expansion of Medicaid/SCHIP/Medicare using reconciliation. Tell voters you’ve heard them and made the bill simpler while still helping 30 million Americans.
- Create a sugary sweet reconciliation sidecar measure with as many popular ideas as possible to fix the Senate bill (include a public option, Medicare buy-in, and drug re-importation, eliminate Nebraska’s special deal, and fix or eliminate the excise tax). Pass both bills on the same day. Finally, run against Joe Lieberman and the Senate for messing things up, while pointing to how you did everything you could to stand up to the evil insurance companies, and managed, with hard work, to salvage a very decent health care reform package.
Either strategy should work. Policy-wise, both routes could produce a decent health care reform package if Democrats choose to use reconciliation smartly. For pure political reasons, I lean towards very expansive reconciliation sidecar strategy because the Senate Democrats already voted on their bill.
House Democrats can prove they are relevant, take credit for the very popular provisions in the reconciliation measures, and blame all the problems on the broken Senate. Conservative Senate Democrats can blame whoever they want. I recommend trying to make an argument that uncompromising Republicans just force the Democrats to go it alone, and only moderate Democrats can move things to the center.
Ignore The Mantra
The Senate bill is unpopular and full of easy political targets for Republicans. It will not magically get more popular by just passing it now. Passing it “as is” in the House will prove that House Democrats are a worthless rubber-stamp, and make them look deaf to the will of the people. It is a death sentence.
House Democrats need to show they are listening by demanding some popular changes, like including a public option. The public option is popular, makes the individual mandate more tolerable, and is a sign that Democrats stood up to the unpopular insurance companies. Even if the changes are relatively small, House members need something to point to so they can say, "we heard you."
Pelosi And Reid Team Up For Potential Party Suicide Pact
It appears that Nancy Pelosi and Harry Reid are both currently on board with the reconciliation sidecar strategy to fix the Senate bill. This could be a good thing. It would allow them to fix many of the bill's problems while re-inserting extremely popular provisions like the public option and the Medicare buy-in. Unfortunately they are thinking about using the reconciliation sidecar to make a very unpopular Senate bill pure political poison.
Pelosi and Reid, for some reason, want to have the Democratic Party enter into a collective suicide pact. They plan to use the reconciliation sidecar to mainly just raise some people's taxes to give special tax breaks to unions. From Politico:
You must be kidding me. This is the dumbest thing I have heard from Democrats this month -- a month dominated by terrible decisions by Democrats.
Pelosi's and Reid's plan to get the very unpopular Senate bill passed in the House is to pass a separate, even more radically unpopular measure using reconciliation. Because that is what the health care bill needs right now, more new taxes and more special giveaways to different interest groups.
If they want to fix the very unpopular excise tax, which they should, the secret is to pay for it with popular progressive cost control ideas. They should use the savings from the public option/Medicare buy-in/drug re-importation to pay for fixing the excise tax. This eliminates the need for more taxes and makes the top banner story about the reconciliation sidecar the popular public option/Medicare buy-in instead of a deal with labor unions.
This is not rocket science. If Democrats try to use reconciliation to only pass a deal for labor unions paid for with another tax increase, it will be the death of the party in 2010. If Democrats stand up to the private insurance corporations, give people the very public option they want, and then reduce the excise tax people hate using those savings; health care reform might become popular or at least palatable to most Americans.
Pelosi and Reid, for some reason, want to have the Democratic Party enter into a collective suicide pact. They plan to use the reconciliation sidecar to mainly just raise some people's taxes to give special tax breaks to unions. From Politico:
The changes being considered track closely with the agreements House and Senate leaders made in White House meetings last week, according to a source. They include the deal with labor unions to ease the tax on high-end insurance plans, additional Medicare cuts and taxes, the elimination of a special Medicaid funding deal for Nebraska and a move to help cover the gap in seniors' prescription drug coverage. Pelosi is also working to change the Senate provision that sets up state insurance exchanges. The House prefers a single, national exchange.
You must be kidding me. This is the dumbest thing I have heard from Democrats this month -- a month dominated by terrible decisions by Democrats.
Pelosi's and Reid's plan to get the very unpopular Senate bill passed in the House is to pass a separate, even more radically unpopular measure using reconciliation. Because that is what the health care bill needs right now, more new taxes and more special giveaways to different interest groups.
If they want to fix the very unpopular excise tax, which they should, the secret is to pay for it with popular progressive cost control ideas. They should use the savings from the public option/Medicare buy-in/drug re-importation to pay for fixing the excise tax. This eliminates the need for more taxes and makes the top banner story about the reconciliation sidecar the popular public option/Medicare buy-in instead of a deal with labor unions.
This is not rocket science. If Democrats try to use reconciliation to only pass a deal for labor unions paid for with another tax increase, it will be the death of the party in 2010. If Democrats stand up to the private insurance corporations, give people the very public option they want, and then reduce the excise tax people hate using those savings; health care reform might become popular or at least palatable to most Americans.
The "Reconciliation Only" Option: Just Give Medicaid to Those Who Can't Afford Insurance
If the House Democrats can't find the vote for the Senate bill, and the Senate Democrats are too collectively ego-driven to support a reconciliation sidecar, then the only remaining strategy I can see for a significant increase in insurance coverage is to use reconciliation to just give most Americans who can't afford health insurance access to coverage through Medicaid, Medicare, or SCHIP. This is simple, clean, easy to explain, and a more cost-effective way to expand coverage. Not going this route in the first place was a huge mistake.
The Senate bill expanded insurance to 15 million Americans by increasing Medicaid eligibility for every American to 133% of the federal poverty line (FPL), and by maintaining the SCHIP program. That represented $395 billion of the total cost of the bill. The Kaiser Family Foundation concluded that roughly 30 million of the uninsured in this country are below 200% of the FPL. A recent poll by them also found that when people were told the bill would expand Medicaid to every family making less than $29,000 a year, 62% of voters said that made them more supportive of the bill, while only 22% said they were less supportive.
Expanding Medicaid to everyone below 215% of the FPL, and expanding SCHIP coverage to all uninsured children, should give roughly 30 million more Americans insurance for a cost of just under $800 billion, which is less than the Senate bill.
The Medicaid expansion could be structured to also work as a de facto extreme catastrophic insurance policy for people over 215% FPL. You could set it up so that if anyone suffered from a major medical emergency, which cost so much it effectively made their yearly income below 215% FPL, they would, at that point, be covered by Medicaid. This would effectively put an end to medical bankruptcy in this country.
Early Medicare buy-in could be added for people without insurance who are between 47-65. This is the group who, even if they have money, tend to have the toughest time finding affordable, quality health insurance.
Expanding Medicaid, Medicare, and SCHIP are all doable under reconciliation. A bill that does these three things would only need a simple majority in the Senate, would be cheaper than the current Senate bill, and probably be no more than 30 pages long. This strategy of simply giving people who can't afford insurance coverage through Medicaid and Medicare is extremely easy to explain. Also, these public programs are already covered under the Hyde amendment, so there shouldn't be objections from anti-choice Democrats like Bart Stupak. I don't doubt for a second that a 30-page bill that simply gave those without insurance Medicaid would be dramatically more popular than the current Senate bill.
Don't buy the lie that passing the Senate bill "as is" in the House is the only option. The Senate can adopt a reconciliation sidecar strategy, or they can do a significant coverage expansion even more cost effectively by using a reconciliation measure for a whole new bill. The problem is not reluctant House members or Senate rules. The problem is the Democratic senators themselves.
The Senate bill expanded insurance to 15 million Americans by increasing Medicaid eligibility for every American to 133% of the federal poverty line (FPL), and by maintaining the SCHIP program. That represented $395 billion of the total cost of the bill. The Kaiser Family Foundation concluded that roughly 30 million of the uninsured in this country are below 200% of the FPL. A recent poll by them also found that when people were told the bill would expand Medicaid to every family making less than $29,000 a year, 62% of voters said that made them more supportive of the bill, while only 22% said they were less supportive.
Expanding Medicaid to everyone below 215% of the FPL, and expanding SCHIP coverage to all uninsured children, should give roughly 30 million more Americans insurance for a cost of just under $800 billion, which is less than the Senate bill.
The Medicaid expansion could be structured to also work as a de facto extreme catastrophic insurance policy for people over 215% FPL. You could set it up so that if anyone suffered from a major medical emergency, which cost so much it effectively made their yearly income below 215% FPL, they would, at that point, be covered by Medicaid. This would effectively put an end to medical bankruptcy in this country.
Early Medicare buy-in could be added for people without insurance who are between 47-65. This is the group who, even if they have money, tend to have the toughest time finding affordable, quality health insurance.
Expanding Medicaid, Medicare, and SCHIP are all doable under reconciliation. A bill that does these three things would only need a simple majority in the Senate, would be cheaper than the current Senate bill, and probably be no more than 30 pages long. This strategy of simply giving people who can't afford insurance coverage through Medicaid and Medicare is extremely easy to explain. Also, these public programs are already covered under the Hyde amendment, so there shouldn't be objections from anti-choice Democrats like Bart Stupak. I don't doubt for a second that a 30-page bill that simply gave those without insurance Medicaid would be dramatically more popular than the current Senate bill.
Don't buy the lie that passing the Senate bill "as is" in the House is the only option. The Senate can adopt a reconciliation sidecar strategy, or they can do a significant coverage expansion even more cost effectively by using a reconciliation measure for a whole new bill. The problem is not reluctant House members or Senate rules. The problem is the Democratic senators themselves.
In Act Of Collective Insanity, Senate Democrats Don't Collectively Back Reconciliation Sidecar
Well this is just a remarkably stupid move from Senate Democrats. After ruining health care reform and costing themselves a seat, they refuse to promise to start working on a reconciliation sidecar measure that might just make their bill passable in the House. From Politico:
Now this is an act of egotism beyond description, and a result of Democrats treating the 60-vote myth as sacred while letting every member of the caucus act like a spoiled five-year-old. The Senate Democrats are effectively saying that on a major piece of legislation, the House of Representatives should have absolutely no say.
The insanity of this position is that there are not 218 votes in the House to pass the current Senate bill. There is zero reason to believe that there will be any more votes in a few days or weeks. So, any other route to passing health care reform also requires starting over in the Senate. Either with a new reconciliation-only bill (a good strategy that could create a good bill), or a dramatically scaled-down bill that might get Republican support (a comical pipe dream that is doomed to fail). Both of these ideas would take just as long, or probably much longer, than a reconciliation sidecar.
I hope that the House Democrats do not back down on this. This is an issue even bigger than heath care, this is a question about America: Do we live in a constitutional democracy, or unrepresentative, spoiled bratocracy? For too long, the House sat quietly while the Senate launched a series of anti-constitutional power grabs. The result, over the years, is that the Senate has fallen into a state of collective, ego-driven insanity where each member is king and no one ever accomplishes anything. The Senate is now a corrupt, dysfunctional, completely broken institution. If the House will not finally use this crisis to force the Democratic senators to confront the inherent problems with our government, I see little hope for the future of the Republic.
Part of the negotiations center on whether Reid can provide an ironclad guarantee that the Senate will not leave the House in the lurch, aides said. If the House agrees to pass the Senate bill with a companion measure — or a “cleanup” bill — to make fixes, they want to know that the Senate will indeed pass it, too.
There was some talk among Senate leadership on Thursday of putting together a letter signed by 51 Democratic senators pledging to pass a cleanup bill if the House would pass the Senate bill. But that effort fizzled when support for it didn’t materialize, insiders said.
“The Senate moderates’ viewpoint is, ‘We passed our bill. We’re not going to spend three weeks on some other bill,’” said a Democratic lobbyist who represents clients pushing for reform.
Now this is an act of egotism beyond description, and a result of Democrats treating the 60-vote myth as sacred while letting every member of the caucus act like a spoiled five-year-old. The Senate Democrats are effectively saying that on a major piece of legislation, the House of Representatives should have absolutely no say.
The insanity of this position is that there are not 218 votes in the House to pass the current Senate bill. There is zero reason to believe that there will be any more votes in a few days or weeks. So, any other route to passing health care reform also requires starting over in the Senate. Either with a new reconciliation-only bill (a good strategy that could create a good bill), or a dramatically scaled-down bill that might get Republican support (a comical pipe dream that is doomed to fail). Both of these ideas would take just as long, or probably much longer, than a reconciliation sidecar.
I hope that the House Democrats do not back down on this. This is an issue even bigger than heath care, this is a question about America: Do we live in a constitutional democracy, or unrepresentative, spoiled bratocracy? For too long, the House sat quietly while the Senate launched a series of anti-constitutional power grabs. The result, over the years, is that the Senate has fallen into a state of collective, ego-driven insanity where each member is king and no one ever accomplishes anything. The Senate is now a corrupt, dysfunctional, completely broken institution. If the House will not finally use this crisis to force the Democratic senators to confront the inherent problems with our government, I see little hope for the future of the Republic.
Time For Obama To Do A Domino's Pizza Commercial
Have you see the new Domino's Pizza ads? The ones where the Domino's Pizza chiefs read extremely critical letters and watch brutal focus groups? People say the pizza is awful and tastes like cardboard. The Domino's Pizza chiefs apologizing and admitting the critics are right, but they conclude with the Domino's team saying that they listened to the American public, and, as a result, created a brand new, much tastier pizza. What President Obama should do right now is the same thing with health care reform.
Obama's Domino's Pizza Ad
Obama should apologize for messing up this health care reform effort, for breaking his promises about health care because he let the special interests have too much power, and for not doing more to rein in the banks. He should let the American people know he heard them last Tuesday; should say that he was so busy focusing on ways to stop an economic meltdown that he let too many Wall Street CEOs and bad actors make out like bandits after ruining our economy.
Obama should own up to his failures on health care, while also carefully spreading the blame around. Acknowledge that it was his fault for letting others demagogue health care, and own up to not doing enough to explain it to the America people. He should be apologizing for allowing himself to be so consumed with the very noble of goal helping people get health insurance, that he lost sight of the important details. He let himself cut too many terrible deals within a broken Senate, and allowed a handful of senators to hold the bill hostage until it became a big giveaway to the health insurers.
After admitting his failings, he should rapidly pivot to his solution. Point out that the Senate bill, now before the House, still has some good elements (and list them), but it is seriously flawed. It doesn't do enough to help regular Americans, and doesn't do enough to hold the insurance companies honest. He should state that the message from the voters was clear. They wanted change. They wanted an end to the broken ways of Washington. The voters want a bill meant to help Main Street instead of the insurance CEOs, and that is what they will get.
Obama will instruct House members to not vote for the current bill until the Senate passes a separate measure using reconciliation to fix the problems with the first bill. Explaining that, by using reconciliation, Republicans and special interests won't be able use the rules of the Senate to hold these improvements, which would benefit the American people, hostage. Say that, with reconciliation, the insurance companies can't protect themselves from competition by preventing the American people from getting the choice of a public option. Only after the bill has been fixed will he ask the House to vote on both the bill and the fixes, and then only if it is a bill that puts people in power, not the private insurance companies. (Alternately, he could tell the Senate to start fresh using reconciliation to simply give everyone who can't afford insurance coverage through Medicaid/SCHIP/Medicare.)
The Effect
I think the evidence points to the Massachusetts special election being about populist anger over what appeared to be an administration too friendly to banks, insurance companies, and drug companies. But, to a larger extent, it does not matter. The second Obama makes the grand gesture to say that was the message, the meme enters the DC blood stream.
It makes Obama look like he is listening to voters. Most importantly, it sends the message that people are upset with the corrupt process and the anti-consumer compromises, but not the general goal of health care reform. (The other option is to say that people are, in general, against the idea of health care reform, and Obama wasted his first year pursuing something the public did not want.)
Obama should hope that people still like pizza, and they just think this current pizza tastes bad. If that is the case, Obama can still come out looking stronger by delivering a better pizza.
Obama's Domino's Pizza Ad
Obama should apologize for messing up this health care reform effort, for breaking his promises about health care because he let the special interests have too much power, and for not doing more to rein in the banks. He should let the American people know he heard them last Tuesday; should say that he was so busy focusing on ways to stop an economic meltdown that he let too many Wall Street CEOs and bad actors make out like bandits after ruining our economy.
Obama should own up to his failures on health care, while also carefully spreading the blame around. Acknowledge that it was his fault for letting others demagogue health care, and own up to not doing enough to explain it to the America people. He should be apologizing for allowing himself to be so consumed with the very noble of goal helping people get health insurance, that he lost sight of the important details. He let himself cut too many terrible deals within a broken Senate, and allowed a handful of senators to hold the bill hostage until it became a big giveaway to the health insurers.
After admitting his failings, he should rapidly pivot to his solution. Point out that the Senate bill, now before the House, still has some good elements (and list them), but it is seriously flawed. It doesn't do enough to help regular Americans, and doesn't do enough to hold the insurance companies honest. He should state that the message from the voters was clear. They wanted change. They wanted an end to the broken ways of Washington. The voters want a bill meant to help Main Street instead of the insurance CEOs, and that is what they will get.
Obama will instruct House members to not vote for the current bill until the Senate passes a separate measure using reconciliation to fix the problems with the first bill. Explaining that, by using reconciliation, Republicans and special interests won't be able use the rules of the Senate to hold these improvements, which would benefit the American people, hostage. Say that, with reconciliation, the insurance companies can't protect themselves from competition by preventing the American people from getting the choice of a public option. Only after the bill has been fixed will he ask the House to vote on both the bill and the fixes, and then only if it is a bill that puts people in power, not the private insurance companies. (Alternately, he could tell the Senate to start fresh using reconciliation to simply give everyone who can't afford insurance coverage through Medicaid/SCHIP/Medicare.)
The Effect
I think the evidence points to the Massachusetts special election being about populist anger over what appeared to be an administration too friendly to banks, insurance companies, and drug companies. But, to a larger extent, it does not matter. The second Obama makes the grand gesture to say that was the message, the meme enters the DC blood stream.
It makes Obama look like he is listening to voters. Most importantly, it sends the message that people are upset with the corrupt process and the anti-consumer compromises, but not the general goal of health care reform. (The other option is to say that people are, in general, against the idea of health care reform, and Obama wasted his first year pursuing something the public did not want.)
Obama should hope that people still like pizza, and they just think this current pizza tastes bad. If that is the case, Obama can still come out looking stronger by delivering a better pizza.
Fixing Health Reform Through the Reconciliation Sidecar: 13 Improvements, 6 Ways to Save Money, 4 Important Benefits
Today's reports continue to point to the reconciliation sidecar strategy as the preferred option on Capitol Hill for moving forward with health care reform. The strategy requires the House to pass the Senate bill "as is" only after the Senate has passed measures with several fixes to the Senate bill that can then pass the senate through budget reconciliation. Reconciliation measures can't be filibustered, so they only need a simple majority in the Senate, but because of the Byrd Rule, most only deal with budgetary matters. The reconciliation measure would also need to be net budgetary neutral.
There is a lot that needs to be fixed in the Senate bill--and now it can be fixed, using reconciliation to make it palatable. As voted out by the Senate on Christmas Eve, their version of health reform legislation suffers from many problems:
Some of these fixes will cost the government money, but many of them will result in substantial savings. The goal should be to pay for the things that cost money with the savings from the things that save money.
What Costs the Government Money?
Total cost: roughly $255 billion.
What Saves Money or Increases Revenue for the Government?
Total savings/revenue generated: roughly $260 billion (with additional but yet-un-scored savings from Medicare/Medicaid buy-in, and Medicare direct drug price negotiations).
There are many progressive changes that need to be made to the Senate bill. Fortunately, many of the changes that are overwhelmingly supported by the American people--like the public option--would save the government money. That money can be used to fix other problems in the bill, like the structure of the excise tax. The smart move for Congressional Democrats would be to fully pay for any reconciliation sidecar using progressive cost-saving solutions.
This strategy will have four important political benefits:
There is a lot that needs to be fixed in the Senate bill--and now it can be fixed, using reconciliation to make it palatable. As voted out by the Senate on Christmas Eve, their version of health reform legislation suffers from many problems:
- It lacks a public option.
- It contains insufficient affordability tax credits.
- It lacks a single, national exchange.
- It has no Medicare buy-in or Medicaid buy-in.
- It needs a stronger employer mandate.
- It needs an excise tax fix.
- Special Nebraska Medicaid funding needs to be removed or more fairly allocated.
- It contains an insufficient expansion of Medicaid.
- It lacks a go-ahead for drug re-importation.
- It does not contain provisions for direct Medicare drug price negotiation.
- Annual limits on out-of-pocket costs are much too high.
- Its expansion of community health care centers is insufficient.
- It needs stronger risk adjustment mechanisms (cost neutral, but affects the budget).
Some of these fixes will cost the government money, but many of them will result in substantial savings. The goal should be to pay for the things that cost money with the savings from the things that save money.
What Costs the Government Money?
- Fixing the excise tax (as per agreement with labor unions)--cost $60 billion.
- Extending extra Nebraska Medicaid money to all states--cost $35 billion.
- Increased affordability tax credits and lower annual out-of-pocket limits (there is no one "right" amount, but for the sake of argument I will set a number)--cost $150 billion.
- Increased funding for community health care centers--$10 billion.
- Creating a national exchange (no official CBO score, but cost should not be more than $1 billion).
Total cost: roughly $255 billion.
What Saves Money or Increases Revenue for the Government?
- A strong public option--saves $110 billion (only $25 billion if it is the "level playing field" public option).
- Replacing Senate "free rider" provision with employer mandate--generates an additional $107 billion.
- Medicaid expansion from 133% to 150% FPL--saves $25 billion (in truth, Medicaid should be extended to 200% FPL, or whatever percentage it stops being more cost effective for the government).
- Allowing drug re-importation--saves $19 billion.
- Direct Medicare drug price negotiation (no official CBO score, but should save several billion dollars).
- Early Medicare buy-in for 50-65, after the exchange starts (no official CBO score, but should save several billion dollars).
Total savings/revenue generated: roughly $260 billion (with additional but yet-un-scored savings from Medicare/Medicaid buy-in, and Medicare direct drug price negotiations).
There are many progressive changes that need to be made to the Senate bill. Fortunately, many of the changes that are overwhelmingly supported by the American people--like the public option--would save the government money. That money can be used to fix other problems in the bill, like the structure of the excise tax. The smart move for Congressional Democrats would be to fully pay for any reconciliation sidecar using progressive cost-saving solutions.
This strategy will have four important political benefits:
- Would put popular provisions back in the bill, and therefore could make the whole idea of health care reform more popular.
- Will help save hard-working Americans money.
- Will signal that Democrats are finally standing up to the pharmaceutical and health insurance industries.
- Will not require inclusion of any new tax increases in the reconciliation measure.
Kent Conrad Signals He Would Accept Reconciliation Sidecar
Senator Kent Conrad (D-ND) today stated that he is open to the reconciliation sidecar strategy for passing health care reform. This plan would have the House pass the Senate bill as is, with a reconciliation measure to fix the Senate bill effectively being passed at the same time.
Conrad is both a fairly conservative Democrat and the chairman of the Senate Budget Committee, through which the reconciliation measure would need to pass. This makes his even tepid support of the reconciliation sidecar strategy an important indicator that it may well become the preferred path for passage of health care reform. Further evidence was provided by SEIU President Andy Stern, who also expressed conditional support for the idea, while President Obama has now clearly taken the alternative “rush” strategy off the table.
If Democrats decide to using the reconciliation sidecar strategy, the question is what will be put in the reconciliation bill. The best political move would be to include a public option. The public option is very popular, and it would also save money. The money saved by the public option could be used to pay for changes like increased affordability or fixing the teacher tax.
Sen. Kent Conrad (D-N.D.) made clear his openness to applying budget reconciliation to healthcare, a position he opposed prior to this week’s special election in Massachusetts, is contingent on the content of the bill.
[…]
"If the House passed the Senate bill, could reconciliation, that process, be used to fix things that might be improved upon? Yes," Conrad said. "Would I support it? I can’t know that without knowing what would be included in the package."
Conrad is both a fairly conservative Democrat and the chairman of the Senate Budget Committee, through which the reconciliation measure would need to pass. This makes his even tepid support of the reconciliation sidecar strategy an important indicator that it may well become the preferred path for passage of health care reform. Further evidence was provided by SEIU President Andy Stern, who also expressed conditional support for the idea, while President Obama has now clearly taken the alternative “rush” strategy off the table.
If Democrats decide to using the reconciliation sidecar strategy, the question is what will be put in the reconciliation bill. The best political move would be to include a public option. The public option is very popular, and it would also save money. The money saved by the public option could be used to pay for changes like increased affordability or fixing the teacher tax.
How To Pay For Teacher Tax Fix: Savings From Public Option, Or New Taxes?
Now that Martha Coakley has lost, it seems that there are only two paths to passing health care reform--and both use reconciliation. One path would be a new, redesigned bill passed using reconciliation. The other would be to force the House to pass the Senate bill as is. Given that the Senate bill is unlikely to gain majority support in the House, the only way House Democrats would accept passing the Senate bill without changes is with a promise to fix the bill using a separate piece of legislation passed through budget reconciliation.
The top issue that would need to be “fixed” is the so-called “Cadillac” excise tax on health insurance, which is, in reality, a teacher tax. The “fix,” negotiated by the labor unions, would reduce revenue for the bill by $60 billion over ten years. It would also be safe to assume that the House Democrats would like the reconciliation “fix” to spend more money on several other segments of health care reform, such as increasing affordability tax credits, fully closing the Medicare Part D donut hole, providing more money to community health centers, adding additional funding to state insurance regulators, sending more money to state Medicaid programs. All these changes would cost several billion dollars.
Since the reconciliation instructions for health care reform require the measure to reduce the deficit by some amount, fixing the teacher tax and all the other above improvements would need to be paid for. These could be paid for either with additional tax increases, or with other popular progressive cost control ideas, like the public option and drug re-importation. The strong public option that would pay Medicare rates plus 5% is projected by the Congressional Budget Office to save $110 billion. Removing the Medicare provider opt-out clause would save an additional $91 billion, for a total savings of roughly $200 billion.
A public option designed to pay Medicare rates plus 5% probably would be unable garner majority support in both chambers, but the evidence strongly indicates that the “level playing field” public option--which would pay negotiated rates--could get majority votes in both the House and Senate (through budget reconciliation). The CBO has determined that even this weaker public option would still save the government $25 billion. There are several ways to slightly strengthen the public option to enhance cost reduction. For example, a trigger could be designed that would be pulled if costs on the exchange increased too quickly; the public option could then begin charging Medicare rates plus 5%. One such trigger on payment change for the public option has been projected to save the government an additional $25 billion.
Besides the public option, there are several other progressive cost control improvements that could accompany the Senate bill through use of reconciliation. Expanding Medicaid eligibility from 133% FPL to 150% FPL would save around $25 billion. Some form of Medicaid buy-in for people between 133%-200% FPL could also be designed to save billions.
Drug re-importation and direct Medicare drug price negotiations are both potential progressive sources of savings. Drug re-importation would save the government $19.4 billion and save consumers $100 billion over ten years, according to the CBO. Additional prudent purchasing powers for the exchanges, and higher minimum medical loss ratios for insurance companies are two ideas that could potentially be scored by the CBO as saving money. Shortening the exclusivity period of biosimilars would save the government money, although it may or may not run afoul of the Byrd rule.
These are all popular progressive cost control ideas that were not adopted in the Senate bill because they could not get 60 votes--but they could get a simple majority. These progressive, money-saving ideas (like the public option and Medicaid expansion) could be used to pay for the necessary improvements to the Senate bill that would cost money (like fixing the teacher tax and increased affordability tax credits).
Having the savings from the very popular public option pay for fixing the excise tax on health care benefits would be the politically smart thing to do. It would look like reconciliation was being used to improve cost control in the bill, and make the reform more popular in general. The only other option is to pay for the fix to the excise tax with other new tax increases. That would be a very bad political move. This would make the reconciliation measure look like a corrupt give-away to labor unions, with new tax increase to boot.
Democrats in Congress have a stark choice. If they want to pass the Senate bill as is in the House, but fix many of its worst problems using reconciliation, they will need to pay for some of these improvements. They can pay for these changes with smart, progressive cost control ideas, like the public option, supported overwhelmingly by the American public, or the can pay for them with more new taxes. If this decision is not a political no-brainer for Democrats, then they don't deserve to win re-election.
Now that Martha Coakley has lost, it seems that there are only two paths to passing health care reform--and both use reconciliation. One path would be a new, redesigned bill passed using reconciliation. The other would be to force the House to pass the Senate bill as is. Given that the Senate bill is unlikely to gain majority support in the House, the only way House Democrats would accept passing the Senate bill without changes is with a promise to fix the bill using a separate piece of legislation passed through budget reconciliation.
The top issue that would need to be “fixed” is the so-called “Cadillac” tax on health insurance, which is, in reality, a teacher tax. The “fix,” negotiated by the labor unions, would reduce revenue for the bill by $60 billion over ten years. It would also be safe to assume that the House Democrats would like the reconciliation “fix” to spend more money on several other segments of health care reform, such as increasing affordability tax credits, fully closing the Medicare Part D donut hole, providing more money to community health centers, adding additional funding to state insurance regulators, sending more money to state Medicaid programs. All these changes would cost several billion dollars.
Since the reconciliation instructions for health care reform require the measure to reduce the deficit by some amount, fixing the teacher tax and all the other above improvements would need to be paid for. These could be paid for either with additional tax increases, or with other popular progressive cost control ideas, like the public option and drug re-importation. The strong public option that would pay Medicare rates plus 5% is projected by the Congressional Budget Office to save $110 billion. Removing the Medicare provider opt-out clause would save an additional $91 billion, for a total savings of roughly $200 billion.
A public option designed to pay Medicare rates plus 5% probably would be unable garner majority support in both chambers, but the evidence strongly indicates that the “level playing field” public option--which would pay negotiated rates--could get majority votes in both the House and Senate (through budget reconciliation). The CBO has determined that even this weaker public option would still save the government $25 billion. There are several ways to slightly strengthen the public option to enhance cost reduction. For example, a trigger could be designed that would be pulled if costs on the exchange increased too quickly; the public option could then begin charging Medicare rates plus 5%. One such trigger on payment change for the public option has been projected to save the government an additional $25 billion.
Besides the public option, there are several other progressive cost control improvements that could accompany the Senate bill through use of reconciliation. Expanding Medicaid eligibility from 133% FPL to 150% FPL would save around $25 billion. Some form of Medicaid buy-in for people between 133%-200% FPL could also be designed to save billions.
Drug re-importation and direct Medicare drug price negotiations are both potential progressive sources of savings. Drug re-importation would save the government $19.4 billion and save consumers $100 billion over ten years, according to the CBO. Additional prudent purchasing powers for the exchanges, and higher minimum medical loss ratios for insurance companies are two ideas that could potentially be scored by the CBO as saving money. Shortening the exclusivity period of biosimilars would save the government money, although it may or may not run afoul of the Byrd rule.
These are all popular progressive cost control ideas that were not adopted in the Senate bill because they could not get 60 votes--but they could get a simple majority. These progressive, money-saving ideas (like the public option and Medicaid expansion) could be used to pay for the necessary improvements to the Senate bill that would cost money (like fixing the teacher tax and increased affordability tax credits).
Having the savings from the very popular public option pay for fixing the excise tax on health care benefits would be the politically smart thing to do. It would look like reconciliation was being used to improve cost control in the bill, and make the reform more popular in general. The only other option is to pay for the fix to the excise tax with other new tax increases. That would be a very bad political move. This would make the reconciliation measure look like a corrupt give-away to labor unions, with new tax increase to boot.
Democrats in Congress have a stark choice. If they want to pass the Senate bill as is in the House, but fix many of its worst problems using reconciliation, they will need to pay for some of these improvements. They can pay for these changes with smart, progressive cost control ideas, like the public option, supported overwhelmingly by the American public, or the can pay for them with more new taxes. If this decision is not a political no-brainer for Democrats, then they don't deserve to win re-election.
The top issue that would need to be “fixed” is the so-called “Cadillac” excise tax on health insurance, which is, in reality, a teacher tax. The “fix,” negotiated by the labor unions, would reduce revenue for the bill by $60 billion over ten years. It would also be safe to assume that the House Democrats would like the reconciliation “fix” to spend more money on several other segments of health care reform, such as increasing affordability tax credits, fully closing the Medicare Part D donut hole, providing more money to community health centers, adding additional funding to state insurance regulators, sending more money to state Medicaid programs. All these changes would cost several billion dollars.
Since the reconciliation instructions for health care reform require the measure to reduce the deficit by some amount, fixing the teacher tax and all the other above improvements would need to be paid for. These could be paid for either with additional tax increases, or with other popular progressive cost control ideas, like the public option and drug re-importation. The strong public option that would pay Medicare rates plus 5% is projected by the Congressional Budget Office to save $110 billion. Removing the Medicare provider opt-out clause would save an additional $91 billion, for a total savings of roughly $200 billion.
A public option designed to pay Medicare rates plus 5% probably would be unable garner majority support in both chambers, but the evidence strongly indicates that the “level playing field” public option--which would pay negotiated rates--could get majority votes in both the House and Senate (through budget reconciliation). The CBO has determined that even this weaker public option would still save the government $25 billion. There are several ways to slightly strengthen the public option to enhance cost reduction. For example, a trigger could be designed that would be pulled if costs on the exchange increased too quickly; the public option could then begin charging Medicare rates plus 5%. One such trigger on payment change for the public option has been projected to save the government an additional $25 billion.
Besides the public option, there are several other progressive cost control improvements that could accompany the Senate bill through use of reconciliation. Expanding Medicaid eligibility from 133% FPL to 150% FPL would save around $25 billion. Some form of Medicaid buy-in for people between 133%-200% FPL could also be designed to save billions.
Drug re-importation and direct Medicare drug price negotiations are both potential progressive sources of savings. Drug re-importation would save the government $19.4 billion and save consumers $100 billion over ten years, according to the CBO. Additional prudent purchasing powers for the exchanges, and higher minimum medical loss ratios for insurance companies are two ideas that could potentially be scored by the CBO as saving money. Shortening the exclusivity period of biosimilars would save the government money, although it may or may not run afoul of the Byrd rule.
These are all popular progressive cost control ideas that were not adopted in the Senate bill because they could not get 60 votes--but they could get a simple majority. These progressive, money-saving ideas (like the public option and Medicaid expansion) could be used to pay for the necessary improvements to the Senate bill that would cost money (like fixing the teacher tax and increased affordability tax credits).
Having the savings from the very popular public option pay for fixing the excise tax on health care benefits would be the politically smart thing to do. It would look like reconciliation was being used to improve cost control in the bill, and make the reform more popular in general. The only other option is to pay for the fix to the excise tax with other new tax increases. That would be a very bad political move. This would make the reconciliation measure look like a corrupt give-away to labor unions, with new tax increase to boot.
Democrats in Congress have a stark choice. If they want to pass the Senate bill as is in the House, but fix many of its worst problems using reconciliation, they will need to pay for some of these improvements. They can pay for these changes with smart, progressive cost control ideas, like the public option, supported overwhelmingly by the American public, or the can pay for them with more new taxes. If this decision is not a political no-brainer for Democrats, then they don't deserve to win re-election.
Now that Martha Coakley has lost, it seems that there are only two paths to passing health care reform--and both use reconciliation. One path would be a new, redesigned bill passed using reconciliation. The other would be to force the House to pass the Senate bill as is. Given that the Senate bill is unlikely to gain majority support in the House, the only way House Democrats would accept passing the Senate bill without changes is with a promise to fix the bill using a separate piece of legislation passed through budget reconciliation.
The top issue that would need to be “fixed” is the so-called “Cadillac” tax on health insurance, which is, in reality, a teacher tax. The “fix,” negotiated by the labor unions, would reduce revenue for the bill by $60 billion over ten years. It would also be safe to assume that the House Democrats would like the reconciliation “fix” to spend more money on several other segments of health care reform, such as increasing affordability tax credits, fully closing the Medicare Part D donut hole, providing more money to community health centers, adding additional funding to state insurance regulators, sending more money to state Medicaid programs. All these changes would cost several billion dollars.
Since the reconciliation instructions for health care reform require the measure to reduce the deficit by some amount, fixing the teacher tax and all the other above improvements would need to be paid for. These could be paid for either with additional tax increases, or with other popular progressive cost control ideas, like the public option and drug re-importation. The strong public option that would pay Medicare rates plus 5% is projected by the Congressional Budget Office to save $110 billion. Removing the Medicare provider opt-out clause would save an additional $91 billion, for a total savings of roughly $200 billion.
A public option designed to pay Medicare rates plus 5% probably would be unable garner majority support in both chambers, but the evidence strongly indicates that the “level playing field” public option--which would pay negotiated rates--could get majority votes in both the House and Senate (through budget reconciliation). The CBO has determined that even this weaker public option would still save the government $25 billion. There are several ways to slightly strengthen the public option to enhance cost reduction. For example, a trigger could be designed that would be pulled if costs on the exchange increased too quickly; the public option could then begin charging Medicare rates plus 5%. One such trigger on payment change for the public option has been projected to save the government an additional $25 billion.
Besides the public option, there are several other progressive cost control improvements that could accompany the Senate bill through use of reconciliation. Expanding Medicaid eligibility from 133% FPL to 150% FPL would save around $25 billion. Some form of Medicaid buy-in for people between 133%-200% FPL could also be designed to save billions.
Drug re-importation and direct Medicare drug price negotiations are both potential progressive sources of savings. Drug re-importation would save the government $19.4 billion and save consumers $100 billion over ten years, according to the CBO. Additional prudent purchasing powers for the exchanges, and higher minimum medical loss ratios for insurance companies are two ideas that could potentially be scored by the CBO as saving money. Shortening the exclusivity period of biosimilars would save the government money, although it may or may not run afoul of the Byrd rule.
These are all popular progressive cost control ideas that were not adopted in the Senate bill because they could not get 60 votes--but they could get a simple majority. These progressive, money-saving ideas (like the public option and Medicaid expansion) could be used to pay for the necessary improvements to the Senate bill that would cost money (like fixing the teacher tax and increased affordability tax credits).
Having the savings from the very popular public option pay for fixing the excise tax on health care benefits would be the politically smart thing to do. It would look like reconciliation was being used to improve cost control in the bill, and make the reform more popular in general. The only other option is to pay for the fix to the excise tax with other new tax increases. That would be a very bad political move. This would make the reconciliation measure look like a corrupt give-away to labor unions, with new tax increase to boot.
Democrats in Congress have a stark choice. If they want to pass the Senate bill as is in the House, but fix many of its worst problems using reconciliation, they will need to pay for some of these improvements. They can pay for these changes with smart, progressive cost control ideas, like the public option, supported overwhelmingly by the American public, or the can pay for them with more new taxes. If this decision is not a political no-brainer for Democrats, then they don't deserve to win re-election.
If You Run On Republican Obstructionism, You Will Lose
Let me put this as simply as possible. Democrats control everything in Washington right now. They control the White House. They have a huge margins in the House and in the Senate. Democrats have larger margins in both chambers than any party has had for decades. They have zero excuses for failing to deliver. Americans will not find some nonsense about having only 59 Senate seats as an acceptable excuse for failing to accomplish anything. If Democrats think they can win in 2010 by running against Republican obstructionism, they will lose badly.
Not only will Democrats lose badly if they adopt this strategy, but they will be laughed at. Republicans never had 59 Senate seats, and that did not stop them from passing the legislation they wanted. Trying to explain to the American people how, despite controlling everything, Democrats cannot do anything, because a mean minority of 41 Republican senators won't let them, is a message that will go over like a lead balloon. If you try to use that excuse, people will think elected Democrats are liars, wimps, idiots, or an ineffectual combination of all three.
The party out of power can always run on stopping what the party in power is trying to do. That is often part of their job as the opposition party. Letting the Republicans obstruct, or claiming that Republicans have obstructed the Democrats' ability to govern only makes the GOP look better organized and more powerful.
The party in power can't run an effective re-election campaign based on how the party out of power is doing to good at a job being the opposition party. It won't work, it can't work, and it will do more harm than good. You can always attack your opponents as part of a broad election strategy, but it can't be a main focus for Democrats in 2010.
The party in power must run on their accomplishments and point to those accomplishments as a down payment on other promises they will fullfill if they are allowed to stay in power. You must deliver something to the voters and hope they like it. If Democrats can't run on their record of passing legislation that makes positive change in people's lives, they will suffer terribly in 2010.
I know, right now, that the Democrats in Washington are a bit shell-shocked by Scott Brown's win in Massachusetts. That is understandable. But the solution is not to shut down Congress for the rest of the year. I know some Democrats can't wait to start using the fact that they only have 59 votes in the Senate as an acceptable excuse for doing nothing. That would be a disaster, and no one--whether they closely follow politics or not--will find that excuse for failing to deliver plausible. This is a warning: make Republican obstructionism your main campaign theme for 2010, and you will lose badly.
Not only will Democrats lose badly if they adopt this strategy, but they will be laughed at. Republicans never had 59 Senate seats, and that did not stop them from passing the legislation they wanted. Trying to explain to the American people how, despite controlling everything, Democrats cannot do anything, because a mean minority of 41 Republican senators won't let them, is a message that will go over like a lead balloon. If you try to use that excuse, people will think elected Democrats are liars, wimps, idiots, or an ineffectual combination of all three.
The party out of power can always run on stopping what the party in power is trying to do. That is often part of their job as the opposition party. Letting the Republicans obstruct, or claiming that Republicans have obstructed the Democrats' ability to govern only makes the GOP look better organized and more powerful.
The party in power can't run an effective re-election campaign based on how the party out of power is doing to good at a job being the opposition party. It won't work, it can't work, and it will do more harm than good. You can always attack your opponents as part of a broad election strategy, but it can't be a main focus for Democrats in 2010.
The party in power must run on their accomplishments and point to those accomplishments as a down payment on other promises they will fullfill if they are allowed to stay in power. You must deliver something to the voters and hope they like it. If Democrats can't run on their record of passing legislation that makes positive change in people's lives, they will suffer terribly in 2010.
I know, right now, that the Democrats in Washington are a bit shell-shocked by Scott Brown's win in Massachusetts. That is understandable. But the solution is not to shut down Congress for the rest of the year. I know some Democrats can't wait to start using the fact that they only have 59 votes in the Senate as an acceptable excuse for doing nothing. That would be a disaster, and no one--whether they closely follow politics or not--will find that excuse for failing to deliver plausible. This is a warning: make Republican obstructionism your main campaign theme for 2010, and you will lose badly.
Steny Hoyer Indicates Support for the "Rush" Strategy
Today, House Democratic Majority Leader Steny Hoyer indicated possible support for the rush strategy to pass health care reform.
Fifteen days is presumably less time than it will take Scott Brown to be seated if he actually wins the Massachusetts Senate race. The “rush” strategy would require Democrats to rush to finish all negotiations on health care and pass the new merged bill through both chambers in the small window of time before the Secretary of State of Massachusetts could officially certify Scott Brown, so (should be be elected) he can be seated.
Trying to execute this rush strategy would be sure to cause a huge partisan firestorm, and it is not clear right now if Obama could convince all the conservative Democrats in the Senate to go along with it. I'm sure the Republicans would accuse Democrats of “cheating” and playing dirty.
From my perspective, the potential political and popular blow-back from using the rush strategy would be equal to blow-back from using other hardball strategies like reconciliation or even the nuclear option to get around the filibuster. Of course, the rush strategy would have all the pain of playing hardball, but lack any of the gain. At least, with reconciliation, Democrats have a chance to win back some of their lost supporters by reviving very popular provisions like the public option and/or Medicare buy-in.
At this point, a vote on health care reform is hard enough to sell to voters. Using the rush strategy to pass it will probably not make that sales job any easier. It seems if Democrats are prepared to take the hit for playing hardball politics to pass reform, the best bet is the reconciliation "sidecar" strategy. First, it would allow Democrats to re-insert popular ideas like the public option and potentially do even more to fix problems like affordability. Second, it could help protect some vulnerable Senate Democrats. Using reconciliation for a side car bill will allow senators like Blanche Lincoln and Ben Nelson to vote against the measure, and legitimately distance themselves from the final health care reform product.
House of Representatives Democratic leader Steny Hoyer said on Tuesday the U.S. Senate's version of healthcare reform was "clearly" better than nothing and the overhaul could pass the U.S. Congress within 15 days.
Fifteen days is presumably less time than it will take Scott Brown to be seated if he actually wins the Massachusetts Senate race. The “rush” strategy would require Democrats to rush to finish all negotiations on health care and pass the new merged bill through both chambers in the small window of time before the Secretary of State of Massachusetts could officially certify Scott Brown, so (should be be elected) he can be seated.
Trying to execute this rush strategy would be sure to cause a huge partisan firestorm, and it is not clear right now if Obama could convince all the conservative Democrats in the Senate to go along with it. I'm sure the Republicans would accuse Democrats of “cheating” and playing dirty.
From my perspective, the potential political and popular blow-back from using the rush strategy would be equal to blow-back from using other hardball strategies like reconciliation or even the nuclear option to get around the filibuster. Of course, the rush strategy would have all the pain of playing hardball, but lack any of the gain. At least, with reconciliation, Democrats have a chance to win back some of their lost supporters by reviving very popular provisions like the public option and/or Medicare buy-in.
At this point, a vote on health care reform is hard enough to sell to voters. Using the rush strategy to pass it will probably not make that sales job any easier. It seems if Democrats are prepared to take the hit for playing hardball politics to pass reform, the best bet is the reconciliation "sidecar" strategy. First, it would allow Democrats to re-insert popular ideas like the public option and potentially do even more to fix problems like affordability. Second, it could help protect some vulnerable Senate Democrats. Using reconciliation for a side car bill will allow senators like Blanche Lincoln and Ben Nelson to vote against the measure, and legitimately distance themselves from the final health care reform product.
Poll Trend Moves Strongly Against Martha Coakley
Democrat Martha Coakley is not just down in most polls against Republican Scott Brown in Massachusetts, but the trends in the poll numbers seem to be moving strongly against her.
All polling firms that have tested the race repeatedly, except, ironically, Pajamas Media, have shown Coakley losing support and Brown gaining steam. Suffolk, Rasmussen, PPP, Research 2000, and ARG all have the same pattern. While the polls vary significantly in their projections for the final margin, across the board, there appears to be a major surge in support for Brown.
Of course, the problem with special elections is that they are “special.” There is no voter history for elections that take place the Tuesday after a three day weekend in January. There is only one race on the ballot. Until three weeks ago, that race was seen as a sleeper--but it has recently blown up, drawing huge national attention. As a result, it is extremely difficult to project who actually turns out to vote.
Pollsters, however, need to guess who will turn out to vote, and this makes actually polling a special election difficult because your poll is only as good as your estimate about the makeup of the voter universe. While this will affect pollsters’ accuracy about the final result, it should not affect the general direction that voters are moving. Clearly, Brown has the wind at his back.
So, the real question for tomorrow will be: can the Massachusetts Democratic machine overcome Brown's momentum? The Democratic machine is Massachusetts is very strong. Democrats have a large registration edge, and the DNC/OFA have a huge list in the state. There are a lot of Democratic voters in the state, even though they are very unenthusiastic about the race. If the Democratic machine can literally drag them out to the polls, they might be able to push Coakley over the edge. Will it be the Democratic machine or the Brown surge that wins the day tomorrow?
All polling firms that have tested the race repeatedly, except, ironically, Pajamas Media, have shown Coakley losing support and Brown gaining steam. Suffolk, Rasmussen, PPP, Research 2000, and ARG all have the same pattern. While the polls vary significantly in their projections for the final margin, across the board, there appears to be a major surge in support for Brown.
Of course, the problem with special elections is that they are “special.” There is no voter history for elections that take place the Tuesday after a three day weekend in January. There is only one race on the ballot. Until three weeks ago, that race was seen as a sleeper--but it has recently blown up, drawing huge national attention. As a result, it is extremely difficult to project who actually turns out to vote.
Pollsters, however, need to guess who will turn out to vote, and this makes actually polling a special election difficult because your poll is only as good as your estimate about the makeup of the voter universe. While this will affect pollsters’ accuracy about the final result, it should not affect the general direction that voters are moving. Clearly, Brown has the wind at his back.
So, the real question for tomorrow will be: can the Massachusetts Democratic machine overcome Brown's momentum? The Democratic machine is Massachusetts is very strong. Democrats have a large registration edge, and the DNC/OFA have a huge list in the state. There are a lot of Democratic voters in the state, even though they are very unenthusiastic about the race. If the Democratic machine can literally drag them out to the polls, they might be able to push Coakley over the edge. Will it be the Democratic machine or the Brown surge that wins the day tomorrow?
VP Biden Attacks The Filibuster, But Will He Do Anything About It?
Vice President Joe Biden had some harsh words for the abuse of the filibuster in the Senate this weekend.
To my knowledge this is the first time someone in the Obama administration has publicly attacked the anti-constitutional and destructive nature of the filibuster so directly. The big question is: will Joe Biden do anything about it?
As Vice President, Joe Biden is officially President pro tempore of the Senate. This gives him the power to help eliminate the filibuster using the so-called “nuclear option.” A senator would need to call a point of order against the filibuster, and Joe Biden as President pro tempore would need to make a parliamentary ruling upholding the point of order. This would likely result in an “appealing from the Chair,” and force a simple majority vote on whether to eliminate the filibuster or not.
I don't suspect that Joe Biden plans to using the “nuclear option” anytime soon, but it is interesting to see statements extremely critical of the filibuster coming from the one individual with probably the most power to eliminate it.
"As long as I have served ... I've never seen, as my uncle once said, the Constitution stood on its head as they've done. This is the first time every single solitary decisions has required 60 senators," he said at a Florida fundraiser, according to the pool report. “No democracy has survived needing a super majority."
To my knowledge this is the first time someone in the Obama administration has publicly attacked the anti-constitutional and destructive nature of the filibuster so directly. The big question is: will Joe Biden do anything about it?
As Vice President, Joe Biden is officially President pro tempore of the Senate. This gives him the power to help eliminate the filibuster using the so-called “nuclear option.” A senator would need to call a point of order against the filibuster, and Joe Biden as President pro tempore would need to make a parliamentary ruling upholding the point of order. This would likely result in an “appealing from the Chair,” and force a simple majority vote on whether to eliminate the filibuster or not.
I don't suspect that Joe Biden plans to using the “nuclear option” anytime soon, but it is interesting to see statements extremely critical of the filibuster coming from the one individual with probably the most power to eliminate it.
If Coakley Loses, Reconciliation Must Be Revived
If Martha Coakley loses the special election for the Massachusetts Senate seat, the big question in Washington is what would happen to health care. It is clear the White House is pushing for the House to pass the Senate bill as is.
This should surprise no one. The Obama has made it clear all along that he favored the Senate bill. The big question is: can they force the Senate bill through the House? Such a move would face some very angry progressives, representatives in labor heavy states who don't want the excise tax, and a small group of conservative Democrats in the House who might bolt at the bill's lack of Stupak's anti-choice amendment. Getting the House to swallow the Senate bill whole would be an extreme uphill battle.
One of the other options is to jam the compromise bill through the Senate before Republican Scott Brown is seated. I don't know if this would even be technically possible, and I doubt you could get all 60 Democratic votes for that move, anyway.
The last option is to use reconciliation, which can't be filibustered. As Chris Van Hollen said, “reconciliation is an option.” They could use reconciliation to pass a new, redesigned health care bill, or they can pass the Senate bill and a reconciliation measure right after to fix the Senate bill.
Using reconciliation to pass a new bill would require a rewriting of the bill so it only deals with budgetary matters. This would probably mean a strong employer mandate, a Medicare buy-in/public option, and a large expansion of Medicaid/SCHIP as the primary ways to expand coverage. Going this route could help make the Stupak abortion language issue moot since Medicaid, Medicare, and SCHIP are already under the existing anti-abortion Hyde amendment.
Passing the Senate bill first, and then fixing it with reconciliation, could also create strong political and policy pressure for reviving the public option or Medicare buy-in. Probably the only way they could jam the Senate bill “as is” through the House would be to get labor on board. To get labor, you need to promise to fix the excise tax, and probably the only way to do that is by using reconciliation. The unions agreed to a “fix” of the excise tax that would cost $60 billion. That money needs to be recouped through other tax increases or cost-cutting measures. Even a weak, “level playing field” public option would save $25 billion, and increasing Medicaid from 133% to 150% FPL should save another several billion.
If Coakley loses in Massachusetts, I don't see how health care reform passes without reviving reconciliation, and, by default, the public option. The evidence indicates that Nancy Pelosi could not find the votes to pass the Senate bill as is. It would seem her only option is to promise to seriously fix the bill right away with reconciliation, or pass a completely redesigned bill using reconciliation. Either way, I don't see how health care reform could move forward without using reconciliation in some manner.
For the moment, at least, the preferred Plan B would be to try to persuade House Democrats to approve the health care bill that the Senate adopted on Christmas Eve, obviating the need for an additional Senate vote and sending the measure directly to President Obama for his signature, administration officials and Congressional aides said on Sunday.
This should surprise no one. The Obama has made it clear all along that he favored the Senate bill. The big question is: can they force the Senate bill through the House? Such a move would face some very angry progressives, representatives in labor heavy states who don't want the excise tax, and a small group of conservative Democrats in the House who might bolt at the bill's lack of Stupak's anti-choice amendment. Getting the House to swallow the Senate bill whole would be an extreme uphill battle.
One of the other options is to jam the compromise bill through the Senate before Republican Scott Brown is seated. I don't know if this would even be technically possible, and I doubt you could get all 60 Democratic votes for that move, anyway.
The last option is to use reconciliation, which can't be filibustered. As Chris Van Hollen said, “reconciliation is an option.” They could use reconciliation to pass a new, redesigned health care bill, or they can pass the Senate bill and a reconciliation measure right after to fix the Senate bill.
Using reconciliation to pass a new bill would require a rewriting of the bill so it only deals with budgetary matters. This would probably mean a strong employer mandate, a Medicare buy-in/public option, and a large expansion of Medicaid/SCHIP as the primary ways to expand coverage. Going this route could help make the Stupak abortion language issue moot since Medicaid, Medicare, and SCHIP are already under the existing anti-abortion Hyde amendment.
Passing the Senate bill first, and then fixing it with reconciliation, could also create strong political and policy pressure for reviving the public option or Medicare buy-in. Probably the only way they could jam the Senate bill “as is” through the House would be to get labor on board. To get labor, you need to promise to fix the excise tax, and probably the only way to do that is by using reconciliation. The unions agreed to a “fix” of the excise tax that would cost $60 billion. That money needs to be recouped through other tax increases or cost-cutting measures. Even a weak, “level playing field” public option would save $25 billion, and increasing Medicaid from 133% to 150% FPL should save another several billion.
If Coakley loses in Massachusetts, I don't see how health care reform passes without reviving reconciliation, and, by default, the public option. The evidence indicates that Nancy Pelosi could not find the votes to pass the Senate bill as is. It would seem her only option is to promise to seriously fix the bill right away with reconciliation, or pass a completely redesigned bill using reconciliation. Either way, I don't see how health care reform could move forward without using reconciliation in some manner.
Van Hollen: Reconciliation Is An Option
Finally, all it takes is the possibility of losing a Senate seat in Massachusetts plus tanking poll numbers for House Democrats for Congressional leaders to admit they really only need a simple majority in the Senate to pass health care reform.
Using reconciliation has been an option for months. Democrats should have started the reconciliation process back in September when it was clear that Republicans had no intention of working on a bipartisan bill. The bill would have been signed before Christmas if they had gone that route.
Instead, Harry Reid spent months watering it down until it could get 60 votes. Senate Democrats engaged in a terrible process of giving into every one of the insane and nonsensical demands from Joe Lieberman, Ben Nelson, and Blanche Lincoln. They removed some of the most popular components, made it clear the Senate was bought by the big health insurance companies, and showed that the Senate Democratic caucus is a completely non-functional group.
Democrats made the bill terrible to win Joe Lieberman's, Ben Nelson's, and Blanche Lincoln's support. And now Van Hollen admits that they did not need to. They could have passed a bill without giving into this handful of conservative senators. It was always possible to pass a bill with a public option, and it is still possible. Instead, they are going to force people to buy an expensive, low quality product from the same poorly regulated private insurance companies that helped ruin our health care system in the first place. I would not want to be the one selling that decision during the next election.
“Even before Massachusetts and that race was on the radar screen, we prepared for the process of using reconciliation,” said Chris Van Hollen of Maryland, chairman of the Democratic Congressional Campaign Committee.
“Getting health-care reform passed is important,” Van Hollen said in an interview on Bloomberg Television’s “Political Capital with Al Hunt,” airing this weekend. “Reconciliation is an option.”
Using reconciliation has been an option for months. Democrats should have started the reconciliation process back in September when it was clear that Republicans had no intention of working on a bipartisan bill. The bill would have been signed before Christmas if they had gone that route.
Instead, Harry Reid spent months watering it down until it could get 60 votes. Senate Democrats engaged in a terrible process of giving into every one of the insane and nonsensical demands from Joe Lieberman, Ben Nelson, and Blanche Lincoln. They removed some of the most popular components, made it clear the Senate was bought by the big health insurance companies, and showed that the Senate Democratic caucus is a completely non-functional group.
Democrats made the bill terrible to win Joe Lieberman's, Ben Nelson's, and Blanche Lincoln's support. And now Van Hollen admits that they did not need to. They could have passed a bill without giving into this handful of conservative senators. It was always possible to pass a bill with a public option, and it is still possible. Instead, they are going to force people to buy an expensive, low quality product from the same poorly regulated private insurance companies that helped ruin our health care system in the first place. I would not want to be the one selling that decision during the next election.
Fear The Part-State/Part-Federal Exchange Frankenstein Monster
The House health care bill's single national exchange with federal regulatory enforcement mechanisms is clearly superior to the Senate's idea of small, state-based exchanges with enforcement by state insurance commissioners. Under the House bill, if states think that they can do a better job than the national exchange, they have the right to opt out and set up their own exchange and enforcement mechanisms.
There is no logical reason to want to go with the Senate's state-based exchanges if your desire is to do what is best for regular Americans. If your desire is to help private insurance companies, then the Senate's structure is the way to go.
But, news today has it, instead of getting what is best for the American people, it appears we are going to get some terrible Frankenstein monster that is part national and part state-based.
I really don't like the sound of this. Federal-state hybrids don't tend to have a good track record. To me, this sounds like a recipe for insurance companies to game the system by slipping between the gulf of what the state regulator is doing and the federal insurance regulatory system is doing.
I guess Ben Nelson doesn't want a national exchange, so we don't get a national exchange. I'm truly amazed that Democrats are letting Ben Nelson ruin our potential health care system, destroy the popularity of the bill, and possibly cost Democrats control of the House. At some point, you would think they would say “enough is enough” to this 60-vote nonsense killing their chances of re-election and ruining our government.
There is no logical reason to want to go with the Senate's state-based exchanges if your desire is to do what is best for regular Americans. If your desire is to help private insurance companies, then the Senate's structure is the way to go.
But, news today has it, instead of getting what is best for the American people, it appears we are going to get some terrible Frankenstein monster that is part national and part state-based.
How to structure the exchanges consumers would use to buy insurance is one of the major outstanding questions. House Democrats favor a single, national exchange while the Senate has endorsed multiple state-based exchanges
Van Hollen described a kind of middle ground that would have a "national component" and more uniformity.
I really don't like the sound of this. Federal-state hybrids don't tend to have a good track record. To me, this sounds like a recipe for insurance companies to game the system by slipping between the gulf of what the state regulator is doing and the federal insurance regulatory system is doing.
I guess Ben Nelson doesn't want a national exchange, so we don't get a national exchange. I'm truly amazed that Democrats are letting Ben Nelson ruin our potential health care system, destroy the popularity of the bill, and possibly cost Democrats control of the House. At some point, you would think they would say “enough is enough” to this 60-vote nonsense killing their chances of re-election and ruining our government.
Republicans Don't Need To Run On Repealing The Whole Bill
President Obama wants to have a fight with the Republican who will run on repealing the whole health care bill. While I'm sure some Republicans in the deep red districts will run on that platform, I doubt the bulk of the Republican party will. I don't think Obama will get the fight he claims to want. I suspect many Republicans will wisely run on repealing just the most unpopular parts, repealing the taxes, and against the very corrupt way the bill was written.
There is a history for this strategy. After the Republicans passed Medicare Part D, did Democrats run against it by saying they would repeal the whole thing? No, Democrats ran against the most unpopular parts and the clearly corrupt manner in which the bill was written. In fact, the Republicans can probably dust off every single talking point the Democrats used against Medicare Part D. All the corrupt deals Bush cut with PhRMA for the Medicare Part D bill were protected as part of Obama's deal with them for this bill.
Republicans will probably run on repealing just the deeply unpopular provisions, like the individual mandate and the tax on health insurance benefits. We know those are winning messages because Obama campaigned on them in 2008.
The GOP might call the bill a bundle of corrupt promises masquerading as reform. They can point to the sweetheart deal for drug companies, the huge subsidies given to the private insurance companies, the deal cut with the hospitals, and the special carve-out for unions. Republicans will also be able to make a big deal about the lack of promised transparency and the many other broken promises from Obama about health care.
I can even picture Republicans attacking Democrats for passing a bill that lacks “Republican solutions” like tort reform and drug re-importation. Yes Republicans can now steal the mantle of being the party that supports drug re-importation because Obama killed in on the Senate floor. Some clever Republicans in bluer districts might even run a campaign on “fixing” the bill by removing all of the Democrats’ sweetheart deals and corporate giveaways.
Will Republicans actually be able to, or want to, deliver on promises like repealing the individual mandate or allowing drug re-importation? It is very unlikely, but that is not the point. The point is that it makes for great campaign fodder.
Health care reform will not be a simple “yes” or “no” issue in the midterm elections. It will not be a purely “we must keep this bill” or “we must completely repeal this bill” fight. Republicans will attack the bill's dozens of weak points.
The only defense for a deeply compromised bill is to have it in effect so people can judge for themselves if the benefits outweigh the negatives. The problem is, the bill does not really help anyone for four years. Democrats will have almost no immediate tangible positives to point to as a justification for their votes.
Between now and 2014, Republicans will point to every big premium increase, every higher co-pay, and every spike in drug prices as proof that “Democrats failed on health care.” Fair or not, the Republicans might start placing the blame for every new problem with our health care system at the feet of Democrats.
Democrats allowed a handful of powerful special interests and conservative Democrats to kill all the most popular elements in the bill. The public option, Medicare buy-in, drug re-importation, repeal of the anti-trust exemption, cheaper drugs for Medicare with direct drug price negotiations were all removed.
This is not meant to be a doomsday prediction or a campaign manual for Republicans (they already know how to run against this bill). This is meant to be a massive warning to Democrats. All year, I have been trying to warn Democrats in Congress. They are about to commit political suicide by over-promising, under-delivering, and making themselves appear tools of the corporations ripping off regular Americans. If you say you are going to reform health care you better reform health care.
Health care reform is not unpopular because of attack campaigns against it. No amount attack commercials was able to really dent the strong support for a public option. The bill is unpopular because Democrats kept removing every popular idea from the bill. Democrats are driving themselves straight off a cliff. They need to change course. Having the President say the only thing the very unpopular bill needs to save Democrats in 2010 is a good PR campaign is not helping the party.
If Democrats insist on passing this bill, they should start by removing all the most unpopular components ripe for Republican attack. Then, Democrats need to turn around and pass additional health care measures that start helping lots of people now--not in the distant future. They need to prove right away that health care reform is a good thing for regular Americans to save themselves in 2010. Finally, in the next few months, Democrats should take all the very popular ideas removed to appease Joe Lieberman and Ben Nelson and move them through the process with reconciliation. Democrats can save themselves from this self-destruction, but, like recovering addicts, they must first admit that they have a serious problem.
There is a history for this strategy. After the Republicans passed Medicare Part D, did Democrats run against it by saying they would repeal the whole thing? No, Democrats ran against the most unpopular parts and the clearly corrupt manner in which the bill was written. In fact, the Republicans can probably dust off every single talking point the Democrats used against Medicare Part D. All the corrupt deals Bush cut with PhRMA for the Medicare Part D bill were protected as part of Obama's deal with them for this bill.
Republicans will probably run on repealing just the deeply unpopular provisions, like the individual mandate and the tax on health insurance benefits. We know those are winning messages because Obama campaigned on them in 2008.
The GOP might call the bill a bundle of corrupt promises masquerading as reform. They can point to the sweetheart deal for drug companies, the huge subsidies given to the private insurance companies, the deal cut with the hospitals, and the special carve-out for unions. Republicans will also be able to make a big deal about the lack of promised transparency and the many other broken promises from Obama about health care.
I can even picture Republicans attacking Democrats for passing a bill that lacks “Republican solutions” like tort reform and drug re-importation. Yes Republicans can now steal the mantle of being the party that supports drug re-importation because Obama killed in on the Senate floor. Some clever Republicans in bluer districts might even run a campaign on “fixing” the bill by removing all of the Democrats’ sweetheart deals and corporate giveaways.
Will Republicans actually be able to, or want to, deliver on promises like repealing the individual mandate or allowing drug re-importation? It is very unlikely, but that is not the point. The point is that it makes for great campaign fodder.
Health care reform will not be a simple “yes” or “no” issue in the midterm elections. It will not be a purely “we must keep this bill” or “we must completely repeal this bill” fight. Republicans will attack the bill's dozens of weak points.
The only defense for a deeply compromised bill is to have it in effect so people can judge for themselves if the benefits outweigh the negatives. The problem is, the bill does not really help anyone for four years. Democrats will have almost no immediate tangible positives to point to as a justification for their votes.
Between now and 2014, Republicans will point to every big premium increase, every higher co-pay, and every spike in drug prices as proof that “Democrats failed on health care.” Fair or not, the Republicans might start placing the blame for every new problem with our health care system at the feet of Democrats.
Democrats allowed a handful of powerful special interests and conservative Democrats to kill all the most popular elements in the bill. The public option, Medicare buy-in, drug re-importation, repeal of the anti-trust exemption, cheaper drugs for Medicare with direct drug price negotiations were all removed.
This is not meant to be a doomsday prediction or a campaign manual for Republicans (they already know how to run against this bill). This is meant to be a massive warning to Democrats. All year, I have been trying to warn Democrats in Congress. They are about to commit political suicide by over-promising, under-delivering, and making themselves appear tools of the corporations ripping off regular Americans. If you say you are going to reform health care you better reform health care.
Health care reform is not unpopular because of attack campaigns against it. No amount attack commercials was able to really dent the strong support for a public option. The bill is unpopular because Democrats kept removing every popular idea from the bill. Democrats are driving themselves straight off a cliff. They need to change course. Having the President say the only thing the very unpopular bill needs to save Democrats in 2010 is a good PR campaign is not helping the party.
If Democrats insist on passing this bill, they should start by removing all the most unpopular components ripe for Republican attack. Then, Democrats need to turn around and pass additional health care measures that start helping lots of people now--not in the distant future. They need to prove right away that health care reform is a good thing for regular Americans to save themselves in 2010. Finally, in the next few months, Democrats should take all the very popular ideas removed to appease Joe Lieberman and Ben Nelson and move them through the process with reconciliation. Democrats can save themselves from this self-destruction, but, like recovering addicts, they must first admit that they have a serious problem.
Looking At The Labor Deal: Why Would Anyone Want To Move To The Exchange?
Late yesterday the labor unions struck a deal with the White House about the excise tax. The key points seem to be: raising the threshold, exempting dental and vision benefits from the excise tax, adjusting for age and health status, adding a carve-out for collectively bargained plans until 2018, and starting in 2017, plans created under collective bargaining agreements can move to the exchange.
The indexing problem was not fixed. It will stay at “consumer price index plus 1%.” Therefore, changes like the raising of the threshold or exempting vision benefits do not fix the problem--the tax will eventually start hitting more and more middle class families as time goes on. This deal just means they’ve kicked the can further down the road by several years. It is still very possible this will turn into another alternative minimum tax problem in the next decade.
Exempting dental, in effect, further raises the threshold, but I don't think this concession was really designed just for the labor unions. I have no proof for this, but I would not be surprised if this change has as much, or even more, to do with keeping dentists happy.
I think the most important change is the adjustment for age, gender, health status, and workplace risk. Very little about the cost of a health care plan has to do with how generous the plan is. Price is most affected by the age and gender of the people being insured. Without knowing the details of how they will calculate this adjustment, I can't say how good the change is, but ideally, it is structured so the tax tends to hit generous plans, and not just companies that employee a lot of older women.
Moving to the Exchange
The temporary collective bargaining carve-out for the unions is self-explanatory. The provision that allows for the possible moving of collective bargaining plans (i.e. labor union plans) to the exchanges in 2017 seems very fishy. It is especially strange comsidering that the White House seems to be lightly walking back its commitment to this provision.
I don't understand why unions would want to move to the exchange. Exchanges have so far failed to reduce the growth rate of health insurance. There is little reason to believe they would in the future especially if they are small, state-based exchanges like the ones created by the Senate bill. Most importantly, exchanges add just another middleman, and another layer of waste. Most very large employers self-insure, and only contract out their administrative work to private insurance companies. If, instead of self-insuring, companies gave their union employees vouchers to buy insurance from a private insurance company on the exchange, that would just add a few percentage points more waste to the cost of the care. Also, at this point, I have very little confidence that insurance on the exchange will be good or properly regulated.
Why would anyone want to move from a large employer plan to the new exchanges? I honestly don't know. My strong suspicion is that there is another very important part to this provision we currently don't know about. It could be that large unions are planning to move all their members off of multiple employer plans and onto a single, massive plan for the whole union. Maybe the unions got the right to collective bargain on the exchange with insurers. I know in the Netherlands there is a similar system with an exchange for individuals, but large employers are able to collectively bargain for even lower prices. Either way, I get the sense that there is much more to this moving-to-the-exchange provision than we know right now.
The indexing problem was not fixed. It will stay at “consumer price index plus 1%.” Therefore, changes like the raising of the threshold or exempting vision benefits do not fix the problem--the tax will eventually start hitting more and more middle class families as time goes on. This deal just means they’ve kicked the can further down the road by several years. It is still very possible this will turn into another alternative minimum tax problem in the next decade.
Exempting dental, in effect, further raises the threshold, but I don't think this concession was really designed just for the labor unions. I have no proof for this, but I would not be surprised if this change has as much, or even more, to do with keeping dentists happy.
I think the most important change is the adjustment for age, gender, health status, and workplace risk. Very little about the cost of a health care plan has to do with how generous the plan is. Price is most affected by the age and gender of the people being insured. Without knowing the details of how they will calculate this adjustment, I can't say how good the change is, but ideally, it is structured so the tax tends to hit generous plans, and not just companies that employee a lot of older women.
Moving to the Exchange
The temporary collective bargaining carve-out for the unions is self-explanatory. The provision that allows for the possible moving of collective bargaining plans (i.e. labor union plans) to the exchanges in 2017 seems very fishy. It is especially strange comsidering that the White House seems to be lightly walking back its commitment to this provision.
I don't understand why unions would want to move to the exchange. Exchanges have so far failed to reduce the growth rate of health insurance. There is little reason to believe they would in the future especially if they are small, state-based exchanges like the ones created by the Senate bill. Most importantly, exchanges add just another middleman, and another layer of waste. Most very large employers self-insure, and only contract out their administrative work to private insurance companies. If, instead of self-insuring, companies gave their union employees vouchers to buy insurance from a private insurance company on the exchange, that would just add a few percentage points more waste to the cost of the care. Also, at this point, I have very little confidence that insurance on the exchange will be good or properly regulated.
Why would anyone want to move from a large employer plan to the new exchanges? I honestly don't know. My strong suspicion is that there is another very important part to this provision we currently don't know about. It could be that large unions are planning to move all their members off of multiple employer plans and onto a single, massive plan for the whole union. Maybe the unions got the right to collective bargain on the exchange with insurers. I know in the Netherlands there is a similar system with an exchange for individuals, but large employers are able to collectively bargain for even lower prices. Either way, I get the sense that there is much more to this moving-to-the-exchange provision than we know right now.
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