Ben Nelson Now Angling To Kill New Health Insurance Rating Authority

Ben Nelson (D-NE), living up to his role as the great defender of the health insurance industry, is now leading the fight against the new Health Insurance Rating Authority that Obama proposed as part of his health care reform package (PDF). From Politico:

Nelson quietly urged Democratic leaders to reject Feinstein’s effort to include in the Senate health care bill a proposal empowering federal authorities to block high rate increases by health insurers, POLITICO has learned. And that irked Feinstein, who swallowed her pride and voted for the Senate bill even though she felt it shortchanged her state of California in some areas.

While I might be mistaken, from my studies of reconciliation and the Byrd rule, I've believe that this new Health Insurance Rating Authority would violate the Byrd rule because it is unlikely to be seen as affecting the budget.

If that is the case, having it survive in any reconciliation bill it would either require some hardball from Joe Biden or a vote of 60 senators to waive the Byrd rule. If Ben Nelson is a "no," it is hard to imagine two Republican senators voting to protect the new federal agency.

Nelson's opposition to the idea re-enforces my belief that Obama added it to his proposal for cynical political (and not policy) reasons. Knowing that it would never become law, the president surmised that the proposal would force Republicans to take a potentially difficult vote, but its likely exclusion from budget reconciliation would ensure that private health insurance companies were spared oversight by a new agency. If Obama is serious about keeping the insurance industry honest, he would push for mechanisms that would not violate the Byrd rule, ones that could pass with a simple majority as part of reconciliation, like a public option or Medicare buy-in.

Shocking News: Americans Care About Results, Not Process Or Senate Rules

While to most people in greater America this would seem like common sense, it is amazing how many people inside the Beltway will find this news mind-boggling. A new poll shows that the majority of Americans in many states don't object to Democrats using reconciliation to pass health care reform if they think the bill will benefit their families. When asked:

If the Senate passes a health care reform bill that you consider to be beneficial to your family, would you object to the Senate's use of "reconciliation" rules to pass that bill with a majority vote, or not?

Fifty-five percent of people in Nevada would not object. The numbers were 67% in Illinois, 65% in Washington, 58% in Missouri, 60% in Virginia, 66% in Iowa, and 53% in North Dakota.

The important part of the question is clearly whether people think the health care reform bill will result in a benefit to their families. If people think a bill is a bad bill that will hurt them, then they don't want it passed using reconciliation, regular order, or with massive bipartisan support, for that matter. They simply don't want it passed. If people think it is a good bill, however, one which would personally make their lives better, they simply want it passed into law, and don't care about the process.

The problem for Democrats is that the current Senate bill is very unpopular. If Democrats plan to use reconciliation they should only use it to make the bill more popular. This can be done by stripping out unpopular ideas (e.g. the excise tax and individual mandate), and by adding very popular provisions that really take on the insurance and drug industries (public option, Medicare buy-in, and drug re-importation, for example).

Hey, New York Times: Why Don't You Tell The Senate To Just Pass The House Health Bill?

The New York Times editorial page is now basically demanding that the House of Representatives effectively give up their constitutional rights and powers. No longer will they be the writer of laws and originator of all bills dealing with taxes, like the founders intended, but instead they should serve only as a rubber stamp for the House of Lords the dysfunctional Senate with its ridiculous rules allowing for endless obstructionism:

Here is a basic fact: If the House Democrats voted tomorrow to approve the Senate bill, health care reform would become the law of the land.

The president and Speaker Nancy Pelosi should push the House to accept the fundamentally sound Senate bill. If they still cannot garner enough votes from their own caucus, they should alter the Senate bill slightly with parallel legislation that could be passed with budget reconciliation.

Here is a basic fact for the New York Times editorial board: Harry Reid could take the health care bill that passed that House and put it on the Senate floor. If Republicans try to filibuster, Reid can call a constitutional point of order saying that the Senate rules, which allow unlimited obstructionism, stopping a constitutional majority vote from acting to pass a bill, are unconstitutional. Or, Reid could put up a rule change to drop the 60-vote threshold for cloture to 50; if Republicans filibuster the rule change, Reid could call a constitutional point of order saying that any rule changes can't be filibustered. Vice President Joe Biden, as President of the Senate, can uphold the point of order, effectively forcing a simple majority vote on the motion. If it gets 50 votes (with Biden casting the tie breaking vote), the filibuster is killed. The House bill would then get an up or down majority vote in the Senate. If it passed, it would go the the President's desk for his signature, and the House health care bill could be law by Tuesday.

Now I doubt Harry Reid would ever use the “constitutional option” like Republican Senate Majority leader Bill Frist almost did back in 2005, but it does not change the fact that Senate Democrats could. The Senate could approve the bill that passed the House and have it signed into law by next week. If Senate Democrats are really fed up with Republican obstructionism, at any time, if they really wanted to, they could take steps to end it.

While it might be a “fact” that the House could pass the Senate bill unchanged, it is also a “fact” that the Senate could quickly pass the House bill unchanged. Maybe the reason the Senate is so dysfunctional is that major news organizations like the New York Times seem to ignore the simple facts about what the Senate can actually do, and, instead, lets senators get away with pretending there are no ways around their own made-up rules. The 60-vote threshold is not part of the Constitution, nor is it carved in stone. It can be changed. It should be changed.

Durbin Asks Supporters To Help End Filibuster While Giving Up On Attempt To Break One

Talk about bad timing. Senate Majority Whip Dick Durbin launched a campaign today to end the filibuster and restore the ability for a simple majority of senators to pass legislation. His efforts include an email to supporters directing them to sign a petition at fedupwiththefilibuster.com to stop the abuse of rules that prevent majority rule. While I support the idea of ending the filibuster, I question why Durbin is just asking supporters to sign petitions instead of going to the floor right now with the help of Vice President Joe Biden to raise a Constitutional point of order against a potential filibuster of a Senate rules change, forcing an up or down vote on the matter, is beyond me? If he really wants to end the filibuster, and thinks it is wrong, he can take floor action to do just that.

What makes Durbin's timing so terrible is that in the past two days, Republican Senator Jim Bunning (KY) launched a one man filibuster against a modest extension to unemployment insurance and COBRA coverage. After promising to stay up all night to “break” Bunning, Durbin relented and let the very tired Bunning go home to get a good night's sleep. Unable or unwilling to “break” Bunning the next day, the Senate decided to adjourn for the weekend. David Waldman has the more:

So they had him to the point where he was shouting obscentities [sic] on the Senate floor and decided... to let him go home for a good night's sleep.

Awesome!

He probably slept a hell of a lot better than the Kentuckians who are out of work and depending on those benefits, I can tell you that. No word on whether Senate Democrats actually tucked him in.

It is a good thing that Dick Durbin realizes that the Senate is broken. It is even better that he is looking at possible solutions and rule changes that could potentially fix the Senate so it can function for the American people. But If Durbin can't convince his caucus to spend one night fighting to break a simple one-man filibuster blocking a bill that helps Americans in need keep their COBRA health insurance, how can we expect him to actually fight the much harder battle for a Senate rule change?

The words are good, Senator Durbin, but you need actions to back them up if you want people to believe you are serious and worth trying to help. The American people, and the progressive base, are sick and tired of the meaningless posturing with zero intention to play hardball in order to deliver on those promises (cough. . . public option. . . cough).

Why Doesn't John Barrasso Have A Universal Catastrophic Insurance Bill Then?

President Obama and Sen. John Barrasso (R- WY) got into a very interesting back-and-forward during the bipartisan health care summit. Barrasso tried to defend catastrophic insurance saying it makes people the “best consumers of health care.” Obama thought that was insufficient for many lower middle class Americans. The important thing is that this is not really the debate because Barrasso does not even want to help all Americans get catastrophic coverage.

If Barrasso actually thought there were great merits to people only having catastrophic insurance, why does he not submit a bill to that effect? It would be easy to write a bill to provide Americans with, at minimum, catastrophic insurance. The cost would be relatively cheap compared to the current Senate bill. It could even be written to be a fairly good bill.

Singapore has a system with universal catastrophic insurance, which you can opt-out of, combined with special health saving accounts. The country has some impressive health statistics, although that probably has a lot to do with their healthy lifestyle and relative young population--but it does show such a system is workable.

The problem is that Barrasso is not really arguing for the policy merits of making sure all Americans have catastrophic insurance (and only catastrophic insurance), or making the moral case that providing it is all the government should be required to do. In the current system, millions of Americans can't even get catastrophic coverage. Millions of Americans are denied even this limited coverage because of pre-existing conditions or because they can't afford it. There also exists a problem where millions of Americans think that they have catastrophic coverage, but really don't. They will have their policy recisioned when they actually get sick, find out that their policy does not really cover their specific catastrophic illness, or get dropped when their coverage exceed the lifetime limit. No bill Barrasso has proposed would solve these problems, no bill offered by Barrasso takes a step toward making catastrophic insurance available and workable for all Americans.

Barrasso did not argue for just providing Americans with catastrophic insurance, he just argued that the government should not try to help people who currently can only get actual catastrophic insurance get better insurance. The people who can't even get that are out of luck. If Barrasso really thinks that catastrophic insurance combined with health savings accounts is such a great idea, he should put together a bill to provide all uninsured Americans with exactly that. I bet he could easily get bipartisan support and see his bill become law. The biggest thing stopping Republicans from seeing their solution to universal health insurance become law is that they refuse to even create a solution.

Obama Finally Admits He Might Not Be Able To Bridge The Partisan Divide On Health Care

During the bipartisan health care reform summit, President Obama said that they would try to bridge the divide between Democrats and Republicans on the issue. But Obama finally admitted that they simply might not be able to bridge the divide. There is just no way Republicans are going to vote for Obama's omnibus health care reform bill.

By finally, publicly acknowledging that bipartisanship on health care reform might not be possible, Obama is creating the political space for Democrats to work on a partisan health care bill. This should help pave the way for using reconciliation.

This is something Obama should have acknowledged months ago, back in August, when it became clear the Republican party would not support health care reform. Instead of wasting months try to win over Olympia Snowe (R-ME), and trying to thread the 60-vote needle as support for reform keep falling month after month, Democrats should have moved forward with reconciliation and finished reform last September.

Bipartisan health care reform was not going to happen, and everyone has know that for months. If Obama had pushed Democrats to move forward with a partisan reconciliation bill months ago, and, instead of spending months wooing Snowe, spent that time clearly explaining to the American people that the divide was too great between Republicans and Democrats, reform would have been finished by now. The partisan cover from Obama was and is needed, but now it might have come too late.

Kent Conrad Basically Declares Senate Bill And Reconciliation Sidecar Strategy Dead

Today, Kent Conrad (D-ND) basically declared the current Senate bill--with a plan to pass fixes using reconciliation--dead. Conrad said the only way forward is that the Senate bill must first pass completely unchanged in the House. There is simply not (nor will there be) the votes for that in the House. From TPM:

"The only way this works is for the House to pass the Senate bill and then, depending on what the package is, the reconciliation provision that moves first through the House and then comes here," said Sen. Kent Conrad (D-ND) outside the upper chamber this morning. "That's the only way that works."

I pointed out that House leadership, including Speaker Nancy Pelosi, has repeatedly insisted they won't take a flier on a reconciliation package--that they will only pass the Senate bill after the smaller side-car reconciliation bill has been all wrapped up.

"Fine, then it's dead," Conrad said.

I simply do not believe Nancy Pelosi can ever whip the votes to pass the current Senate bill unchanged. Even with a solemn promise from Democratic senators that they would support reconciliation, I don't believe it is possible.

Voting on the Senate bill first would require House Democrats to vote for the Cornhusker kickback, the extremely toxic excise tax, and the Nelson abortion language that Bart Stupak has called unacceptable. That vote would be bad politics even if the reconciliation fix did happen later--and there is no reason to trust that it would. The House Democrats simply don't--and shouldn't--trust the Senate Democrats. Also, the reconciliation fixes Obama outlined are small, and unlikely to make the unpopular Senate bill any more popular.

If (and that is a big “if”) Conrad is correct and Pelosi is wrong, the Senate bill and reconciliation sidecar strategy are really dead. I can't see them passing the House and Democrats need to switch to a plan B. It would seem Democrats' best path forward is to pass a new clean, simple, easy to explain, reconciliation-only bill. Say, for example, just Medicaid/CHIP for all the uninsured below 200% FPL, and small business tax credits to help buy insurance. The only other option is to see what small bipartisan bills are out there and try to do a piece-by-piece approach.

Using Reconciliation For Health Care Is Neither New Or Extraordinary

There is a great new article from NPR showing that there is nothing new or extraordinary about using reconciliation to pass health care reform. Reconciliation is a normal, perfectly usable tool to pass health care reform. It has been used repeatedly by both parties. Of course, this is the same message FDL has been repeating for months while Democratic congressional members, administration officials, and administration-friendly reporters have been actively trying to claim that you can't use reconciliation.

Here is a list of health care reforms passed using reconciliation:

A History Of Reconciliation
For 30 years, major changes to health care laws have passed via the budget reconciliation process. Here are a few examples:

1982 — TEFRA: The Tax Equity and Fiscal Responsibility Act first opened Medicare to HMOs

1986 — COBRA: The Consolidated Omnibus Budget Reconciliation Act allowed people who were laid off to keep their health coverage, and stopped hospitals from dumping ER patients unable to pay for their care

1987 — OBRA '87: Added nursing home protection rules to Medicare and Medicaid, created no-fault vaccine injury compensation program

1989 — OBRA '89: Overhauled doctor payment system for Medicare, created new federal agency on research and quality of care

1990 — OBRA '90: Added cancer screenings to Medicare, required providers to notify patients about advance directives and living wills, expanded Medicaid to all kids living below poverty level, required drug companies to provide discounts to Medicaid

1993 — OBRA '93: created federal vaccine funding for all children

1996 — Welfare Reform: Separated Medicaid from welfare

1997 — BBA: The Balanced Budget Act created the state-federal childrens' health program called CHIP

2005 — DRA: The Deficit Reduction Act reduced Medicaid spending, allowed parents of disabled children to buy into Medicaid

There are many possible, fairly comprehensive health care reform packages that could be passed using just reconciliation. You could easily do a CHIP-style program for everyone without insurance. I personally have laid out several potential reconciliation-only health care bills (here, here, here, here, and here).
Of course, if the administration and Congressional Democrats had not spent months dismissing reconciliation and clinging to the 60 vote excuse, there would be no need to scramble to make the case now for reconciliation. If Democrats were smart, they could have used this back in July when it first become clear bipartisan reform was impossible, and had a health care reform bill signed into law roughly six months ago. I would hope that the one lesson Democrats learn from this debacle is that, when it comes to health care reform, always plan on only using reconciliation. Spending months on doomed-to-fail attempts to get bipartisan votes will kill reform everytime.

Eric Cantor Makes Case House Democrats Don't Have Votes For Health Care Reform

House Minority Whip Eric Cantor has released a memo (PDF) laying out the case that the Democrats simply don't have the votes in the House to pass the Senate health care bill with a reconciliation sidecar strategy. Clearly, it is to the Republican Party's benefit to strongly make the case that Democrats don't have the votes for health care reform in order to create a self-fulfilling feedback loop, so Cantor is probably overstating his case in this memo. With that in mind, however, it makes for an interesting read, and gives people a good sense of how the whip operation will be run, who it will be directed at, and who might be the potential swing votes.

The biggest stumbling block that Cantor highlights is abortion. Cantor claims it should cost Democrats 12 votes.

1. Cao, Anh (LA)
2. Costello, Jerry (IL)
3. Dahlkemper, Kathy (PA)
4. Donnelly, Joe (IN)
5. Driehaus, Steve (OH)
6. Ellsworth, Brad (IN)
7. Kaptur, Marcy (OH)
8. Kildee, Dale (MI)
9. Lipinski, Dan (IL)
10. Oberstar, Jim (MN)
11. Stupak, Bart (MI)
12.Wilson, Charlie (OH)

I would dispute (slightly) a few of these members. Republican Cao was probably always a lost cause, regardless of the abortion language. I can't see him casting the one vote to put them over the edge, so even if he ends up voting for the bill, it will probably be only after the bill has enough Democratic votes to pass anyway. Brad Ellsworth is trying to get the nod for the Indiana Senate race; bucking the party and killing Obama's health care bill would probably cost him the nomination, so I suspect, at this point, he is a reliable "yes" vote if needed. How many others could be flipped for different reasons is also an open question.

Assuming this list is even partially accurate, it is a big problem. I have laid out a potential strategy for dealing with abortion through reconciliation sidecar. Barring some similar fix to the abortion issue, or some serious strong arm strategy to flip the Stupak Democrats, Pelosi would need to find votes among the conservatives Democrats who previously voted against health care reform. Finding a dozen conservative Democrats who don't care about the abortion language--and who are now willing to vote for a very unpopular Senate health care bill--seems like a Herculean task.

Public Option Hot Potato Continues: Gibbs Tries To Stop Public Option By Blaming Ten Unnamed Senators

The game of kill the public option hot potato continues, and, along with President Obama's cowardly "leadership" on the matter, it is on full display today. During today's White House press conference, Press Secretary Robert Gibbs said the President did not include the public option because it does not have enough of the majority's votes. . . or something like that (via Huffington Post):

"We have seen obviously that though there are some that are supportive of this, there isn't enough political support in a majority to get this through," Gibbs responded. "The president... took the Senate bill as the base and looks forward to discussing consensus ideas on Thursday."

Of course, the public option did have a majority of votes only a few weeks ago. That is according to public whip counts and statements from senators like Tom Harkin (D-IA). So, the reason it probably does not have the votes is because Obama refuses to push for it -- and, more importantly, has surrogates like Robert Gibbs go out to try to suppress efforts to round up the votes.

The important thing is that Gibbs refuses to say that the public option is not included because Obama does not want it included. Honesty like that would require courage, so Gibbs passes the blame to an unnamed group of at least 10 Democrats, tossing the public option hot potato right back into Harry Reid's lap. (Previous scapegoats were "bipartisanship," Olympia Snowe, and then Joe Lieberman.) If Democrats are going to break their promise and fail to deliver on a public option that enjoys overwhelming support among the American people is because of ten members of the Democratic Senate caucus, then we deserve to know who they are.

So, Secretary Gibbs, who are the ten senators who will kill the public option that Obama promised?

We live in a Democracy and have the right to judge our representatives by their actions. Tell us, who are the ten members of the Senate Democratic Caucus who choose their the private insurance lobbyist pals over the majority of Americans. This is the inherent transparency necessary for a functioning Democracy, and key to fixing the ways of Washington--something Obama ran on in 2008.

Steny Hoyer Passes Public Option Hot Potato Back To Senate And Obama

The White House and Senate Majority Leader Harry Reid have been engaged in a game of kill the public option hot potato for awhile. Now, there seems to be some efforts to possibly blame the failure of the public option on the House Democrats. Clearly, House Majority Leader Steny Hoyer wants no part of the blame, and has passed the hot potato right back to the White House and Senate Democrats. After all, the House did pass the public option once already. (Via TPM)

"I think the public option can pass in the House. But it's not in the President's proposal," Hoyer said in response to a question from TPM.

"I think it is obviously an item the President has decided--he was for the public option as well--decided is not something that perhaps the Senate can buy," he said.

The public option is incredibly popular with the American people, supported overwhelming by the Democratic base, and is fiscally conservative. It is good politics, good policy, and maybe the only hope of turning around health care reform's awful poll numbers. The only problem is that lobbyists from private insurance companies don't like it, and Democrats have decided it is infinitely more important to keep a few lobbyists happy, instead of delivering on promises to constituents.

So, the public option hot potato game continues, and Democrats slowly destroy any hope of keeping control of the House or the Senate in a misguided, Alamo-style defense of the private insurance industry. At least Congressional Democrats will go down fighting for what they believe in: protecting unpopular, large, private corporations from competition, or anything that would help regular Americans save money.

The Great Rockefeller Flip Flop: Now Working To Stop The Public Option

When the going gets tough, it are appears Sen. Jay Rockefeller does a complete 180 flip-flop. The man who spent all year trying to depict himself as a strong advocate for the public option, is now trying to stop an attempt to revive the idea:

"I don't think the timing of it is very good," the West Virginia Democrat said on Monday. "I'm probably not going to vote for that, although I'm strongly for the public option, because I think it creates, at a time when we really need as much bipartisan[ship] ... as possible. "

Rockefeller added: "I don't think you [pursue] something like the public option, which cannot pass, will not pass. And if we get the Senate bill--both through the medical loss ratio and the national plans, which have in that, every one of them has to have one not-for-profit plan, which is sort of like a public option."

If you plan to vote against something, you are not allowed to call yourself a supporter. Worrying that the public option would make health care reform appear “partisan” is such a stupid excuse, it is comical. The Senate bill already passed on a pure partyline vote, with every Democrat voting "yes" and every Republican voting "no." By definition, that is as partisan as anything can get. With the only path forward for the current Senate bill a purely partisan reconciliation measure, worries about looking bipartisan are just silly.

Finally, Rockefeller is saying currently existing not-for-profit insurance companies like some of the Blue Cross Blue Shield insurers are “sorta like a public option.” This is worse than nonsense, this is a bald face lie. They are sorta like a public option in the same way a fine pearl necklace is sorta like a loop of used dental floss if you wear around you neck.

Why would Rockefeller tell this lie? Maybe it is to justify breaking his word to vote against anything without something like a public plan:

SIEGEL: Can you imagine voting against a bill because it lacks a public option?

Sen. ROCKEFELLER: No. I will vote against a bill that doesn't have something that is very similar to a public plan. Give it any name you want, but it's got to have - it's got to be no profit. It's got to challenge the insurance companies. I mean, they're in the business of making money.

Rockefeller went from promising to vote against any bill without some form of a public alternative to the current insurance companies, to promising to vote against any effort to create a public option. He now says the exact same insurance companies he railed against are “sorta like a public option.”

Right here is a perfect example of why Americans hate Washington. This kind of nonsense is why the Democratic base will have such low turnout in November.

Obama's Weird Fetish For “Splitting The Difference” On Everything

President Barack Obama has a fetish for “splitting the difference” that defies both logic and common sense. It is like he is incapable of deciding what is the correct path, and feels some overwhelming desire to just take the halfway point between any two positions. Look at this passage in his health care proposal to see the absurd extreme that he has taken this split-the-difference thinking to:

Invest in Community Health Centers. Community health centers play a critical role in providing quality care in underserved areas. About 1,250 centers provide care to 20 million people, with an emphasis on preventive and primary care. The Senate bill increases funding to these centers for services by $7 billion and for construction by $1.5 billion over 5 years. The House bill provides $12 billion over the same 5 years. Bridging the difference, the President’s Proposal invests $11 billion in these centers.

This is just crazy. I doubt Obama actually thought $11 billion was, policy-wise, the right amount to spend on Community Health Centers. The idea enjoys broad popular support with the public, both parties, and policy experts. I doubt there is any political reason for splitting the difference. Either you think it is a good idea, or you do not. I don't believe Obama studied the data and concluded $12 billion was just $1 billion too much, and that, by coincidence, that number is exactly half of the difference between the House and Senate bills. One billion dollars is a rounding error in this bill, and I doubt Obama would even risk getting into a fight over the change. Why even put the minor change in the 11-page proposal? Why not let the House have one single win?

I can just picture Obama sitting with his policy people and them all leaping for joy that they found a provision in both bills that was almost identical except for the funding level. They quickly moved to “split the difference” to show the media how compromisy they can be. They probably put no more thought into the move than thanking their lucky stars that the funding was two round numbers they could split right down the middle to show how they try to split anything right down the middle.

My advice to all Washington politicians moving forward: Always ask Obama for twice as much as you want because his overwhelmingly desire is to just split the number in half. Think of him like King Solomon, but the difference is his goal would be to really give both women one half of a baby.

Thanks to comment from puppethead

Public Option Dramatically More Popular Than Senate Bill - So Obama Pushes Senate Bill Without Public Option

New Research 2000 polling by the Progressive Change Campaign Committee shows that the Senate health care bill is very unpopular--but the public option is extremely popular (via Greg Sargent, full results):

* In Nevada, only 34% support the Senate bill, while 56% support the public option.

* In Illinois, only 37% support the Senate bill, while 68% support the public option.

* In Washington State, only 38% support the Senate bill, while 65% support the public option.

* In Missouri, only 33% support the Senate bill, while 57% support the public option.

* In Virginia, only 36% support the Senate bill, while 61% support the public option.

* In Iowa, only 35% support the Senate bill, while 62% support the public option.

*In Minnesota, only 35% support the Senate bill, while 62% support the public option.

*In Colorado, only 32% support the Senate bill, while 58% support the public option.

Looking at these numbers, it is mind boggling that the White House decided the path forward on health care reform is to try to basically push the current Senate bill, almost unchanged, while trying to stop the public option from being included. It is an unbelievable act of political malpractice. A five-year-old could do a better job seeing what the right political play should be.

Only in our broken “democracy” could the opinion of a handful of lobbyists representing one of the most unpopular industries in American have more sway than the opinion of roughly 65% of Americans. The American people have spoken loud and clear about what they want from health care reform, and it is a public option. The Congressional Democrats have decided they would rather be friends with insurance CEOs, instead of delivering on what they promised and know their constituents want. With such behavior, no one should be shocked that the incumbent Congressional Democrats are heading toward a midterm electoral blood bath.

Obama's Un-Sellable Hodgepodge Of Minor Health Care Changes

The big question right now is, how do you sell Obama's new health care proposal? His proposal is basically the Senate bill with some minor tweaks. Some of the changes should be popular--like a minor increase in affordability tax credits--and some changes--like an increase in the individual mandate penalty--should end up very unpopular. What I don't see is a strong public argument for using reconciliation--or any big move--that would manufacture more support for the unpopular Senate bill.

The biggest “improvement” that might be used to justify the reconciliation bill could be the new “Health Insurance Rate Authority” to prevent unreasonable premiums increases. The idea should be popular, but it seems unlikely to make it into the final bill. I would be curious to see how this compares in polls to, say, Medicare buy-in, which actually stands a chance of not violating the Byrd rule and, therefore, becoming law. I guess Democrats hope to blame Republicans for this new agency's failure, but as we have seen with the public option, promising a popular policy that Democrats don't plan to actually deliver can blow back hard.

Delaying the excise tax might gain some support, but the excise tax is so politically toxic that it is hard to imagine simply delaying its implementation would change public opinion. Dropping it completely seems to be the only way to deal with it politically. Increased affordability tax credits and fully closing the Medicare Part D donut hole are probably both popular. And increases in the employer mandate penalty could go either way.

On the other hand, increasing the individual mandate penalty should prove to be very unpopular, and an act of political suicide I simply can't understand. Efforts to cut more waste, fraud, and abuse out of Medicare and Medicaid should be popular, but the Republican party has successfully framed them as cuts to Medicare. I would not be surprised if Republicans make more “cuts to Medicare” very unpopular.

This proposal by the White House shows a misunderstanding of the mood of the country. It is now clear that Obama always wanted a bill very much like the current Senate bill, and simply can't see that it is a bad bill, unpopular with the American people for policy reasons. The White House keeps blaming messaging because they are too ego-driven to admit that they made a bad product. They are trying to keep the currently very unpopular Senate bill as unchanged as possible, which is a big mistake. This shows a tone deafness to the American people who've said that they don't like this bill as it now is. There needs to be big, new improvements to show people that the Democrats heard the complaints, and responded by making the bill more consumer friendly, and less a giveaway to the insurers.

I don't see how you sell this package of minor changes, some likely to be popular, and other unpopular. It is hard to explain, and there is no simple justification for the reconciliation measure. This package is basically putting a new bow on an unpopular Senate bill. It is a resale that I can't imagine working.

It's Official: Obama Is Against The Public Option

The White House finally made official what we have known for a long time: President Obama is against the public option. How do we know this? Because Obama, for the first time ever, released his own official health care reform proposal -- and it does not contain a public option.

You can't claim to support an idea if you are unwilling to make it part of your own proposal. Since the package is designed to pass using reconciliation, the fact that Joe Lieberman, Blanche Lincoln, and Ben Nelson are against the public option is irrelevant. The public option already passed the House, and Sen. Tom Harkin said a public option had the support of a majority of senators, so there is no reason it cannot be passed through budget reconciliation. Joe Lieberman may have played the part of the anti-public option boogeyman before, but now Obama is stepping up to prevent the PO from coming to fruition.

Just to be clear, you can't "support" something if you make no effort to see that it passes. If you do things that directly harm its chances of becoming law, like not include it in your health care proposal, then you are against it. But don't worry, even as Obama takes steps to make sure that people don't have an alternative to the private insurance companies that helped ruin our health care system, he did take steps to make sure you face an even bigger IRS penalty if you refuse to buy the poorly regulated product from the private insurance companies.

Obama's New Health Insurance Rate Authority: New Policy Or Just More Cynical Politics?

This morning, Obama released his new health care reform plan. It was a series a changes to the Senate health care bill. One was the addition of a new Health Insurance Rate Authority. It was an idea recently introduced by Dianne Feinstein. Can this new authority become law or is it just a cynical pure politics play?

Since Obama has made it clear that the final health care bill has to be based on the current Senate bill, and the Republican party has made it equally clear they will not sign on to a slightly modified Senate bill, the only path forward is reconciliation. Anything in a reconciliation bill must not violate the Byrd rule (unless Joe Biden is willing to play hardball). After extensive study of the matter, I find it very likely that this new Health Insurance Rate Authority would be ruled in violation of the Byrd rule.

If Joe Biden is unwilling to play hardball, the Byrd rule can still be waived to protect the new agency by a vote of 60 senators. I doubt any Republican will vote to waive the Byrd rule for this new agency, and suspect even a few Democrats, like Ben Nelson, would also vote against it. As a result, the prospects of this Health Insurance Rate Authority becoming law seems remote. It would likely get stripped from the bill at the last moment. Although it would provide Democrats with an good talking point to attack Republicans who took a standalone vote against this one provision.

Personally, I'm upset about the potentially cynical politics of this move. There are several things that could likely be passed through reconciliation that might hold the insurance companies honest. Things like a public option, Medicare/Medicaid/Tricare buy-in, possibly tougher minimum medical loss ratios, and/or maybe even a national exchange. That fact the Obama's health care proposal contains none of these potentially Byrd rule-proof ideas to “hold the insurance companies honest,” but instead contains a new agency unlikely to become law, is highly disappointing.

It sounds like a classic Rahm Emanuel idea of a win-win. Republicans are forced to take a difficult vote. Democrats get to pretend they supported something popular, but, in the end, Democrats don't need to worry about hurting a potential donor because the insurance companies also win when Republicans kill the idea. Of course, in the end, regular people are the big losers because they are forced by the government to buy a poorly regulated product from private insurance companies.

Firing Or Ignoring The Parliamentarian - It’s Called Leadership

Greg Sargent is reporting that Senate Majority Leader Harry Reid is now expressing openness to possibly including the public option in a reconciliation measure. But, apparently, unnamed Senate aides think there might be procedural problems:

It’s far from decided whether reconciliation will ultimately be used to pass reform. What’s more, senior Senate aides still think there’s a procedural obstacle in their path: They insist that in order for them to pass a fix to their bill via reconciliation, the House must pass it first — something House leaders oppose.

In addition, Senate leadership aides say they’re uncertain whether the Senate parliamentarian will sign off on the possibility of passing the public option via reconciliation in the first place. And, finally, aides want assurances from the White House that it will use its clout to help round up Senate support for the public option, should it come to a vote.

It is amazing how procedural hurdles manage to keep coming out of nowhere to stop the public option and protect the private insurance industry.

If Harry Reid is really worried that the current Senate parliamentarian will advise the presiding officer of the Senate that the public option runs afoul of the Byrd rule, which I highly doubt, Reid will have two options:

1) Fire the Parliamentarian

The Senate parliamentarian serves at the pleasure of the Senate majority leader--in this case, Harry Reid. Reid can just fire the guy and hire someone who will conclude that a public option--which will save the federal government $25-$110 billion--in fact affects the budget. That should not be hard. (Hint: I might be willing to accept a new position if offered better pay and benefits.) This is how Republicans played hardball. When former parliamentarian Bob Dove ruled in a way that then Senate Majority Leader Trent Lott did not like, he simply replaced him.

2) Ignore the Parliamentarian

The Parliamentarian technically serves only an advisory role in reconciliation. Even if the parliamentarian thinks that the public option fails to meet the requirements of the Byrd rule, that does not matter. Technically, the ultimate decision is up to the presiding officer in the Senate, which would be Joe Biden. If Biden ignores the parliamentarian, and rules against a point of order to remove the public option, it would take 60 votes to take the public option out of the bill.

There is nothing technically stopping Reid from passing the public option through reconciliation if he can find 50 votes. If Reid is willing to play hardball like previous Senate majority leaders, he can overcome these hurdles. If the public option dies dur to "procedure" reasons, and not because of a lack of votes, you will know Reid did not really want to go out for the public option. He decided that he would rather make excuses than protect Americans from the private insurance companies.

Health Care Reform: How Democrats Might Deal With Abortion Language Through Reconciliation

The New York Times is reporting that the White House is preparing to use reconciliation to advance health care reform. Reconciliation will be used to make changes to the Senate bill to make it an acceptable compromise between the House and the Senate. As always, the elephant in the room is abortion.

Democrats said it was still unclear how the president would deal with other disagreements, including the issue of insurance coverage for abortions.

Abortion remains “a wild card,” said a Democrat on Capitol Hill.

The House passed the very restrictive Stupak anti-choice amendment. The Senate bill included Ben Nelson's abortion language, which, while very restrictive, is not quite restrictive enough for some anti-choice Democrats in the House, and some powerful pro-life lobbying groups. Stupak has previously claimed to have enough votes to bring down health care if the abortion language is not to his standards.

Changing the abortion language through reconciliation can be difficult because of the Byrd rule. Any provision that does not impact the budget can be stripped from the bill by a senator raising a point of order. It is widely believed that changing the abortion language would be found in violation of the Byrd rule.

So, does that make changing the abortion language impossible through reconciliation? The answer is, not really. If a senator were to raise a point of order to remove the abortion language, and the presiding officer of the Senate was to uphold the point of order, it could still be waived by a vote of 60 senators. If 60 senators voted to keep the abortion language in the reconciliation measure it could stay in.

This means a united Republican Senate caucus could have the compromise abortion language removed from the reconciliation measure. They might consider doing this if they thought removing the abortion language would ruin the compromise and could cause all of health care reform to fail. Of course, this is a move that could really backfire. Pro-life voters might get furious with Republican senators for effectively voting against a standalone provision to restrict abortion coverage. It would also allow conservative Democratic House members to blame Republicans for removing the more restrictive abortion language, and that could create the political cover to vote for the Nelson language in Senate bill, which is still a big step backwards for women's reproductive rights. Bit that would enable Democrats to pass reform anyway.

I suspect that not all 41 members of the Republican Senate caucus will be able to be whipped into taking what would effectively be a standalone vote on simply restricting abortion coverage. Too many of Republicans depend on pro-life voters, and the vote could end up a killer in a presidential primary for any Republican senator who has their eye on 2012 or 2016. It would seem Democrats could probably peel off at least a few Republicans for just this one vote on waiving the Byrd rule. If a few Republicans voted for it, they would probably vote en mass for it.

It is possible that Democrats could deal with an abortion compromise through the reconciliation sidecar strategy if they could get 60 votes to waive the Byrd rule. It seems like a possibility, and one of the only routes for Democrats to deal with the issue. And, it has the plus side of possibly putting Republicans in an awkward place.

The big issue for Democrats will be their base. Reports indicate that the changes in the reconciliation measure will probably be a new tax on the wealthy, a deal with the unions to raise the limit and protect their members from the excise tax, and some other minor changes. Nothing that will really fire-up a demoralized base, or win over swing voters. If those changes are combined with even more restrictions on a woman's reproductive rights in a single bill, I picture it being impossible to rally enough supporters to pass the reconciliation measure. If they don't add popular provisions favored by progressives--like public option, Medicare buy-in, or drug re-importation--I don't see how they get the grassroots energy to get anything across the finish line.

Reconciliation Can Be Used To Pass Anything; Here’s How

There has been a lot of talk about using reconciliation lately. What is important is that reconciliation measures by law face only limited debate in the Senate, so, as a result, can't be filibustered. Reconciliation measures can pass with a simple, Constitutional majority vote. Part of the what governs reconciliation is the Byrd rule. These are a set of parameters for what can and can't be part of a reconciliation measure. Effectively every provision in the bill must affect the budget, or it can be removed by the Byrd rule. In theory, this very much restricts what reconciliation can be used for, but the decision of how to apply the Byrd rule is ultimately up to Joe Biden.

What is important is whose job it is to decide if a provision runs afoul of the Byrd rule. The Senate parliamentarian’s role is to make the determination and advise the presiding officer of the Senate, normally the Vice President, on how to rule. By tradition, the presiding officer essentially always rules in accordance with the parliamentarian's advice, but technically the final decision is completely up to the presiding officer.

Normally, a senator raises a point of order, saying a provision in the reconciliation bill violates the Byrd rule. Assuming he or she agrees, the parliamentarian makes a determination, and tells the presiding officer that it does violate the Byrd rule. The presiding officer normally rules in accordance with the parliamentarian’s advice, and sustains the motion. The provision would be removed, unless 60 senators vote to waive the Byrd rule for that provision, allowing it to stay in the bill. Under reconciliation, it takes 60 votes to waive a point of order or overturn the chair's ruling against a point of order.

As the presiding officer of the Senate, VP Joe Biden does not need to follow the advice of the parliamentarian. During debate on a reconciliation bill, he has the power to reject every point of order made about a provision that might violate the Byrd rule. And, if he did, it would take 60 votes to overrule him and remove the provision. Ultimately, Joe Biden could decide that nothing, or almost nothing, runs afoul of the Byrd rule, and allow practically anything to pass the Senate using reconciliation and a simple majority vote.

This would be a violation of Senate tradition re: reconciliation and the Byrd rule, but it is still technically allowed under a strict interpretation of the rules. It is important to remember that the “tradition” of reconciliation only dates back to its creation in 1974, and the Byrd rule was created in 1985.

Of course, the Republicans have decided to use a strict interpretation of the rules governing debate to violate Senate tradition by creating a de facto supermajority requirement for ever piece of routine business. If the Republican are willing to play hardball by with the Senate rules by filibustering everything, the Democrats have no other option but to respond in kind.

Using reconciliation for everything is not a perfect solution--ideally, the Senate would function according to the Constitution, and allow a simple majority to pass legislation through regular order. But If Democrats were willing to match Republican hardball tactics with hardball tactics of their own, they can technically use reconciliation to pass almost any law they want with a simple majority.

For more information on reconciliation and the Byrd rule, you can read the following Congressional Research Services report.

A Delicate Balance? Public Option Will Not Upset Health Care Reform Compromise - Because No Compromise Currently Exists

A push is currently underway in the Senate to have Democrats include the public option as part of any reconciliation fix. Several Democrats have signed on to Sen. Michael Bennet's (D-CO) letter. Some commentators like Jonathan Cohn and Ezra Klein think adding the public option would disturb some delicate balance of a potential compromise.

The problem is that there is no delicately negotiated compromise to be disturbed.

There is not some magic, perfectly designed compromise hanging on by a thread that Democrats are just waiting to spring on us. If Democrats thought they had the votes for a very modest reconciliation sidecar strategy right now, they would be doing it as we speak. There would not have been weeks of wheel spinning, and this upcoming, silly, televised, bipartisan meeting.

Even if Democrats reach an agreement in principle that can garner the votes in both chambers for a small reconciliation bill, comprised of only some tax modifications and small changes around the edges, I suspect support would disintegrate under public scrutiny and Republican attacks. This small reconciliation measure will be hard to understand, hard to sell, and even harder to justify. Knowing Democrats, they will foolishly put some sweeteners in it to win a few votes, which Republican will latch on to. The Democratic base will not rally around this weird hodgepodge of tax modifications, and the reconciliation will probably die as it makes its way through Congress. I simply can't imagine any deal on small changes to the Senate bill holding on to enough votes after going through a full-on Republican assault.

A reconciliation bill with a public option just makes better political sense. It gives Democrats their best hope of rallying their base. The public option is an easy, two-word justification for the reconciliation measure, and will hopefully distract the media's attention away from possibly less popular changes and special deals that might infest the reconciliation measure. The PO will doubtless be the thing that Republicans attack in the reconciliation measure, but polling has shown their months of attacking the public option has not hurt its popularity. Unlike any of the other changes a smaller reconciliation measure might make, the public option has proven that it can hold up under attack.

Worrying that the public option might ruin a non-existent compromise on a smaller reconciliation bill, one which would quickly shed support votes the second Republicans started the attacks, is misguided. The only hope for health care is a reconciliation sidecar fix, and the only hope of selling reconciliation to the American people is to use it to do something extremely popular--like add a public option. With people already tired of the debate, another bill that no one can understand is not a way forward.

People Hate The Process For The Policies It Produced In Health Care Reform

The White House is pushing hard the meme that Americans' disapproval for health care reform is purely based on their disgust with the process. While the process has been stomach-turning to watch, people also do actually hate many of the proposed policies within the bill. The White House seems incapable of acknowledging that the Senate bill they designed is something the American people do not want. They are blaming the messaging, but not the product. This is unfortunate because the only hope of making the bill more popular, and therefore creating the political space needed to pass reform, is to change the proposals to make the legislation more in line with what the American people want. No amount of creative messaging, no strong PR push alone can make the bill popular.

Unpopular Policy

It is true that the bill contains some very popular provisions, but it also contains some incredibly unpopular provisions. Probably the two least popular provisions are the excise tax and individual mandate. The fact that both are extremely unpopular should come as no surprise to Obama. He won his campaign successfully running against both ideas. Why his team thought they should fight hard to include both ideas in the bill or why they thought adding two provision that Obama ran against would not kill popular support for reform is beyond me.

People also dislike the bill because they feel that many of the popular provisions promised by Obama were stolen from them. People really want a public option, a Medicare buy-in, and drug re-importation. Having these popular provisions removed from the bill by “process” while the unpopular ones stayed is what made the process unpopular. People were not upset simply because the process took a long time or was partisan. People are angry because the process was used by unprincipled senators to make the policies in the bill worse for regular Americans and more friendly to corporations.

Making the Bill Popular With Policy Changes

The Democrats do have the option to use reconciliation to try to make the bill more popular by making policy changes. The Democrats can completely drop the excise tax, which is political death sentence, right now, and replace it with a more popular tax on the rich. There are many possible fixes to the individual mandate. The provisions could be dropped for now or replaced with an alternative like a back premium payment system, which should have a near identical effect. Having a public option makes the individual mandate much more palatable. Adding a public option and/or a Medicare buy-in would probably turn out to be very popular.

The Alternative: More Process And More Of The Same Same

The alternative is to go through even more process, reconciliation, to pass the same very unpopular Senate bill with only minor changes. If you believe it is simply process that turned people off to health care, this will only make the bill more politically toxic. Spreading the meme that Americans were turned off by the process, and not the product, should make every Democrat extremely reluctant to move forward with health care reform.

On the other hand, if you believe, like I do, that people disliked the process because it resulted in unpopular policy changes, using reconciliation to add the public option and take out the excise tax should make reform more popular. If reconciliation could make reform more popular by making popular policy changes Democrats would have a reason to embrace it. I understand the White House is reluctant to acknowledge that they designed an inherently unpopular bill, but I don't see how health care reform moves forward until they do and take steps to make the bill better with popular policy changes.

Richard Burr: The Most Endangered Sitting Senate Republican

A new PPP poll shows Richard Burr in relatively poor shape heading into his first re-election race for his North Carolina Senate seat. Burr's job approval numbers a very low, with 35% approving of the job he is doing and 35% disapproving. While Burr is currently ahead of potential Democratic challengers, he is polling well below 50%:

Burr leads Elaine Marshall 43-33, Cal Cunningham 44-32, and Kenneth Lewis 44-31. Two common themes drive those leads for Burr- Republican voters are much more unified than Democrats and independents are leaning toward Burr as well.

The Democratic candidates are still suffering from low name recognition. 29% of voters have an opinion of Elaine Marshall while just 17% do of Kenneth Lewis and 14% do for Cal Cunningham.

Against a generic Democrat, Burr is currently leading 42% to 35%, with 23% not sure.

Burr's numbers are not great, but they are also not terrible. The fact that Burr is currently the most endangered incumbent Republican senator has much more to do with a string of Senate retirees and the relatively bad political climate for Democrats than his own potential weakness. Other Republican senators who might have faced tough re-election races in states like Missouri, Ohio, Florida, Kentucky, and New Hampshire have all retired. David Vitter (LA) is effectively the only other incumbent Republican senator who will possibly have a tough re-election, but, so far, he seems to be in fairly good shape.

The fact that Burr is possibly the only sitting Republican senator who might lose his seat, and is still polling ahead of his potential Democratic opponents, could partly explain why the Republican Senate leadership has been so successful in holding their caucus together for their strategy of complete obstructionism.

House, Senate Conferees Almost Have Possible Tentative Agreement on Fake Health Care Compromise

The Democrats in Congress have still not reach a deal on how to move health care forward. The current favored strategy is a reconciliation sidecar, but the most recent news makes that seem unlikely to succeed. Weeks after losing the Massachusetts Senate seat, Democrats have still not even reached an agreement on whether to even use reconciliation at all. From Greg Sargent:

Here’s the state of play. Right now, leadership aides say, the White House is in talks with House and Senate leaders over the so-called “Cadillac” tax. The House wants the threshold tweaked to make it more palatable to Dem members who oppose it. Some Senators adamantly oppose this. But the leadership is discussing various tweaks that could work.

Crucially, the House leadership may sign on to the compromise even without a tweak to the Cadillac tax, according to a senior leadership aide. That’s because the compromise is not going to be voted on — it’s merely to create something to take to the summit. So this logjam may still get resolved in time.

Basically, what Sargent is reporting is that Democrats might soon reach a deal on a fake compromise that doesn't have the votes to become law to show that they have made progress. This fake deal (that can't pass both chambers) would need to be passed using reconciliation. It appears Senate Democrats still have not even reached a general agreement on using this tool.

After reaching a general agreement to use reconciliation, then the real negotiations will start to find a package that can get the votes of 50 Democrats willing to use reconciliation in the Senate and a majority of the House. This fake compromise, they might possibly reach before the summit, would be the starting point for those further negotiations to reach the real compromise.

It sounds like Democrats are very far from finding a reconciliation sidecar package that would allow the House to pass the Senate bill along with a set of fixes. It is possible that the current Senate bill is just too politically toxic to pass, and the only hope is a new reconciliation-only bill not based on the current Senate bill. At the very least, if House Democrats starting demanding that, it might make Senate Democrats more open to the reconciliation sidecar solution.

Can Some Democratic Challengers Win On An Anti-Washington Message?

The big question for the 2010 election is: Will it be an anti-Democratic election or an anti-Washington/anti-incumbent election? If it is an anti-Democratic year, there is not much Democratic challengers can do expect run hard and smart against a strong headwind. If it is an anti-Washington/anti-incumbent year, several Democratic Senate candidates have potential to run on the message.

Illinois, Missouri, Delaware, North Carolina

In the open Senate seats for Illinois, Missouri, and Delware, the likely Democratic nominees are local elected officials--Illinois State Treasurer Alexi Giannoulias, Missouri Secretary of State Robin Carnahan, and New Castle County Council President Chris Coons--while their likely Republican opponents are all current members of the House of Representatives--Mark Kirk (IL), Roy Blunt (MO), and Mark Castle (DE). If the mood in the country is anti-Congress, these three Democrats are in good shape to use that to attack their Republican opponents.

In North Carolina, the Democrats have a contested primary, but none of the likely winners have served in Congress. Whichever Democrat wins the primary will face Republican incumbent Richard Burr. Burr has poor approval numbers and is currently part of the obstructionist Senate Republican caucus. The North Caroline Senate race is potentially the best place for Democrats to run hard against a broken Washington.

Ohio, Indiana

While running an anti-Washington campaign might not be as easy in the race for the open Ohio seat, it is still possible. The two Democratic candidates, Lee Fisher and Jennifer Brunner, are both statewide officeholders. The Republican, Rob Portman, served in the Bush Administration, and could potentially be depicted as a creature of Washington.

Dan Coats is the likely Republican candidate in Indiana. Having worked as a lobbyist, Coats could easily be attack as a creature of Washington. If Democrats choose a current member of Congress, like Baron Hill or Brad Ellsworth, running against Washington would be basically impossible. On the other hand, if the state party chooses a local businessman, state government officeholder, or popular mayor, they potentially score with a strong anti-Washington and anti-lobbyist campaign.

These six Senate races will be an important barometer of the nation's mode. If the American people have turned against just the Democratic Party, Democrats will perform as poorly in these races as the roughly half-dozen incumbent Democrats facing potentially tough re-election races. If the mode is more anti-Washington/anti-incumbent than just anti-Democratic, these races should outperform the incumbent Democratic senators.

Opposition To Health Care Reform Mainly From Those Who Would Never Vote For Democrats

A new PPP poll is making the rounds today. The poll reports that half of Americans (50%) are opposed health care reform, and only 39% state support. What is interesting is the source of much of the opposition:

Digging a little deeper on those numbers though 64% of respondents planning or open to voting Democratic this fall support it with only 22% opposed. The overall numbers are negative only because of 94/1 opposition among folks who have said there is no way they'll vote Democratic this fall.

Roughly a third of Americans plan to almost always vote for Democrats, and a third plan to almost always vote for Republicans. Given how the Republican Congressional leadership has decided to wage an all-out war on Democrats' health care bill, it is not surprising that the Republican base is nearly unanimously against it.

The incredibly strong opposition to health care reform in the Republican base makes bipartisan reform next to impossible. I doubt any Republican in Congress would ever want to go completely against their entire base to help Democrats achieve a big victory. Combined with the fact the obstructionism has turned into such a successful political strategy, there seems to be zero incentive for Republicans to help Democrats pass health care reform. A successful bipartisan health care bill would probably hurt Republican chances of taking back Congress. It just won't happen.

With the Republican base firmly opposed to reform, the idea that adding any number of “Republican solutions” to health care reform could increase support with core Republican voters is a foolishness. You have a chicken-and-egg problem. The Republican base might be made slightly more open to reform if there were huge buy-in from Congressional Republicans, but a large number of Congressional Republicans would never buy in to a big, unpopular bill opposed overwhelmingly by their base.

The only real chance for Democrats to improve the standing of health care reform is to increase support with their base, and swing voters who would at least consider voting for Democrats. Provisions like a public option and Medicare buy-in appeal strongly to this group. Clearly, months of trying to move the bill to the right has only eaten away support from the left, and done nothing to improve health care reform's standing with the Republican base.

Opposition To Health Care Reform Mainly From Those Who Would Never Vote For Democrats

A new PPP poll is making the rounds today. The poll reports that half of Americans (50%) are opposed health care reform, and only 39% state support. What is interesting is the source of much of the opposition:

Digging a little deeper on those numbers though 64% of respondents planning or open to voting Democratic this fall support it with only 22% opposed. The overall numbers are negative only because of 94/1 opposition among folks who have said there is no way they'll vote Democratic this fall.

Roughly a third of Americans plan to almost always vote for Democrats, and a third plan to almost always vote for Republicans. Given how the Republican Congressional leadership has decided to wage an all-out war on Democrats' health care bill, it is not surprising that the Republican base is nearly unanimously against it.

The incredibly strong opposition to health care reform in the Republican base makes bipartisan reform next to impossible. I doubt any Republican in Congress would ever want to go completely against their entire base to help Democrats achieve a big victory. Combined with the fact the obstructionism has turned into such a successful political strategy, there seems to be zero incentive for Republicans to help Democrats pass health care reform. A successful bipartisan health care bill would probably hurt Republican chances of taking back Congress. It just won't happen.

With the Republican base firmly opposed to reform, the idea that adding any number of “Republican solutions” to health care reform could increase support with core Republican voters is a foolishness. You have a chicken-and-egg problem. The Republican base might be made slightly more open to reform if there were huge buy-in from Congressional Republicans, but a large number of Congressional Republicans would never buy in to a big, unpopular bill opposed overwhelmingly by their base.

The only real chance for Democrats to improve the standing of health care reform is to increase support with their base, and swing voters who would at least consider voting for Democrats. Provisions like a public option and Medicare buy-in appeal strongly to this group. Clearly, months of trying to move the bill to the right has only eaten away support from the left, and done nothing to improve health care reform's standing with the Republican base.

Did Harry Reid Use The Public Option To Punk The Democratic Base?

Today, Sen Michael Bennet (D-CO) sent Majority Leader Harry Reid (D-NV) a letter co-signed by Senators Kirsten Gillibrand (D-NY), Jeff Merkley (D-OR), and Sherrod Brown (D-OH). It asked Reid to add the public option to health care reform using reconciliation. The letter makes the case that a public option is popular, good politics, good policy, and makes strong fiscal sense. Sam Stein at Huffington Post has Reid's office's response:

"Senator Reid remains a strong supporter of the public option, but it's always a question of where the votes are," said Reid spokesman Jim Manley in a statement to HuffPost.

Well, this is an interesting response for several reasons. First, getting the votes needed to pass something is Reid's job as majority leader, and the claim that Reid is a great vote-counter has long been justification for why he has the job.

But, more importantly, this statement raises a big question. Why did Reid make the decision to put the public option with a state opt-out provision in the merged Senate bill?

He led the base to believe that he would fight for the public option. Most importantly, he led the base to believe that this modification to the public option could get 60 votes in the Senate needed for cloture, or at least very close to 60 votes. When, eventually, Ben Nelson, Joe Lieberman, and Blanche Lincoln rejected the public option, supporters were led to believe it was only three to five votes shy of passing, and only those few conservative Democrats were to blame.

If the public option with a state opt-out was only a few votes shy of 60, it should clearly have at least 50 votes for passage by a reconciliation measure that can't be filibustered, right? What Reid's spokesman now appears to be saying is that the public option doesn't have even 50 votes in the Senate.

Isn't it strange, now that the barrier to getting a public option has been dramatically lowered, Reid still does not have the sway to round up the votes he needs to deliver on his promise? It sounds like when Reid added the public option to the Senate bill, he did it purely to grandstand for the base, but with zero intent of delivering. I remember Reid using this move to gather a lot of email address, and probably donations. So, the question Reid needs to answer is:

Who are the nine Senate Democrats telling Reid they will kill health care reform if it contains the public option supported overwhelming by the Democratic base?

I wonder if Reid will continue to protect the nine Democratic senators who are demanding that the health care reform stay very unpopular and very friendly to the health insurance industry.

A Possible Reconciliation-Only Bill: Block Grant To States

If Democrats are looking for a political “win” on health care reform and a brand new bill that would be easy to sell to American people, one option is a reconciliation-only bill that just provides block grants to states. The concept is very simple. Democrats would decide how much they wanted to spend (say, $600 billion), and then spend it as block grants given to states to figure out their own way to deal with health care reform. Ideally, the block grant would come with a waiver to ERISA laws to give states more flexibility.

The idea is simple, clean, and easy to explain. The whole bill would only need to be a few pages long. It would simply give money to each state based on some formula for the states themselves to decide how best to increase insurance coverage. The block grants would come with only a few restrictions that the money only be used to increase insurance coverage and insurance quality. Politically, the idea is difficult to attack because there are no details to attack, that is all left to the states.

How states use the money would be up to them. It could be Medicaid expansion, Massachusetts style exchanges with subsidies, expand programs like Washington's basic health plan, a system that subsidizes employer mandates, a universal basic care program through massive expansion of community health centers, a universal, state-run extreme catastrophic insurance plans, etc. It would be smart to include a bit of a stick to encourage states to act. For example, after one year, if the state fails to pass a law to deal with their block grant, it would automatically be directed to a modest Medicaid expansion in the state.

Democrats would promise that after five years there would be an evaluation of each state's ideas to see if any state or group of states should serve as a model for further reform. It could be sold as the right response to Republican complaints about a “one size fits all” solution, and complaints about how the bill is too long and hard to understand.

Policy-wise, this is far from an ideal solution, but, politically, it might be the simplest and least unpopular path for the Democrats to achieve something big on health care reform. It is easy to understand and easy to explain. It would allow Democrats to say they listened to the American people, and changed in response to the complaints they heard. Most importantly, from a political standpoint, the idea would be for states to quickly expand existing programs that they already have to help the uninsured. If this new bill started helping people right away, instead of four years from now, it might convince Americans that the Democrats controlling Washington are actually passing laws to help regular Americans.

Health Care: Excise Tax May Be A Goner

The New York Times is reporting that the excise tax on employer-provided insurance may be dropped as part of any potential health care bill. The excise tax is extremely unpopular, and, purely from a political perspective, dropping it would be a very smart move.

Senator Kent Conrad, Democrat of North Dakota, supports the tax but said the outlook for it was “very cloudy.”

The House speaker, Nancy Pelosi of California, said, “The excise tax has no support, very little support, in our caucus.”

At meetings of the House Democratic Caucus, lawmakers from Massachusetts, including Representatives Edward J. Markey and Richard E. Neal, said they were struck by the vehemence of opposition to the tax in their districts.

Mr. Markey recalled that a constituent had poked him in the chest and said: “Eddie, I’ve voted for you my whole life. But if you think you will tax my benefits and give the money to Ben Nelson in Nebraska, you’re crazy.” Senator Nelson, Democrat of Nebraska, voted for the bill after it was rewritten to provide extra Medicaid money to his state.

The political problems with the excise tax are manifold. Besides the fact that the tax polls so poorly, its real danger is that it violates not one but two tax promises made by Obama during the 2008 campaign. Obama campaigned directly against John McCain's idea of taxing insurance benefits, and Obama promised not to raise taxes on anyone making less than $250,000 a year.

Talk of dropping the excise tax is the first sign I have seen that Democrats might use the reconciliation sidecar strategy to make health care reform more popular. If Democrats are really looking for a way to pay for dropping the excise tax, I have several suggestions. Clearly the best solution is the very popular public option or Medicare buy-in, both would save billions.

Democrats Looking to Choose a Washington Insider for Indiana Senate Race in Anti-Washington Year

With Evan Bayh's (D-IN) surprise retirement announcement the day before the filing deadline for the primary, the question quickly turns to who will be his Democratic replacement in the race. If no candidate manages to get on the ballot for the primary, the candidate will needed to be selected by the state party.

Indications are right now that the top two choices of the state party are Rep. Brad Ellsworth and Rep. Baron Hill. Selecting a person currently serving in Congress to run in this political climate would seem like a very bad political move.

Support for Congress and the people who serve there is extremely low. A recent New York Times/CBS News poll found that Congress had a job approval rating of only 15 percent. When asked if people thought most members of Congress deserved re-election, only 8 percent responded yes, while 81 percent responded no.

To put it simply, this is not a good year to be potentially labeled a “Washington insider.” Running as a House member for a Senate seat has all the drawbacks of being an incumbent in an anti-incumbent year, but without the benefit of being a statewide incumbent--high name recognition and having a plurality of people who have previously voted for you.

The likely Republican candidate is Dan Coats, who currently lives in the Washington, DC area and recently worked as a lobbyist. If the Indiana Democratic party selected a popular mayor or statewide officeholder, that candidate could credibly run an anti-Washington campaign against Coats. A smart move in this political climate. That is something neither Ellsworth or Hill could legitimately do. At a time when the American people are extremely angry with Washington, the Indiana Democratic party should think long and hard about making their top of the ticket nominee someone from Washington.

Republican Diaz-Balart Brothers Play Musical Chairs

Republican Lincoln Diaz-Balart (FL-21) announced this morning that he was not going to seek re-election. This paved the way for his brother, Mario Diaz-Balart, who currently represents Florida's 25th congressional district to switch districts. Mario will no longer seek re-election in his own district, but instead try to win his brother's seat. From Mario Diaz-Balart statement:

I will seek election to the U.S. House of Representatives this November for Congressional District 21, a seat which will be left vacant after the retirement of Congressman Lincoln Diaz-Balart.

This is a natural move for me; in my years of public service at both the federal and state levels, I have had the privilege of representing most of the communities that make up Congressional District 21, including Hialeah, Westchester, Doral, Kendall, Miami Lakes, Hialeah Gardens, Medley and Palmetto Bay. I have done so with devotion and dedication, effectively and with proven results.

Presumably, Mario is switching districts because he thinks he is less likely to face a serious Democratic challenger in the 21st. It is hard to imagine that this move would not piss off voters in this political environment. This is not just carpet bagging, but a complete slap in the face to the people in the 25th district. Clearly Mario Diaz-Balart's top priority is just to be a member of Congress, and he has no loyalty to the people who elected him. This just reeks of the sense of entitlement and self-serving that people hate about politicians and Congress.

VA-5: Democrat Tom Perriello In Relatively Decent Shape For Re-election

A new PPP poll of Virginia's 5th congressional district shows Rep. Tom Perriello tied with or leading his potential Republican opponents.

Tom Perriello is tied with Republican frontrunner Robert Hurt at 44% each. Former Congressman Virgil Goode has hinted he may run as an independent if the GOP doesn’t nominate someone sufficiently conservative. In that instance Perriello and Goode tie at 41% with Hurt getting just 12%.

Perriello leads the rest of the GOP field in head to head contests. He has a 46-42 advantage over Ken Boyd, a 45-37 one over Jim McKelvey, a 45-36 edge over Michael McPadden, and a 44-34 one over Laurence Verga.

Normally, being tied with your likely challenger and polling below 50% is not great news for an incumbent, but right now is a very bad time in the polls for Democrats nationally.

Virginia's 5th leans Republican with a PVI of R+5. Perriello won the district by only a few hundred votes, swept into office in what was a very good year for Democrats in Virginia. He has also been heavily attacked for his vote in support of cap and trade, the stimulus bill, and health care reform.

All year, Perriello has been seen as one of the Democrats most likely to face an uphill battle for reelection. The fact that the district is still competitive at this point, even as Democrats are collapsing in the generic ballot, is a relatively good sign for Perriello. It appears that Perriello is strongly outperforming most of his party, which he will need to do to keep a tough seat in what is shaping up to be a very good year for Republicans. Whether Perriello can be one of the Democrats in competitive districts to outperform his party enough to actually survive the Republican swing is an open question.

Judd Gregg Proves The Depth Of Republican Hypocrisy On Health Care Reform

Sen. Judd Gregg (R-NH) has proven the total hypocrisy of the Republican party when it comes to the issue of health care reform with his newest press release. Gregg has asked Obama to ditch the current Senate bill and to start over with his blue print, which is almost identical. Gregg wrote:

“There is significant bipartisan ground from which to reset the health care debate. A good place to start would be my own plan, Coverage, Prevention and Reform (CPR) or the bipartisan Wyden-Bennett Healthy Americans Act. Both of these fiscally responsible, market-based plans would go a long way to produce the reform that the American people need. I look forward to working with the President and my colleagues on both sides of the aisle to get this right.”

The problem is that the current Senate bill is a “market-based plan” with basically the exact same design as Gregg's Coverage, Prevention and Reform proposal. For example, how does the CPR expand coverage:

All Americans should have access to affordable, meaningful health care coverage and no American should lose their life-savings or their home because of illness or injury. The centerpiece of this proposal is to give every American access to an affordable, low-premium major medical private-market health insurance plan that insurers will be required to offer in every state-regulated health insurance market. The proposal:

• Defines a cost structure (not a benefit structure) in order to allow for flexible plan design;


• Expressly allows preventive benefits and disease management under the deductible with nominal co-payments for related office visits;


• Does not include an annual or lifetime cap on expenses above the deductible.

ENSURING ACCESS FOR ALL AMERICANS: In order to ensure that every American has quality, affordable coverage, the proposal requires proof of health insurance for every American over age 18 and requires insurers to offer coverage to all applicants, regardless of health status.

TARGETED SUBSIDIES FOR THOSE MOST IN NEED: The proposal includes direct subsidies for low-income individuals for the purchase of a low-premium major medical health insurance plan – subsidies for both the premium and deductible on a sliding scale up to 300% of the Federal Poverty Level (FPL).

MAXIMIZING STATE FLEXIBILITY AND INDIVIDUAL CHOICES: The proposal directs states to create points of entry for low-income families and individuals to enroll in a health insurance plan and access applicable subsidies. Mechanism design and functions of the point of entry (state-based insurance exchange, regulator, etc.) would be left up to the states. States would also be required to offer additional upgrade packages to be purchased on top of the low-premium major medical health insurance plan for those looking for additional benefits.

So, Gregg's plan would use state-based exchanges, and has an individual mandate requiring every American to buy private insurance. The private insurance would be based on actuarial value, required to cover preventive care, and must not have any annual limits of lifetime limits. To help people afford the insurance, there would be a sliding scale of subsidies for people below a set income level, and a new tax deduction/credit for insurance on the individual market.

I fail to see how this is really different from the Senate bill, which requires people to buy effectively low actuarial value catastrophic insurance, that covers preventive care, from private companies on state-based exchanges, and would provide people with a sliding scale of subsidies to help them afford insurance.

How does Gregg pay for this?

CAP TAX EXCLUSION FOR EMPLOYER-SPONSORED HEALTH INSURANCE: The proposal limits the extent to which employer-paid health insurance premiums and health spending from FSAs and HSAs are excluded from taxation. It includes in employees’ taxable income any contribution that employers and employees made for health care costs that together exceeds $11,500 a year for family coverage or $5,000 a year for individual coverage (based on President Bush’s Bi-Partisan Tax Advisory Panel recommendation).

This is basically identical to the excise tax in the Senate bill, which effectively caps the tax deductible status of employer-provided insurance. The main difference is that the cap in the Senate bill is higher than Gregg wants.

Even most of Gregg's ideas on improving prevention are already in the Senate bill in some form. Take for example:

To provide employers with the opportunity to further develop incentive-based wellness programs, the proposal modifies the Health Insurance Portability and Accessibility Act (HIPPA) to allow rewards for wellness programs to exceed 20 % of the cost of employee-only coverage under a group health plan.

This provision and many other prevention provisions were already adopted in the Senate Finance Committee. The new limit set by the bill is 50%. Likewise, the Senate bill and Gregg's proposal would both try to reform the Medicare fee-for-services payment system.

Conclusion

While there are some differences between Gregg's CPR blueprint and the Senate health care bill, they are, for the most part, very similar. Their plans for providing everyone with insurance and their method for paying for the expansion of coverage are effectively identical. I'm sure Obama would be more than happy push for the few changes to make the Senate bill more in line with Gregg's proposal if Gregg would then promise to endorse the bill.

Starting over with health care reform, as Gregg is asking, to create a bill more Republican-friendly in an attempt to get Republican votes would be foolish. The problem is that the Senate bill is already a Republican-friendly “market-based plan.” It was designed by Max Baucus with that express goal in mind. It is already a very anti-progressive bill that does not reflect the traditional Democratic methods for expanding coverage.

Republican opposition to the Senate bill is simply not policy based. It is based on the cold, political calculation that bringing down health care reform would hurt Democrats in the midterm elections and allow Republicans to win more seats. Obama's refusal to acknowledge this reality has resulted in months wasted and incredible damage done to the Democratic party's brand. If Democrats want health care reform, the only way to make that happen is with Democrats.

Americans Lose Trust In Democrats' Ability To Deal With Big Issues After Watching Them Fail To Deal With Big Issues

This should not come as a shocker to anyone. A new Washington Post/ABC News poll shows that Americans have significantly lost trust in Democrats' ability to deal with the big problems facing our country:

When compared with the early months of Obama's presidency, the GOP's overall gains are striking. A year ago, Democrats held a 26-point advantage on dealing with the big issues; that lead is now six points. At the one-month mark, Obama's lead over the Republicans on dealing with the economy was 35 points; it's now five points.

Who could have guessed this would happen? All Democrats did was spend the better part of a year working on a very big issue called health care reform, and messed it up terribly. They wasted months and fought among themselves like children in an effort to protect the special interests. They removed the very popular public option and repeal of the anti-trust exemption to make the private insurance companies happy, and let a handful of senators hold the bill hostage until they filled it with all sorts of unpopular giveaways, pork, and carve-outs. Even after doing all this, they still failed to pass a bill. As a result of wasting months on health care, Democrats were unable to get another jobs bill passed, deal with finance reform, or fix our student loan system to help middle class families.

Democrats attempted to deal with a big issue and failed. Amazingly, the American people, as a result, no longer trust Democrats' ability to deal with big issues. Failing to govern has done incredible damage to the Democratic Party's brand.

Now, ask yourself, if you were Republicans, would you throw Democrats a lifeline by agreeing to a bipartisan compromise on health care reform? Politically, it would be a terrible move to actually give the American people the idea that Democrats are capable of governing by helping them pass any form of compromised health care reform. That is why bipartisan health care reform will not happen. Proving that Democrats are incompetent is more important to Republicans than any policy changes on health care that Obama could offer.

Bipartisanship Is Defined By The Minority Party; Success Should Be Defined By The Majority

At a press conference the other day, President Obama seemed clearly annoyed that bipartisanship is not working like he thought it should:

"Bipartisanship can't be that I agree to all the things that they believe in or want, and they agree to none of the things I believe in and want, and that's the price of bipartisanship, right, but that's sometimes the way it gets presented," Obama said.

The problem is that Obama is just wrong. By definition, for a piece of legislation to be bipartisan, some members of the minority party must vote for it. This gives the minority party the sole ability to make a bill bipartisan. It is one of the only important things they can do while out of power.

As legislators, the members of the minority have the right, and some would say the duty, to vote against anything that does not meet their standards. They don't need to reach a compromise to help achieve the goals of the majority party. The minority party--in this case the Republicans--can set whatever high price they want from Democrats in exchange for GOP votes.

Personally, I think the demands of the Republicans are completely unreasonable, but I don't question the right of Republicans to make their demands. The important thing is that Democrats don't need Republican votes. They are the party in power, and can move forward with passing their top legislative goals on their own.

The problem for the past year has been President Obama's pathological obsession with bipartisanship, and he clearly has a warped understanding of what bipartisanship really is. It is not achieved by finding some middle ground between your ideas and the other party, it is simply about doing as much as the minority party requires you to do in exchange for their votes. Obama made a mistake by focusing more on bipartisanship than passing the best, most popular legislation he can.

The secret to getting bipartisan support for a bill is not to constantly give in to the demands of the minority party without getting promise of their support in return, the secret is to make the bill so popular that the other party fears the political ramifications of not voting for the bill.

Obama spent months making changes to try to make the bill popular with Congressional Republicans. These changes, like dropping the public option and adding the excise tax, killed the bill's popularity. They were the wrong audience. If, instead, Obama had spent that time focusing on making the bill as popular as possible with the American people, he would have had a better chance of getting Republican votes in the end. Many Republicans would have a tough time voting against a bill that polls in the high 60s, but no Republican has a problem voting against this current bill, which polls in the high 30s.