Harry Reid still has the ability to pass health care reform using reconciliation. Bills passed using reconciliation can't be filibustered, so they only require a simple majority to pass the Senate. The biggest problem with using reconciliation is the Byrd rule.(brief summary and full CRS report) The Byrd rule requires that only provisions related to budget (those that spend, save, or take in money) can be passed using reconciliation. If the Senate Parliamentarian rules that a provision is an “extraneous matter,” it can be removed from the bill by a point of order. Through my research on the matter, I've come to two important conclusions: I'm 90% confident a properly designed public option could pass using reconciliation, and I'm 95% confident that the Stupak anti-abortion amendment could not.
There are several reasons a properly designed public option could survive the Byrd rule. First, the bill saves money. Even the weaker, negotiated rates public option would still reduce the cost of reform to the federal government by roughly $25 billion, according to the CBO. Second, the public option would bring in and pay out large quantities of money in the form of premiums and provider reimbursements. This would all be done in a deficit neutral way, but it would still be related to the budget. If the first two reasons are not good enough to protect the public option from the Byrd rule, other changes could be made. The bill could require the public option to pay the federal government a small profit (i.e. run a surplus) in the first few years. The overall bill could also be slightly rewritten to base tax credits on the cost of premiums for the public option. The important thing is there are ways to get a public option passed using reconciliation.
By the same token, the Stupak amendment would definitely run afoul of the Byrd rule. This rule dealing with abortion is clearly an “extraneous matter” and the Parliamentarian would rule is as such. It violates the first part of the Byrd rule because it does “not produce a change in outlays or revenues.” I see almost no way the Stupak amendment could remain in a bill passed using reconciliation.
There was already good reason for progressives to demand that reconciliation be used. It would protect the public option from the threats of filibuster by Joe Lieberman. It would also not require the public option to be watered down with opt-outs, opt-ins, or other stupid provisions. Thanks to Bart Stupak (D-Mich.) the Democratic base just gained another reasons to push for reconciliation. Remember, if a bill is passed under regular order that does not contain a real public option but contains the Stupak amendment, it is because Harry Reid refused to use reconciliation.
Showing posts with label Harry Reid. Show all posts
Showing posts with label Harry Reid. Show all posts
How The House's Public Option Might Differ From The Senate's
We now have the legislative language for the House's less robust public option (PDF page 211), and it has been reported that Harry Reid plans to include the Senate HELP Committee's public option--with some form of state opt-out procedure. (Whether legislative language for the public option in the merged Senate bill is exactly identical to the HELP committee's public option is not yet 100% guaranteed. We will not know until Reid releases his bill--presumably after the CBO scores it.) Both public options would be very similar. They would only be available on the new exchange. They would both be run by the HHS, and negotiate rates with providers. In both cases, the providers' rates will not be higher in the aggregate than the average rate for other plans on the exchange. While similar, there are a few important differences.
State Opt-Out
The biggest difference between the House's public option and the Senate's public option will be the state opt-out provision. Harry Reid has not yet released how the opt-out would work, but it would give the state government the power to stop the public option from selling health insurance that state. The House's public option will be a true national public option without an opt-out.
Presumed Enrollment and Provider Opt-Out
The House's public option has presumed Medicare provider enrollment with a provider opt-out provision. This is a huge strength that makes the House's public option better than the HELP committee's public option. Under the House bill providers that are part of the Medicare network would be presumed to want to take part in the public option. Medicare providers can easily opt-out of the public option before it starts, and would face no penalty for doing so. This presumed enrollment should make it much easier for the public option to get up off the ground. The HELP committee's public option would require providers to actively sign up for the program.
Provider Rate Floor
The House public option would set a provider rate floor. It could not pay providers less than Medicare rates. The HELP public option contains no rate floor. In theory, it could negotiate rates even lower than what Medicare pays for a procedure. While that is unlikely to happen, it is possible that there are some procedures where Medicare is paying above market rates. Because of this small bit of added flexibility on this issue, the HELP public option is technically slightly stronger. Both would not pay rates in the aggregate higher than the average for other insurance plans on the exchange.
State Advisory Councils
Under the HELP public option each state would establish public or non-profit State Advisory Councils. They would be responsible for making non-binding recommendations to the Secretary of HHS on how to better run the public option in their state. What effect their non-binding recommendations would have is hard to guess, but, in general, it sounds like a smart if limited idea. The House bill would not create State Advisory Councils.
Preferred Physicians and Participating Physicians
The House bill directly spells out how the public option's physicians network would work. It would have “preferred physicians,” who would be like in-network providers that accept the negotiated rates as full payment. It would also have “participating, non-preferred physicians.” They agree to not impose additional charges equal to or greater than 15% above the negotiated rate. They would function sort of like out-of-network providers. The HELP bill does not spell out how the public option's network would work.
Besides the state opt-out (and we still don't know how that will work), the most important difference is the presumed enrollment for Medicare providers. The House bill will not force any Medicare providers to take part in the public option and would let them start opting out a full year before the program starts. But it is just human nature that people are much more likely to not drop out of a program than they are to actively enroll in one, regardless how easy it is to enroll or drop out. The benefit of having a ready network to potentially build off of could be critical to successfully launch a new nation-wide insurance entity. Maintaining this provision is very important moving forward.
State Opt-Out
The biggest difference between the House's public option and the Senate's public option will be the state opt-out provision. Harry Reid has not yet released how the opt-out would work, but it would give the state government the power to stop the public option from selling health insurance that state. The House's public option will be a true national public option without an opt-out.
Presumed Enrollment and Provider Opt-Out
The House's public option has presumed Medicare provider enrollment with a provider opt-out provision. This is a huge strength that makes the House's public option better than the HELP committee's public option. Under the House bill providers that are part of the Medicare network would be presumed to want to take part in the public option. Medicare providers can easily opt-out of the public option before it starts, and would face no penalty for doing so. This presumed enrollment should make it much easier for the public option to get up off the ground. The HELP committee's public option would require providers to actively sign up for the program.
Provider Rate Floor
The House public option would set a provider rate floor. It could not pay providers less than Medicare rates. The HELP public option contains no rate floor. In theory, it could negotiate rates even lower than what Medicare pays for a procedure. While that is unlikely to happen, it is possible that there are some procedures where Medicare is paying above market rates. Because of this small bit of added flexibility on this issue, the HELP public option is technically slightly stronger. Both would not pay rates in the aggregate higher than the average for other insurance plans on the exchange.
State Advisory Councils
Under the HELP public option each state would establish public or non-profit State Advisory Councils. They would be responsible for making non-binding recommendations to the Secretary of HHS on how to better run the public option in their state. What effect their non-binding recommendations would have is hard to guess, but, in general, it sounds like a smart if limited idea. The House bill would not create State Advisory Councils.
Preferred Physicians and Participating Physicians
The House bill directly spells out how the public option's physicians network would work. It would have “preferred physicians,” who would be like in-network providers that accept the negotiated rates as full payment. It would also have “participating, non-preferred physicians.” They agree to not impose additional charges equal to or greater than 15% above the negotiated rate. They would function sort of like out-of-network providers. The HELP bill does not spell out how the public option's network would work.
Besides the state opt-out (and we still don't know how that will work), the most important difference is the presumed enrollment for Medicare providers. The House bill will not force any Medicare providers to take part in the public option and would let them start opting out a full year before the program starts. But it is just human nature that people are much more likely to not drop out of a program than they are to actively enroll in one, regardless how easy it is to enroll or drop out. The benefit of having a ready network to potentially build off of could be critical to successfully launch a new nation-wide insurance entity. Maintaining this provision is very important moving forward.
Reid Crossed The Rubicon
Most of the political media, many of the people in Congress, even Harry Reid himself may not have realized it yet, but Monday, Reid crossed the Rubicon. Like Julius Caesar stepped across the point with his progressive base. Reid can't back down and expect to be cheered for trying his best. To fail now would prove him a weak, worthless, ineffectual leader. Nationally, progressives will begin to seriously ask, “would we be better off with one fewer Democratic senator but Chuck Schumer as Majority Leader?” If the public option opt-out dies in the Senate, or is seriously watered down, there will be hell to pay.
Reid has left his party with no safe outs. Democrats have only three different opportunities to eliminate or water down the (already watered) public option opt-out. First, Reid can go back on his word and strip the provision before bringing the bill to the floor. While the Senate bill is not yet final, as far as the Democratic base is concerned, it is a done deal. To singlehandedly raise the hopes of the progressive community only to quickly smash them could have devastating consequences for Reid. It would prove that a mere threat from Joe Lieberman could completely cause Reid to abandon his principles. This move would make him look incredibly weak. Reid would be abandoning the wishes of a majority of his caucus, the Congress, the Democratic party, and the country simply because Lieberman kind of threatened him.
The second opportunity is when the bill is first brought to the floor--where a handful of Democrats could vote against allowing debate to proceed. The plan would then be for Reid to bring a modified version of the bill up a week later without the public option, after saying “oh well I tried.” This would be incredibly dangerous to the party, and would require of conspiracy of stupidity to even attempt. Letting the first vote on health care reform go down in flames would be depicted as a huge setback in the media.
The two to four senators who voted against allowing the bill to proceed to debate would be cut off from the labor movement and declared pariahs by the grassroots. PACs would instantly be formed, with the single goal of making sure those Democrats never get re-elected. Any argument that attacking these Senators could result in electing a Republican would fall on deaf ears. If a “Democrat” will actively fight against his party on a procedural vote about the number one issue for most Democrats, they might as well be Republicans.
If Reid thinks that move will deflect heat from him, he's in for a rude awakening. The progressives will demand the defiant Senators have their seniority stripped, and Reid will be blamed for failing to strong-arm the last few members. Much of the blow-back will also hit Obama. Unless he is practically on the Senate floor screaming at the members to vote as a caucus, he will have zero credibility left with the base. The base will demand the bill gets moved through reconciliation, not watered down further. Reid has the power to pass reform with a simple majority, and it will be his fault for not using it. Trying to move forward with a much weaker bill will need to be done over the objection of a very angry and betrayed base.
The final opportunity to water down or kill the public option is with amendments, but any amendment to change the public option would require 60 votes. Even assuming all the Republicans would be willing to vote for an amendment to water down the public option (I don't see that happening), it would still take 20 Democratic senators to make it happen. I don't see where Reid will find the 20-plus Democratic votes to cripple the public option, especially if Reid does not want to be one of those votes. Those 20 Democrats might try to explain that voting to kill the public option was necessary for “compromise,” but regardless, they will be labeled “public option killers.” It is a title that will hang like a dead weight on any Democrat.
I know many attempts are going to be made to cripple or kill the public option before health care reform passes. I wouldn't be surprised if it did get watered down at some point. I just can't see how it will happen without blowing up in Reid's and several other Democratic senators' faces. Reid may not know it, but he is across the Rubicon. He got his base expecting a real public option. With the power of reconciliation, Reid can get a public option passed is he was truly determined to. If he fails on his promise to deliver on the public option he will have no one to blame but himself, and will look incredibly weak going into the 2010 election.
Reid has left his party with no safe outs. Democrats have only three different opportunities to eliminate or water down the (already watered) public option opt-out. First, Reid can go back on his word and strip the provision before bringing the bill to the floor. While the Senate bill is not yet final, as far as the Democratic base is concerned, it is a done deal. To singlehandedly raise the hopes of the progressive community only to quickly smash them could have devastating consequences for Reid. It would prove that a mere threat from Joe Lieberman could completely cause Reid to abandon his principles. This move would make him look incredibly weak. Reid would be abandoning the wishes of a majority of his caucus, the Congress, the Democratic party, and the country simply because Lieberman kind of threatened him.
The second opportunity is when the bill is first brought to the floor--where a handful of Democrats could vote against allowing debate to proceed. The plan would then be for Reid to bring a modified version of the bill up a week later without the public option, after saying “oh well I tried.” This would be incredibly dangerous to the party, and would require of conspiracy of stupidity to even attempt. Letting the first vote on health care reform go down in flames would be depicted as a huge setback in the media.
The two to four senators who voted against allowing the bill to proceed to debate would be cut off from the labor movement and declared pariahs by the grassroots. PACs would instantly be formed, with the single goal of making sure those Democrats never get re-elected. Any argument that attacking these Senators could result in electing a Republican would fall on deaf ears. If a “Democrat” will actively fight against his party on a procedural vote about the number one issue for most Democrats, they might as well be Republicans.
If Reid thinks that move will deflect heat from him, he's in for a rude awakening. The progressives will demand the defiant Senators have their seniority stripped, and Reid will be blamed for failing to strong-arm the last few members. Much of the blow-back will also hit Obama. Unless he is practically on the Senate floor screaming at the members to vote as a caucus, he will have zero credibility left with the base. The base will demand the bill gets moved through reconciliation, not watered down further. Reid has the power to pass reform with a simple majority, and it will be his fault for not using it. Trying to move forward with a much weaker bill will need to be done over the objection of a very angry and betrayed base.
The final opportunity to water down or kill the public option is with amendments, but any amendment to change the public option would require 60 votes. Even assuming all the Republicans would be willing to vote for an amendment to water down the public option (I don't see that happening), it would still take 20 Democratic senators to make it happen. I don't see where Reid will find the 20-plus Democratic votes to cripple the public option, especially if Reid does not want to be one of those votes. Those 20 Democrats might try to explain that voting to kill the public option was necessary for “compromise,” but regardless, they will be labeled “public option killers.” It is a title that will hang like a dead weight on any Democrat.
I know many attempts are going to be made to cripple or kill the public option before health care reform passes. I wouldn't be surprised if it did get watered down at some point. I just can't see how it will happen without blowing up in Reid's and several other Democratic senators' faces. Reid may not know it, but he is across the Rubicon. He got his base expecting a real public option. With the power of reconciliation, Reid can get a public option passed is he was truly determined to. If he fails on his promise to deliver on the public option he will have no one to blame but himself, and will look incredibly weak going into the 2010 election.
Obama Still Working To Undermine Reid And Kill The Public Option
According to the Huffington Post,
Would Obama, only one vote shy of a huge victory, refuse to even attempt to twist the arm of that last Democratic hold out? This is a level of disdain, exhibited by the Obama administration for the public option, that boarders on insanity. The White House is telling the media that he will refuse to lift a finger to help pass his signature domestic policy goal simply because it contains a public option (which Obama continues to claim he supports). Is Obama so obsessed with killing the public option and winning the support of one Republican that he is willing to cripple his own Senate Majority Leader?
Instead of accepting that Reid has made his decision and backing him 100%, the Obama administration seems ready to undercut Reid at every turn. Reid will have a hard time whipping the votes he needs if Obama's advisors are telling everyone in Washington that they are secretly expecting (or promoting) Reid's failure. If Obama's advisors have convinced him that angering his base, throwing labor unions under the bus, and making his Senate Majority Leader look so weak it could cost him his re-election is the best way to get a "victory" and pass something labeled "health care reform," he has truly disappeared deep into the bubble.
Update - Greg Sargent is reporting that Chuck Todd is trying to clarify his statement which he claims got twisted. He claims the White House did not literally send that message, it is only "as if' they were sending that message."
NBC News correspondent Chuck Todd reported Tuesday morning that the Obama White House, despite public expressions of support for Senate Majority Leader Harry Reid's decision to pursue an opt-out public insurance option, remains skeptical that Reid can come up with the votes.
The administration basically told Reid, "You're the vote counter. But don't come crying to us when you need that last vote," Todd said on MSNBC.
Would Obama, only one vote shy of a huge victory, refuse to even attempt to twist the arm of that last Democratic hold out? This is a level of disdain, exhibited by the Obama administration for the public option, that boarders on insanity. The White House is telling the media that he will refuse to lift a finger to help pass his signature domestic policy goal simply because it contains a public option (which Obama continues to claim he supports). Is Obama so obsessed with killing the public option and winning the support of one Republican that he is willing to cripple his own Senate Majority Leader?
Instead of accepting that Reid has made his decision and backing him 100%, the Obama administration seems ready to undercut Reid at every turn. Reid will have a hard time whipping the votes he needs if Obama's advisors are telling everyone in Washington that they are secretly expecting (or promoting) Reid's failure. If Obama's advisors have convinced him that angering his base, throwing labor unions under the bus, and making his Senate Majority Leader look so weak it could cost him his re-election is the best way to get a "victory" and pass something labeled "health care reform," he has truly disappeared deep into the bubble.
Update - Greg Sargent is reporting that Chuck Todd is trying to clarify his statement which he claims got twisted. He claims the White House did not literally send that message, it is only "as if' they were sending that message."
A Public Option Opt-In Is Not The Same As State Based Public Plans
The news yesterday was the Harry Reid would include a public option with an opt-out provision in the Senate bill. There has been some reporting Reid might not have the votes for the opt-out and might need to water it down to a public option "opt-in," state-based public plans, or trigger. A public option opt-in and state-based public plans are two very different proposals that many in the media seems to be falsely equating.
A true public option opt-in would be a national public option that states would need to actively opt in to. The federal government would create a single public option entity, but it would only be able to sell health insurance in states that passed a law to allow the public option in their state. This would be similar to the opt-out proposal where states would need to pass a law preventing the public option from providing health insurance. Probably only a dozen of the very bluest states would pass a law opting in to a national public option. Compared to the opt-out, where the hope is only a dozen of the reddest states would pass a law opting out. Besides denying the public option to most Americans, the other big potential problem with the opt-in is that too few states will opt-in to the public option, and it would be unable to develop the sufficient customer base needed to be viable.
State-based public plans was an idea proposed by Sen. Thomas Carper. States already have the power to create their own public companies to sell insurance right now if they want. “Allowing” states to create their own public plans would in no way be a “compromise,” it is the status quo. Besides the federal government potentially providing states with a large quantity of seed money to help start up these state-based public plans, there really is nothing to this proposal. Given the strong restrictions it would place on potential state-based public plans, Carper's original proposal would literally be worse than nothing at all.
A public option opt-in would create a single national public option that states would need to opt in to. It would probably be restricted to only a few of the bluer states in the country. A state-based public plan proposal would help states set up public plans if they wanted. They would probably only be established in the same few blue states, but suffer from several additional problems. Many states would probably be too small to properly support a public plan. Having several different state-based public plans would hurt insurance portability and would probably drive up cost since the many different public plans would lack the benefits of scale.
State-based public plans would be a substantially worse idea than a public option opt-in. I suspect the public option opt-in would be able to function (i.e. remain a viable entity that could sell insurance) but its impact would be extremely limited. Since it would operate in only a few states, I can't see it improving our overall health care system or being big enough to really hold down premiums. Many of the state-based public plans, on the other hand, could easily be too small to even get off the ground or ever function properly. Since the state-based public plans would be limited to the roughly 10% of people on the exchange states like Vermont, Rhode Island, Iowa, West Virginia, Montana, Kansas, etc. would be too small to create a truly viable public plan. While some have confused these two ideas, there is a dramatic and important difference between a public option opt-in and state based public plans.
A true public option opt-in would be a national public option that states would need to actively opt in to. The federal government would create a single public option entity, but it would only be able to sell health insurance in states that passed a law to allow the public option in their state. This would be similar to the opt-out proposal where states would need to pass a law preventing the public option from providing health insurance. Probably only a dozen of the very bluest states would pass a law opting in to a national public option. Compared to the opt-out, where the hope is only a dozen of the reddest states would pass a law opting out. Besides denying the public option to most Americans, the other big potential problem with the opt-in is that too few states will opt-in to the public option, and it would be unable to develop the sufficient customer base needed to be viable.
State-based public plans was an idea proposed by Sen. Thomas Carper. States already have the power to create their own public companies to sell insurance right now if they want. “Allowing” states to create their own public plans would in no way be a “compromise,” it is the status quo. Besides the federal government potentially providing states with a large quantity of seed money to help start up these state-based public plans, there really is nothing to this proposal. Given the strong restrictions it would place on potential state-based public plans, Carper's original proposal would literally be worse than nothing at all.
A public option opt-in would create a single national public option that states would need to opt in to. It would probably be restricted to only a few of the bluer states in the country. A state-based public plan proposal would help states set up public plans if they wanted. They would probably only be established in the same few blue states, but suffer from several additional problems. Many states would probably be too small to properly support a public plan. Having several different state-based public plans would hurt insurance portability and would probably drive up cost since the many different public plans would lack the benefits of scale.
State-based public plans would be a substantially worse idea than a public option opt-in. I suspect the public option opt-in would be able to function (i.e. remain a viable entity that could sell insurance) but its impact would be extremely limited. Since it would operate in only a few states, I can't see it improving our overall health care system or being big enough to really hold down premiums. Many of the state-based public plans, on the other hand, could easily be too small to even get off the ground or ever function properly. Since the state-based public plans would be limited to the roughly 10% of people on the exchange states like Vermont, Rhode Island, Iowa, West Virginia, Montana, Kansas, etc. would be too small to create a truly viable public plan. While some have confused these two ideas, there is a dramatic and important difference between a public option opt-in and state based public plans.
Reid Defies Snowe, Chooses Helping Americans Over Veneer Of Bipartisanship
I'm glad to see that Senate Majority Leader has decided to be a real leader and defy Olympia Snowe (R-ME). There is no reason to have a 60 member caucus if you are unable or unwilling to use it to fulfill the top priority of the Democratic party with the best reform bill possible. It is long past time to dethrone Empress Snowe.
It is important that the Senate bill going into conference committee contain a public option, even if it is one far weaker than it should be. But the bigger news seems to be that Snowe will no longer drive the bill, since she will not support a bill with a public option. Her demand that the bill contain a trigger was only one of her many ill conceived proposals.
I hope that including the opt-out public option is just the first of the positive changes which are made because Reid no longer needs to shape the bill to meet Snowe's every whim. Unfortunately, it seems the Senate bill with still contain the very stupid free rider provision, which Snowe wanted, instead of a mild employer mandate. This is a provision that desperately needs to be improved going forward.
There are areas that should be revisited now that Snowe is no longer on board: Strengthening the exchange so that it can negotiate to help individuals get a better bargain on their health insurance is a critical improvement previously opposed by Snowe. John Kingsdale, who runs the current Massachusetts exchange, said that if the exchanges remain how Snowe wants them, it will be a “policy disaster.”
I would like to see the “national plans,” which would gut a state's ability to properly regulate health insurance, revisited. Increasing the actuarial value of the “bronze level” (lowest minimum qualified insurance plans) and expanding Cantwell's “basic health plan” proposal were both ideas opposed by Snowe, but can ideally now be improved. Strengthening the new ombudsman's office and setting a minimum medical loss ratio for health insurance are two additional changes that should be made.
If Reid can convince his caucus to vote as a bloc on cloture, it would be a display of true leadership. Losing Snowe, and being able to pass a bill with only a simple majority, would be the single best development for health care reform yet--far better news than even the addition of a very weak public option with an opt-out. A bill that can pass the Senate without Snowe's vote will likely be a much better bill in the end. Reid has laid down a good marker today, now he needs to deliver.
It is important that the Senate bill going into conference committee contain a public option, even if it is one far weaker than it should be. But the bigger news seems to be that Snowe will no longer drive the bill, since she will not support a bill with a public option. Her demand that the bill contain a trigger was only one of her many ill conceived proposals.
I hope that including the opt-out public option is just the first of the positive changes which are made because Reid no longer needs to shape the bill to meet Snowe's every whim. Unfortunately, it seems the Senate bill with still contain the very stupid free rider provision, which Snowe wanted, instead of a mild employer mandate. This is a provision that desperately needs to be improved going forward.
There are areas that should be revisited now that Snowe is no longer on board: Strengthening the exchange so that it can negotiate to help individuals get a better bargain on their health insurance is a critical improvement previously opposed by Snowe. John Kingsdale, who runs the current Massachusetts exchange, said that if the exchanges remain how Snowe wants them, it will be a “policy disaster.”
I would like to see the “national plans,” which would gut a state's ability to properly regulate health insurance, revisited. Increasing the actuarial value of the “bronze level” (lowest minimum qualified insurance plans) and expanding Cantwell's “basic health plan” proposal were both ideas opposed by Snowe, but can ideally now be improved. Strengthening the new ombudsman's office and setting a minimum medical loss ratio for health insurance are two additional changes that should be made.
If Reid can convince his caucus to vote as a bloc on cloture, it would be a display of true leadership. Losing Snowe, and being able to pass a bill with only a simple majority, would be the single best development for health care reform yet--far better news than even the addition of a very weak public option with an opt-out. A bill that can pass the Senate without Snowe's vote will likely be a much better bill in the end. Reid has laid down a good marker today, now he needs to deliver.
Repealing Insurance Antitrust Exemption: All Smoke, No Fire
The CBO examined the effect of ending the anti-trust exemption and found:
Senate Majority Leader Harry Reid along with other Democrats made a big show about pushing to eliminate the antitrust exemption for insurance companies. While it maybe decent policy it should have very little effect on the health insurance market. The CBO echos the find of some analysts who have also concluded that the change would be a very minimal. If the move is meant to punish the health insurance companies it is at best a light slap on the wrist. If Democrats want to show that they are being tough on the health insurance companies, then we need some real fire, not so much smoke and mirrors.
Based on information from the Justice Department, the Federal Trade Commission, the National Association of Insurance Commissioners, consumer groups, and private attorneys, CBO estimates that both of those effects would be very small, and thus that enacting the legislation would have no significant effect on the premiums that private insurers would charge for health insurance. Changes in those premiums can affect federal revenues because of the favorable tax treatment that is accorded to employment-based coverage under current law, but any such effects of the legislation would be negligible in CBO’s estimation.
Senate Majority Leader Harry Reid along with other Democrats made a big show about pushing to eliminate the antitrust exemption for insurance companies. While it maybe decent policy it should have very little effect on the health insurance market. The CBO echos the find of some analysts who have also concluded that the change would be a very minimal. If the move is meant to punish the health insurance companies it is at best a light slap on the wrist. If Democrats want to show that they are being tough on the health insurance companies, then we need some real fire, not so much smoke and mirrors.
The When, How, Who, What Of The Public Option Opt-Out
Several news sources are reporting that Harry Reid plans to put a national public option with an opt-out provision in the merged Senate bill. So far, there have been almost zero details on how this national public option with an opt-out provision would be structured. I'm going to explain four important variables and how they could affect the success and availability of the public option.
When
When can states first choose to opt out? There are two different opt-out time frames, which I will call “pre-reform opt-out” and “post-reform opt-out.” The public option is not going to be available until most of the reforms really start in 2013. A “pre-reform opt-out” would allow states to opt out anytime before the public option would first be made available in 2013. This would be a “bad” opt-out provision which would probably result in more states opting out. The earlier that states would be allowed to start opting out, the worse it is. Since no one would yet have access to the public option, opting out before reform started would be politically easier.
A “post-reform opt-out” would only allow states to opt-out after first having the public option available in their state for a period of time (say, 1-4 years). This is a “good” opt-out provision, and the longer the delay before a state can opt out, the better. By first making the public option available, states and their residents would be able to better know if it is something people like. If the public option succeeds as progressives hope, it would be politically more difficult to take away something people already have and like.
How
How would a state opt-out? There are several ways a state could be allowed to opt out: the reform package could require passing a law, or it could allow opt out solely by an act of the state legislature, a decree by the governor, popular ballot referendum, an order by a state insurance regulator, or some combination of the proceeding options. I've previously broken down how many people would likely be denied the public option depending on the different opt out mechanisms. The harder it is for a state to opt out, the better. I suspect, based on polling, a popular ballot referendum would be the mechanism to result in the fewest states opting out. The “best” opt out mechanism would require the state to pass a law opting out of the public option, then requiring it be upheld by a popular referendum.
Who
Who will pay for the added cost of states opting out? By holding down cost on the new health insurance exchange, the public option will reduce the amount of tax credits the federal government will need to provide individuals to help them afford health insurance. The CBO expects even a weaker “level playing field” public option would save the government $25 billion over the next decade. (I've examined the issue in more detail earlier.)
If a state opted out of the public option, it could increase insurance rates and the cost of reform to the federal government. Who should pay for this increased cost? The federal government could just pay the increased cost (the “federal government pays”). Uninsured people living in the state which opted out could pay the cost, by the federal government reducing the amount of their tax credits (the “middle-class pays”). Or the state government could be forced to reimburse the federal government for the added cost that resulted from them opting out (the “states pay”). I think it is unfair to force the rest of the country to pay higher taxes because Texas wants to reject a potential cost saver. The only fair solution would be to make states cover the added cost of opting out. This “states' pay” provision should dramatically discourage states from opting out.
What
What kind of public option will it be? From reporting, the public option is likely going to be a “level playing field” public option which must negotiate rates with providers. We still do not know how the public option will be structured, or how it will be run. Will it get to combine its administrative paperwork functions with Medicare for better efficiency? Will all providers need to opt in to the public option or would Medicare providers be presumed to part of the network unless they opted out? Will it be part of the federal government or just have congressionally appointed management? It could be run directly as a part of department of HHS and run by government employees. It could also be structured like a quasi-public government corporations similar to Amtrak, the Federal Reserve, FDIC, or the Corporations For Public Broadcasting. The Senate HELP Committee's public option would have quasi-subsidiaries in each state to slightly customize the public option for local needs. Would this feature be retained?
A public option that most closely resembles Medicare would be the best possible structure. Having a Medicare provider presumed opted in should help the public option get off the ground more quickly. Allowing Medicare and the public option to use a combined paperwork processing system would save the government money, and cut down on paper work for doctors. Preferably, the public option would be part of HHS and not a stand alone public corporations.
These four categories are some of the most important (but not the only) variables which should determine the viability of Reid's public option with an opt-out. It is possible to design an opt-out that would result in very few if any states opting out. It would be a “post-reform opt-out” with a “states pay” provision. It would require a state law to opt out and a ballot referendum.
On the other hand, it is possible to design an opt-out that would result a large number of states opting out of the public option. If it were a “pre-reform opt-out” where the federal government paid 100% of the added cost, that would be a very “bad” opt-out design. Allowing only a decree by the governor or an act by the state legislature to opt-out the state would also dramatically increase the likely hood of states opting out. Like all things, the devil is in the details. We will soon know if Reid scored a real victory or delivered only an empty triumph.
When
When can states first choose to opt out? There are two different opt-out time frames, which I will call “pre-reform opt-out” and “post-reform opt-out.” The public option is not going to be available until most of the reforms really start in 2013. A “pre-reform opt-out” would allow states to opt out anytime before the public option would first be made available in 2013. This would be a “bad” opt-out provision which would probably result in more states opting out. The earlier that states would be allowed to start opting out, the worse it is. Since no one would yet have access to the public option, opting out before reform started would be politically easier.
A “post-reform opt-out” would only allow states to opt-out after first having the public option available in their state for a period of time (say, 1-4 years). This is a “good” opt-out provision, and the longer the delay before a state can opt out, the better. By first making the public option available, states and their residents would be able to better know if it is something people like. If the public option succeeds as progressives hope, it would be politically more difficult to take away something people already have and like.
How
How would a state opt-out? There are several ways a state could be allowed to opt out: the reform package could require passing a law, or it could allow opt out solely by an act of the state legislature, a decree by the governor, popular ballot referendum, an order by a state insurance regulator, or some combination of the proceeding options. I've previously broken down how many people would likely be denied the public option depending on the different opt out mechanisms. The harder it is for a state to opt out, the better. I suspect, based on polling, a popular ballot referendum would be the mechanism to result in the fewest states opting out. The “best” opt out mechanism would require the state to pass a law opting out of the public option, then requiring it be upheld by a popular referendum.
Who
Who will pay for the added cost of states opting out? By holding down cost on the new health insurance exchange, the public option will reduce the amount of tax credits the federal government will need to provide individuals to help them afford health insurance. The CBO expects even a weaker “level playing field” public option would save the government $25 billion over the next decade. (I've examined the issue in more detail earlier.)
If a state opted out of the public option, it could increase insurance rates and the cost of reform to the federal government. Who should pay for this increased cost? The federal government could just pay the increased cost (the “federal government pays”). Uninsured people living in the state which opted out could pay the cost, by the federal government reducing the amount of their tax credits (the “middle-class pays”). Or the state government could be forced to reimburse the federal government for the added cost that resulted from them opting out (the “states pay”). I think it is unfair to force the rest of the country to pay higher taxes because Texas wants to reject a potential cost saver. The only fair solution would be to make states cover the added cost of opting out. This “states' pay” provision should dramatically discourage states from opting out.
What
What kind of public option will it be? From reporting, the public option is likely going to be a “level playing field” public option which must negotiate rates with providers. We still do not know how the public option will be structured, or how it will be run. Will it get to combine its administrative paperwork functions with Medicare for better efficiency? Will all providers need to opt in to the public option or would Medicare providers be presumed to part of the network unless they opted out? Will it be part of the federal government or just have congressionally appointed management? It could be run directly as a part of department of HHS and run by government employees. It could also be structured like a quasi-public government corporations similar to Amtrak, the Federal Reserve, FDIC, or the Corporations For Public Broadcasting. The Senate HELP Committee's public option would have quasi-subsidiaries in each state to slightly customize the public option for local needs. Would this feature be retained?
A public option that most closely resembles Medicare would be the best possible structure. Having a Medicare provider presumed opted in should help the public option get off the ground more quickly. Allowing Medicare and the public option to use a combined paperwork processing system would save the government money, and cut down on paper work for doctors. Preferably, the public option would be part of HHS and not a stand alone public corporations.
These four categories are some of the most important (but not the only) variables which should determine the viability of Reid's public option with an opt-out. It is possible to design an opt-out that would result in very few if any states opting out. It would be a “post-reform opt-out” with a “states pay” provision. It would require a state law to opt out and a ballot referendum.
On the other hand, it is possible to design an opt-out that would result a large number of states opting out of the public option. If it were a “pre-reform opt-out” where the federal government paid 100% of the added cost, that would be a very “bad” opt-out design. Allowing only a decree by the governor or an act by the state legislature to opt-out the state would also dramatically increase the likely hood of states opting out. Like all things, the devil is in the details. We will soon know if Reid scored a real victory or delivered only an empty triumph.
Obama Fighting For To Kill Public Option With Snowe's Trigger
Talking Points Memo is reporting that Obama is now actively working to kill the public option.
Reid and Obama both claim they want a real public option. Now they have a chance to deliver.
The grassroots, House members, senators, and policy experts have all called Snowe's trigger idea worthless. A public option has strong majority support, and is favored overwhelming among self-identified Democrats. If Reid and Obama reject this chance to deliver on both of their promises to provide Americans with a the choice of a public option, it will stand as a monumental betrayal.
If the public option is sacrificed, just to possibly win the support of one unnecessary Republican vote, Harry Reid might as well resign and officially declare Olympia Snowe Senate Majority Leader. In the next few days, if there is a “trigger,” we will know Reid's continued "leadership" is less than worthless to progressives.
Multiple sources tell TPMDC that Senate Majority Leader Harry Reid is very close to rounding up 60 members in support of a public option with an opt out clause, and are continuing to push skeptical members. But they also say that the White House is pushing back against the idea, in a bid to retain the support of Sen. Olympia Snowe (R-ME).Given the reports that Reid is within a vote or two of being able to pass a bill that includes a national public option with an opt-out, a full-court press by both Reid and Obama should be sufficient to insure health care reform contains a public option. Democrats clearly seem to have the power to get a public option with an opt-out provision passed through the Senate using regular order (or, of course, using reconciliation).
Reid and Obama both claim they want a real public option. Now they have a chance to deliver.
The grassroots, House members, senators, and policy experts have all called Snowe's trigger idea worthless. A public option has strong majority support, and is favored overwhelming among self-identified Democrats. If Reid and Obama reject this chance to deliver on both of their promises to provide Americans with a the choice of a public option, it will stand as a monumental betrayal.
If the public option is sacrificed, just to possibly win the support of one unnecessary Republican vote, Harry Reid might as well resign and officially declare Olympia Snowe Senate Majority Leader. In the next few days, if there is a “trigger,” we will know Reid's continued "leadership" is less than worthless to progressives.
Will Reid Dare Defy Empress Snowe On The Public Option Opt-Out
ABC is reporting Reid is leaning towards putting a national, weak, "level playing field" public option with an opt-out provision in the merged bill. The move could be a result of real leadership, terror at the thought of losing his election, courage, profound personal conviction, incredible pressure from inside the caucus, necessity, or a combination of all of the above. Whatever the reason, Reid seems to believe he can get the 60 votes needed for cloture on a bill that includes a weak public option with an opt-out, even if the whole caucus would not end up voting for the bill itself:
Would Harry Reid really defy Snowe? As with all things related to Reid, I suggest waiting until there is solid proof before casting judgment.
Reid is now convinced that Democratic critics of the public option will support him when it counts – on the procedural motion, which requires 60 votes, to defeat a certain GOP-led filibuster of the bill. Once the filibuster is beaten, it only takes 51 votes to pass the bill.This move would be in direct defiance of Empress Snowe's decree that the bill must not have a public option, even with an opt out:
"Would [inclusion of a public option] be enough for you to vote against the cloture motion?" a reporter asked Snowe on her way off the Senate floor Thursday afternoon.Sen. Max Baucus (D-MT) has spent months wooing Snowe by integrating her terrible ideas into the Senate Finance Committee bill. Even a few days ago, Baucus was pushing to water down the bill further to make it more to her liking. It's being reported that, at the thought of losing his prized token Republican support for his bill, “Baucus went to DEFCON 1."
"On the public option? I'd say I'm against a public option, so yes," Snowe said.
"But would it be enough for you to say, 'I'm not going to proceed to this bill?'" the reporter pressed. Snowe nodded on her way into the elevator.
Snowe said she also opposes the opt-out version of the public plan, which would allow individual states to remove their residents from the federal exchange. "I don't support that," she said.
Would Harry Reid really defy Snowe? As with all things related to Reid, I suggest waiting until there is solid proof before casting judgment.
Update: Baucus really wants to keep Snowe on board and/or kill the public option. TPM is reporting that he went to conservative Democratic senators to try to whip them up against the public option with opt out.
This, apparently, didn't sit well with Senate Finance Committee Chairman Max Baucus, who is determined to keep Sen. Olympia Snowe's vote.
"Baucus met with moderates this morning and got them nervous." Or tried at least. Snowe clearly laid down her mark. And Sen. Ben Nelson (D-NE) didn't seem particularly pleased. But of all the Senate's conservative Democrats, none have yet rebelled.
Wyden Is Causing Trouble Again (For Reid)
Senator Ron Wyden's annoying insistence that Democrats not lie to the American people about health care reform is causing trouble for the party leadership again. His office was not happy with a new talking point sent out by the leadership, falsely claiming that if you don't like your current health insurance you would be offered a new, affordable choice.
That drew a quick rebuttal, not from Republican Leader Mitch McConnell, but from Wyden’s Communications Director Jen Hoelzer. Here's what she sent to 490 Democratic Communicators:
I just wanted to flag for colleagues that their bosses should be careful using the talking point that under the Dem bill, Americans who don’t like the coverage they have, will be able to choose something else. As CBO Director Elmendorf indicated last week, under the current legislation, seven years after implementation, more than 90 percent of Americans will remain barred from shopping for insurance in the exchange. This means that not only will MOST Americans be stuck with the coverage they have – whether they like it or not – if reform establishes a public option, more than 90 percent of Americans won’t be able to choose it. As many of you know, this is why Senator Wyden has been fighting so hard to get his Free Choose proposal into the bill, so that we can tell our constituents that if you don’t like the coverage they have, they can choose something better. But right now, that’s not the case. Let me know if you have any questions. Jen
Will Harry Reid bring the hammer down on Wyden for stepping out of line, like he did on Chuck Schumer for publicly saying it would be Reid's fault if the Senate bill lacked a public option:
They even printed out a copy of the Maddow transcript so that Reid could read it back to Schumer, a person familiar with the situation told POLITICO.
Reid, who has never been shy about jabbing Schumer when the aggressive New York Democrat oversteps, eventually caught up with Schumer on the Senate floor Wednesday and asked him about the quotes.
Later in the week, Reid described the exchange as amenable [sic] — while making clear he was the boss.
“Any conversation I’ve had with Sen. Schumer about health care, including “The Rachel Maddow Show,” has been of a positive nature,” Reid told reporters. “Sen. Schumer is entitled to his own opinion.”
You hear that Wyden? Be prepared for Reid's wrath. You better get in line or Reid may sternly read notes to you and make snide comments behind your back.
Does Reid Even Read His Own Website?
On Senate Majority Leader Harry Reid's website, under health care reform, there is a debunking common myths section. The very first myth debunked is that:
As David Waldman explains, if Reid puts the public option in the merged bill brought to the floor it would take 60 votes to remove it and there are not 60 votes against the public option in the Senate. Conversely, if Reid leaves the public plan out, it would take 60 votes to add one, and there are not 60 votes for a stand-alone amendment for a public option.
“The public plan is no longer an option” is only a myth if Reid chooses to make it a myth. It is completely within Reid's power to make a real public option part of the Senate bill, but Reid also has the power to kill the public option in the Senate. So, will Reid make a liar of himself, or make a liar out of those claiming the public option is no longer viable?
Myth: The Public Plan Is No Longer An OptionReid's website is correct, the public plan is still very much alive--but it will likely stay alive only if Reid chooses to keep it alive. The Senate Finance Committee's bill did not contain a public option, but the Senate HELP Committee's bill did. It is completely up to Reid to decide how to merge these two bills. As Rockefeller and Schumer have pointed out, it is completely within Reid's power to put the Senate HELP Committee's public option in the merged bill.
Senator Reid supports the creation of a public option that would keep the insurance companies honest and provide care that puts patients first.
- The objective remains to develop legislation that reduces costs, improves outcomes, and protects choice and provide stability and security to our health care system. Senator Reid is working tirelessly to bring both sides of the aisle together and is hopeful that a quality, comprehensive, bi-partisan bill is within reach.
- Under the proposed health insurance reform bill, Americans would have the choice of private insurance company plans and also the option to choose coverage from a public plan. This public option would be offered through the health insurance exchange and would compete on a level playing field with private insurance plans to ensure private insurers operate honestly and reduce costs while improving services. Those who choose the public option would pay premiums for their coverage, and the public plan would use those premiums for operating expenses.
As David Waldman explains, if Reid puts the public option in the merged bill brought to the floor it would take 60 votes to remove it and there are not 60 votes against the public option in the Senate. Conversely, if Reid leaves the public plan out, it would take 60 votes to add one, and there are not 60 votes for a stand-alone amendment for a public option.
“The public plan is no longer an option” is only a myth if Reid chooses to make it a myth. It is completely within Reid's power to make a real public option part of the Senate bill, but Reid also has the power to kill the public option in the Senate. So, will Reid make a liar of himself, or make a liar out of those claiming the public option is no longer viable?
Will Reid Submit To The Tyranny Of The Five?
In a conference call today, Senate HELP Committee chairman Tom Harkin (D-IA) again stated his conviction that health care reform will have a public option. In defense of the public option Harkin pointed out that a majority of Senate solidly supporting the idea.
Not all Democratic senators need to vote for a bill with a public option, they only need to vote for cloture to end a filibuster of the bill. Conservative Democrat Mark Pryor (D-AR) doesn't think Democratic senators refusing to vote for cloture is a likely scenario. Even Joe Lieberman (I-CT) sounds unlikely to vote against cloture:
The public option has a strong majority in the Senate. So far, none of the five Democrats opposed to the public option have publicly given any indication they would let the whole of health care reform die because it contained a public option. Even if Democrats threaten to filibuster a bill with a public option, Reid can now choose to move the bill forward with only a simple majority using reconciliation.
As Rockefeller (D-WV) and Schumer (D-NY) have said, the decision to include a public option is completely in Reid's hands. Is Harry Reid going to let his caucus to be ruled by a tiny handful of senators or will he stand with the vast majority of his party?
"There are 52 solid Democrats for a public option and only about five Democrats really kind of opposed to it," Harkin added. "One has to ask if the 52 should give into the five or if the five should come on board with the vats majority. I think the answer is clear."
Not all Democratic senators need to vote for a bill with a public option, they only need to vote for cloture to end a filibuster of the bill. Conservative Democrat Mark Pryor (D-AR) doesn't think Democratic senators refusing to vote for cloture is a likely scenario. Even Joe Lieberman (I-CT) sounds unlikely to vote against cloture:
Lieberman said he was “inclined to let the motion to proceed” (or cloture) go forward, but “I haven’t decided yet.”
The public option has a strong majority in the Senate. So far, none of the five Democrats opposed to the public option have publicly given any indication they would let the whole of health care reform die because it contained a public option. Even if Democrats threaten to filibuster a bill with a public option, Reid can now choose to move the bill forward with only a simple majority using reconciliation.
As Rockefeller (D-WV) and Schumer (D-NY) have said, the decision to include a public option is completely in Reid's hands. Is Harry Reid going to let his caucus to be ruled by a tiny handful of senators or will he stand with the vast majority of his party?
Harry's Other Headache, The $245 Billion Medicare Payment Fix To Buy Off The AMA
The Senate is planning to move with remarkable speed (for them) to pass $245 billion doctors fix for Medicare. The bill will completely skip the normal committee process and head straight to the floor next week.
At issue is the is Medicare sustainable growth rate (SGR) formula. The formula would mandate automatic cuts to Medicare reimbursement rates. For years, Congress has used short term “patches” to prevent the payment cuts mandated by the SGR. The patching of the SGR has turned into a lobbying boondoggle.
If the formula is not fixed, next year, doctors would see a 21 percent cut in Medicare reimbursements. Essentially, no one in Washington expects the SGR to ever be allowed to fully go into effect, but the CBO's long term budget projects must assume that it will.
Permanently fixing the SGR formula is a top priority of the American Medical Association (AMA). Harry Reid and the White House plans to introduce a $245 billion bill to do just that. The fact that the SGR fix is not paid for does not sit well with some conservative Democratic senators. Both Sen. Conrad (D-ND) and Sen Bayh (D-IN) have expressed their opposition to an unpaid SGR fix:
*Note if the money for $245 billion SGR fix was instead used to improve affordability in the current health care reform bills, it would be more than enough money to actually provide affordable universal health insurance for all Americans.
Update - Politico is reporting that Reid maybe working on an agreement with some Republicans to pass the SGR fix.
At issue is the is Medicare sustainable growth rate (SGR) formula. The formula would mandate automatic cuts to Medicare reimbursement rates. For years, Congress has used short term “patches” to prevent the payment cuts mandated by the SGR. The patching of the SGR has turned into a lobbying boondoggle.
If the formula is not fixed, next year, doctors would see a 21 percent cut in Medicare reimbursements. Essentially, no one in Washington expects the SGR to ever be allowed to fully go into effect, but the CBO's long term budget projects must assume that it will.
Permanently fixing the SGR formula is a top priority of the American Medical Association (AMA). Harry Reid and the White House plans to introduce a $245 billion bill to do just that. The fact that the SGR fix is not paid for does not sit well with some conservative Democratic senators. Both Sen. Conrad (D-ND) and Sen Bayh (D-IN) have expressed their opposition to an unpaid SGR fix:
"It needs to be done but I couldn't vote for something that is going to raise the deficit by $245 billion, not at a time when we are already hemorrhaging red ink," Bayh said. "I am for the fix but I don't think we should blow the roof off the deficit -- not at a time when we are already running record deficits."Failure to fix the SGR could cost Obama's health care efforts the support of the AMA. Passing the fix will test Majority Leader Harry Reid's and President Obama's abilities to twist the arms of conservative Democratic senators into voting for cloture on a bill they object to. (Something Reid is pretending is impossible to do for a health care reform bill that includes a public option.)
*Note if the money for $245 billion SGR fix was instead used to improve affordability in the current health care reform bills, it would be more than enough money to actually provide affordable universal health insurance for all Americans.
Update - Politico is reporting that Reid maybe working on an agreement with some Republicans to pass the SGR fix.
Rockefeller Jumps on the "Blame Reid for Killing the Public Option" Bandwagon
In an interview with Bloomberg Television, Sen. Jay Rockefeller (D-WV) put the responsibility for getting a public option squarely on Senate Majority leader Harry Reid's shoulders.
Earlier this week, Sen. Chuck Schumer (D-NY) made waves by also preemptively placing blame on Reid should the Senate health care reform bill fail to contain a public option. The message is clear, if the bill brought to the Senate floor by Reid has a public option, there are not the votes to remove it. If Reid, solely in his power as majority leader, chooses to include a public option in the merged bill, it is almost assured that there will be a public option.
Rockefeller and Schumer may be trying to publicly put pressure on Reid to include the public option, or preparing to their explaination to supporters on why they failed to secure a public option. Most likely, it is a combination of the two. Regardless, Harry Reid is facing a tough choice. If he kills the public option to please a handful on conservative Democratic senators, he will face a tough election being branded as the man who singlehandedly killed the public option.
HUNT: Well, let me ask you about that, because it would appear there are not the votes for the kind of public option that you’ve advocated and maybe even that Senator Schumer advocated.
Would you be willing to accept the Olympia Snowe proposal of a trigger? You’ve expressed reservations about it in past.
ROCKEFELLER: Harry Reid can put into that mark whatever he wants. And so if he puts in mine - less likely - Chuck Schumer’s - more likely, - if he decides to do that, then it’ll take 60 votes to take it out because it will be in the mark and that’s the genius of that melding of both ways.
Earlier this week, Sen. Chuck Schumer (D-NY) made waves by also preemptively placing blame on Reid should the Senate health care reform bill fail to contain a public option. The message is clear, if the bill brought to the Senate floor by Reid has a public option, there are not the votes to remove it. If Reid, solely in his power as majority leader, chooses to include a public option in the merged bill, it is almost assured that there will be a public option.
Rockefeller and Schumer may be trying to publicly put pressure on Reid to include the public option, or preparing to their explaination to supporters on why they failed to secure a public option. Most likely, it is a combination of the two. Regardless, Harry Reid is facing a tough choice. If he kills the public option to please a handful on conservative Democratic senators, he will face a tough election being branded as the man who singlehandedly killed the public option.
Blame Harry, If There Is No Public Option
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On the Rachel Maddow Show last night, Senator Chuck Schumer (D-NY) publicly delivered a message that is likely not to sit well with Senate majority leader Harry Reid. Schumer basically said it was completely up to Reid if he wanted to put a public option in the combined Senate bill that is brought to the floor. (The HELP bill contains a public option and the Finance bill does not.) Schumer also said if Reid puts a public option in the Senate bill, it would not be removed and likely become law.
Well, first leader Reid has the option of putting [the public option] in the final bill. If he puts it in the final bill, in the combined bill, then you would need 60 votes to remove it, and there are clearly not 60 votes against the public option. And so we're urging him to do that, and he is seriously considering it. Once it passes the Senate, if that were to happen, it is in the House bill, it is in the Senate bill, and it would have to be in the final product. So, it is very important to see if the public option is in the bill leader Reid puts together. He hasn't yet made up his mind, but many of us who believe in the public option are urging him to do so. So far, we are getting heard.
The message is pretty simple. Reid has the power to pass a public option. If the public option is killed in the Senate, the blame rests squarely on Reid. The question is, with a very tough election coming up, does Reid want to be know as the man who killed the public option?
All Hail Empress Snowe
I know many on the left have taken to calling Republican Senator Olympia Snowe, President Snowe. This has been in response to the Democratic party leadership willingness to do almost anything to gain/keep Snowe's support for health care reform. Frankly, this does not fully encompass just how much power has been handed over to Snowe.
After all, many presidents (Nixon, Clinton, Truman, Johnson) have tried and failed to get the health care bill they wanted passed the United States Senate. Snowe is basically being told that she can write whatever health care bill she wants. This is more say than has been offered to any president in the past 100 years.
You see Snowe has achieved a level of power far in excess of that of a mere president in our multi-branch system of government with its checks and balances. The mock title “President Snowe” simply does not do justice to the amount Max Baucus, Harry Reid, Rahm Emanuel, and Barack Obama have invested in her. Her sway on the issue of health care reform is closer to that of absolute monarch than of any American president in history. I think Empress Snowe more properly summarizes how completely some in the Democratic leadership are prepared to defer to her.
Mr. Reid will gather the group in his office, on the second floor of the Capitol for its first official meeting on Wednesday. The group includes Senator Max Baucus, Democrat of Montana, the Finance Committee chairman, Senator Christopher J. Dodd, Democrat of Connecticut, who was acting chairman of the HELP committee when it passed its health care bill and representatives from the White House.
Jim Manley, a spokesman for Mr. Reid, said that Senator Olympia J. Snowe of Maine, the lone Republican on the Finance Committee to vote in favor of the bill, would be invited to future sessions. And Mr. Manley said the Democratic leader was prepared to go to substantial lengths to hold Ms. Snowe’s support.
“He is prepared to do what he can to keep her on board while putting together a bill that can get the 60 votes necessary to overcome a Republican filibuster,” Mr. Manley said.
After all, many presidents (Nixon, Clinton, Truman, Johnson) have tried and failed to get the health care bill they wanted passed the United States Senate. Snowe is basically being told that she can write whatever health care bill she wants. This is more say than has been offered to any president in the past 100 years.
You see Snowe has achieved a level of power far in excess of that of a mere president in our multi-branch system of government with its checks and balances. The mock title “President Snowe” simply does not do justice to the amount Max Baucus, Harry Reid, Rahm Emanuel, and Barack Obama have invested in her. Her sway on the issue of health care reform is closer to that of absolute monarch than of any American president in history. I think Empress Snowe more properly summarizes how completely some in the Democratic leadership are prepared to defer to her.
Good Day For Baucus, Bad Day For Real Reform
I'm sure Chairman Baucus, Senate Majority Leader Reid, and President Obama are all pleased that Republican senator Olympia Snowe voted for the Baucus bill in committee. Their goals have long been to pass anything they could slap the label “health care reform” on and declare victory. Sadly, Snowe's support could signal a bad day for real reform.
Snowe has long been opposed to some of the most important elements of reform. I'm not just referring to her opposition to a real public option and her support for a worthless trigger proposal.
Snowe opposes a real employer mandate, and instead favors a disastrously stupid “free rider” provision. It could have serious consequences for low-income workers.
She is against giving the exchanges the power to negotiate with private insurance companies. This is a provision that should help keep down the cost of health care. It would save individuals money and the government money. Snowe fears it is too much government involvement. John Kingsdale, who runs Massachusetts's exchange, called Snowe's insistence that the exchanges not have the power to negotiate price with insurance companies a recipe for disaster.
Just today, during the committee hearing, she reaffirmed her support for “national plans.” This would allow health insurance companies to sell national plans in any states. Individuals state would lose the power to regulate these insurance plans sold in their states. The national plans would be exempt from all minimum benefit requirements mandated by the state legislature. This has been for a long time one of the top goals of the for-profit health insurance industry.
These are only the few changes that I know Snowe requested. Other good ideas, like a minimum medical loss ratio for insurance sold on the exchange, a stronger regulator, and a better defined minimum benefits package, could also have been excluded at the request of Snowe. For Example, Cantwell's “basic health plan” amendment did not get Snowe's vote in committee. It may be left out of the merged bill because Snowe opposes it.
I fear all of these terrible ideas from Sen. Snowe will make their way into the final bill. Obama has signaled his desperation to win the support of Snowe, and seems willing to accept any idea she has regardless how bad. Snowe's vote may make it easier for the Democratic leadership to declare a political victory, but the cost of winning Snowe's support could be that health care reform is a policy failure. In which case, it is the American people who are the real losers.
Snowe has long been opposed to some of the most important elements of reform. I'm not just referring to her opposition to a real public option and her support for a worthless trigger proposal.
Snowe opposes a real employer mandate, and instead favors a disastrously stupid “free rider” provision. It could have serious consequences for low-income workers.
She is against giving the exchanges the power to negotiate with private insurance companies. This is a provision that should help keep down the cost of health care. It would save individuals money and the government money. Snowe fears it is too much government involvement. John Kingsdale, who runs Massachusetts's exchange, called Snowe's insistence that the exchanges not have the power to negotiate price with insurance companies a recipe for disaster.
Just today, during the committee hearing, she reaffirmed her support for “national plans.” This would allow health insurance companies to sell national plans in any states. Individuals state would lose the power to regulate these insurance plans sold in their states. The national plans would be exempt from all minimum benefit requirements mandated by the state legislature. This has been for a long time one of the top goals of the for-profit health insurance industry.
These are only the few changes that I know Snowe requested. Other good ideas, like a minimum medical loss ratio for insurance sold on the exchange, a stronger regulator, and a better defined minimum benefits package, could also have been excluded at the request of Snowe. For Example, Cantwell's “basic health plan” amendment did not get Snowe's vote in committee. It may be left out of the merged bill because Snowe opposes it.
I fear all of these terrible ideas from Sen. Snowe will make their way into the final bill. Obama has signaled his desperation to win the support of Snowe, and seems willing to accept any idea she has regardless how bad. Snowe's vote may make it easier for the Democratic leadership to declare a political victory, but the cost of winning Snowe's support could be that health care reform is a policy failure. In which case, it is the American people who are the real losers.
Senate Finance Committee Ends Amendment Process, Next Stop Reid's Office
The Senate Finance Committee late last night finished amending the chairman's mark. The amended bill will be sent to the CBO for analysis. It is assumed that by Tuesday the CBO will have a preliminary score of the bill. If bill scores as not adding to the deficit, the committee should vote on the piece of legislation.
The bill is expected to pass despite the fact that several Democratic members of the committee are unhappy with the shape of the legislation. Committee members have been lobbied by administration officials to keep the process moving forward.
The big question is whether Republican Sen. Olympia Snowe will vote for the bill. Snowe appears to be the only Republican senator who might possibly vote for health care reform. She could vote against the bill in committee, but eventually vote for the bill after it is amended on the floor. If she voted for the bill in committee it might give her greater sway in deciding on how the two Senate bills (FinCom and HELP) are merged. HELP Committee Chairman Tom Harkin does not see room at the table for Republicans when the bills are merged.
Once out of committee, the bill must be merged with the Senate HELP Committee bill. The HELP bill contains a public option, tougher regulations, and more generous subsidies. Majority Leader Harry Reid will be responsible for merging the two bills. It is up to Reid as to whether or not the bill that is brought to the floor contains a public option.
The bill is expected to pass despite the fact that several Democratic members of the committee are unhappy with the shape of the legislation. Committee members have been lobbied by administration officials to keep the process moving forward.
The big question is whether Republican Sen. Olympia Snowe will vote for the bill. Snowe appears to be the only Republican senator who might possibly vote for health care reform. She could vote against the bill in committee, but eventually vote for the bill after it is amended on the floor. If she voted for the bill in committee it might give her greater sway in deciding on how the two Senate bills (FinCom and HELP) are merged. HELP Committee Chairman Tom Harkin does not see room at the table for Republicans when the bills are merged.
Once out of committee, the bill must be merged with the Senate HELP Committee bill. The HELP bill contains a public option, tougher regulations, and more generous subsidies. Majority Leader Harry Reid will be responsible for merging the two bills. It is up to Reid as to whether or not the bill that is brought to the floor contains a public option.
A Trigger Is An Affront To The American People
With Senate Majority Leader now saying he thinks a trigger is “pretty doggone good idea” it is important to know what supporting a trigger says to the American people. To support the trigger idea you first need to already accept most of the arguments for a public option. You must believe that it could bring down cost, provide competition, and/or be less likely to use unethical practices. If one simply doesn't think a public option would be able to work they should oppose it in any configuration including as a possible trigger.
To support the trigger idea you must also believe that even after the new regulated marketplace is put in place there is still a distinct possibility that insurance companies will continue to rapidly increase premium and treat costumer badly. You must believe that it is possible that our new health insurance marketplace could turnout to have many problems, because of the lack of a public option.
When a politician says they support the trigger idea they are telling their constituents, I know insurance companies treat their clients bad and charge way too much for their products. I know there is a way the government could create a public option that would help millions of Americans with these problems, but helping people is not my top priority. I think it is much more important to give large for-profit corporations another chance to screw over the American people.
Of course, most politicians who claim to support the trigger idea are really opposed to the whole idea of a public option. They support a public option because they are cowards unwilling to be honest with the American people and say they are against the public option. Their goal is a trigger that will never be used, so they can trick their constituents into believing they stand with the vast majority of the country, which supports a public option.
Supporting the trigger idea is an affront to the American people. It is infinitely worse than opposing the public option. If a member of Congress honestly opposes the public option for philosophical reasons or because they think that it would be an unworkable policy, they should make their argument and let their constituents decide. The voters will eventually judge them for their stance.
Supporting a trigger is telling your constituents that there is this great idea which could help millions of Americans get more affordable health care, but I think it is more important to give the large for-profit health insurance corporations another chance to pay nice before providing regular people with relief. To support a trigger is to stand proudly with the health insurance industry against the middle class Americans.
To support the trigger idea you must also believe that even after the new regulated marketplace is put in place there is still a distinct possibility that insurance companies will continue to rapidly increase premium and treat costumer badly. You must believe that it is possible that our new health insurance marketplace could turnout to have many problems, because of the lack of a public option.
When a politician says they support the trigger idea they are telling their constituents, I know insurance companies treat their clients bad and charge way too much for their products. I know there is a way the government could create a public option that would help millions of Americans with these problems, but helping people is not my top priority. I think it is much more important to give large for-profit corporations another chance to screw over the American people.
Of course, most politicians who claim to support the trigger idea are really opposed to the whole idea of a public option. They support a public option because they are cowards unwilling to be honest with the American people and say they are against the public option. Their goal is a trigger that will never be used, so they can trick their constituents into believing they stand with the vast majority of the country, which supports a public option.
Supporting the trigger idea is an affront to the American people. It is infinitely worse than opposing the public option. If a member of Congress honestly opposes the public option for philosophical reasons or because they think that it would be an unworkable policy, they should make their argument and let their constituents decide. The voters will eventually judge them for their stance.
Supporting a trigger is telling your constituents that there is this great idea which could help millions of Americans get more affordable health care, but I think it is more important to give the large for-profit health insurance corporations another chance to pay nice before providing regular people with relief. To support a trigger is to stand proudly with the health insurance industry against the middle class Americans.
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