Here's an interesting wrinkle to healthcare reform that illuminates the difficulty of hammering out legislation with so many voices pulling lawmakers in different directions. It played out in the wee hours of the Senate Finance Committee's last markups to the healthcare bill submitted by Baucus last Friday morning. I'll let Ezra Klein set the stage:
But the drama came late in the evening. About one in the morning, Wyden's Free Choice Act came before the committee. But it never came up for a vote.
Instead, Max Baucus effectively ruled it out of order. The reason? It didn't have a full CBO score. This came as a surprise to Wyden and his team, who'd gotten the amendment scored by the CBO, and had been in endless negotiations with Baucus, the White House, employers, and labor over the past week. If the score was in fact partial, as Baucus and Conrad claimed, you'd think someone might have mentioned it. No one did.
But suddenly, in the wee hours of Friday morning, the chairs of the Finance and Budget Committees were explaining that the amendment lacked a valid score. ANde an amendment without a valid score is "out of order." Wyden was left with little choice but to withdraw the amendment. It was not deliberative democracy at its finest. But it served its purpose: it killed the amendment.
Klein does a great job of explaining Wyden's amendment and its importance to reform, but here I'll just say it would have given all Americans full access to the health insurance exchange, the place that allows consumers to buy a policy that falls under the restrictions of newly enacted community standards - no discrimination against preexisting conditions, etc - as well as the public option, when that's passed. If you work for a big company and you don't like your insurance, under Wyden's amendment you could ditch it and get something better.
With the amendment scratched, however, you're stuck with what you have. Reform will not touch you in any significant way.
For those of us who have been watching the legislative "process" unfold, that's not really much of a wrinkle, right? We've seen how Senators, time after time, cut down legislation that would open up the market to real competition, real choice, and access to effective and affordable insurance for fear of injuring the private insurance industry. Old hat, eh?
But the surprise in this particular amendment's demise is who opposed it:
The proposal was doomed by the joint opposition of businesses and labor. Businesses didn't like it because they lose control over their employees' health benefits. Labor groups didn't like it because they lose control over their members' health benefits. That's not an entirely selfish concern: It is easier to bargain on behalf of your workers or members if they have no other options, and thus are guaranteed customers for the insurer. But it is a short-sighted concern. It means the protection and preservation of a system where employers offer us one or two health-care choices, which may or may not be of high quality, and which will almost certainly dissolve if we leave or lose that job. It also means a system in which insurers compete less, and costs are further hidden from consumers, and businesses continue to bargain on their own.
One of the biggest mysteries to me swirling around healthcare reform is, where were the major corporations? Of all the stakeholders in healthcare reform, it's America's business community that stands to gain the most from good, comprehensive healthcare reform. (Okay, maybe the uninsured and the ill stand to gain more from an individual's point of view...) Under, say, a single-payer healthcare system, the burden for providing employee health benefits would - poof! - vanish. Sure, there'd be taxes to pay for the system that business would necessarily share, but it'd be no doubt considerably less than what they're dishing out now.
Of course, the present character of reform has removed them from the debate. Their beef isn't with the uninsured. It's with costs. They're there to shoot down anything that might steal from their bottom line - an employer mandate, say - but sitting quietly otherwise. And why not? For most of them, as with most of us, this bill will change the present healthcare status quo not one bit. Killing Wyden's amendments ensures that.
As for the unions, well they're looking out for their members. Period. A robust public option open to all reduces their bargaining power for their members.
It's frustrating to watch all this, isn't it? To get something good and comprehensive, like a single-payer system say, or a public option open to all, would require compromises from deep-pocketed groups to allow legislation to pass that would work against their interests. In short, they'd have to support something that's good for the country and its citizens, but bad for them in the short term, which takes courage.
I'm not saying it isn't possible. But under the conditions that this debate started - with a complex array of hodge-podge proposals and counter-proposals born out of the lukewarm pot of compromise with disparate and competing ideologies - there never was something to get excited, or courageous, about.
And thus died the Wyden amendment in the early morning hours in a Capitol Hill committee room late last week.
You're looking at the narrative that will be written about this Democratic Congress, with Max Baucus as its figurehead, if the public option, and healthcare reform along with it, fails.
It may not be fair, it may show a lack of understanding of "how Washington works," it may even be pessimistic, but that's how it is. And I'm flabbergasted that this is surprising anyone, especially those that have the means to move the debate and change the narrative. And, oh yeah, pass meaningful healthcare reform.
Good news from the Senate Finance Committee Wednesday, which defeated two bad amendments by Utah's Orrin Hatch (R) that could have left women with worse health care coverage than they had before health care reform.
Hatch wanted an amendment to eliminate a major compromise that let private insurance companies continue to cover abortion care but not fund coverage for this care under any government or public option. He also proposed an amendment to prohibit all private companies participating in health insurance exchanges from providing coverage for abortion care.
Thanks Max for standing by women is this fight to retain our current benefits and for your help keeping these private decisions in the hands of women, families, and doctors.
For now, women can continue to make these tough decisions based on our own moral beliefs and medical needs--not Orrin Hatch's.
Finance is but one committee--an important committee, to be sure, but one all the same. The bill from the Senate Health, Education, Labor, and Pensions (HELP) Committee has a public plan. So do the bills that came out of three House committees over the summer. Senator Harry Reid has indicated he probably won't include a public plan when he merges the Finance and HELP proposals, but there will be a chance to add one duirng the floor vote debate and then again during conference committee deliberations, assuming the House passes one.
Remember, the public option doesn't need 60 votes in the Senate - as Baucus seems to be claiming - it needs 51. And, right now, it's likely a healthcare bill without the public option wouldn't pass the House. Even if reform passes the Senate without the public option, there's still reconciliation.
Despite how long it's seemed to take already, it's still early.
Rockefeller's ability to channel these feelings may seem odd, given his privileged pedigree. But it makes sense given what he's done with his career. Remember, West Virginia didn't choose him. He chose West Virginia, starting with his service as a VISTA volunteer. He knows his constituents very well. And he acts that way.
You see this in his advocacy for the public plan. The arguments you hear in the debate are mostly about costs, payment rates, and how best to make a market function. But for Rockefeller, it really boils down to a simple proposition: A public plan is good because you know it will always be there for you.
The government isn't going to point to an obscure provision on page 152 of your manual and deny you essential services. The government isn't going to comb through your medical records and decide that, having taken your premiums for several months, you're not eligible for coverage after all. The government isn't going to stop offering coverage next year because it can't make a profit big enough to satisfy Wall Street.
Most Senators have no idea what's it's like to be in our shoes.
Cohn and others (Matt Singer?) think health care reform is worth passing without the public option. I disagree.
Without the public option, there's still no protection from having insurers denying claims for typos or other arbitrary reasons. There's no protection from insurers subverting your doctor and deciding what treatment you receive.
Without the public option, there's no guarantee insurers won't raise their prices across the board. In fact, the legislation as written gives insurers an incentive to raise prices, especially under the most progressive legislation with the largest and broadest subsidies. After all, the more expensive insurance is, the more consumers qualify for subsidies, and the more taxpayer money insurers receive. And you can bet the insurers' number-crunchers are right now writing their algorithms calculating to the dime exactly how much they can raise their rates before consumers would rather to pay a fine than purchase their product.
Frankly, without the public option, this healthcare reform is nothing but a large bribe paid out to the private insurance industry to cover our ill citizens, but without any corresponding guarantee or controls to ensure that the industry will uphold its end of the bargain in good faith. And as someone who's been repeatedly burned by my healthcare insurers over the years, please forgive me if I'd like something a little stronger in return than insurers' promises....
Baucus, Conrad, Carper, Lincoln, and Nelson voted against Sen. Rockefeller's public option amdendment.
Baucus, Lincoln, and Conrad voted against Sen. Schumer's public option amendment.
Baucus' statements about the Rockefeller amendment are below the fold.
One of Baucus' reasons for rejecting the public option was his belief that there aren't enough votes in the Senate to pass a healthcare bill with the public option. But Sen. Harkin and others maintain there are 51 votes for the public option -- obviously Baucus means that one or more Democrats would join a Republican filibuster.
Now we have to single out those Senators and put massive pressure on them.
In the meantime, we need to support the Progressive House Caucus and ensure they stick to their promise to vote against any bill without the public option. And we can fund the ad attacking Baucus over the public option.
Max Baucus and four other Democrats -- Nelson, Conrad, Carper, and Lincoln -- vote against the first public option amendment in the Senate Finance Committee...
Today's the big day for health care reform, and a lot of folks have glued to their video screens watching the Senate Finance Committee in action. The Politico reports that the public option was "battered and left to die in August" - gee, I must have missed that memo - but that its future looks brighter today.
The Senate Finance Committee has a live feed up that you can watch, or check out the various live-blogging going on, including that of the New York Times.
Here's my (latest) favorite bit from Ms. Seelye's blog:
Update | 12:42 p.m. Senator John Ensign, Republican of Nevada, asks: If a public option is so popular, why do so many Democrats have a problem with it? The reason, he says, is that it is not popular. "Constituents are really afraid of it," he says.
Hilarious. I think that's the first time I've actually seen a Senator pretend that the Senate actually responds to its constituencies on health care issues.
Not every Democrat right now would prefer the public option in the Senate ... but no Democrat in the end is going to vote against a procedural question to kill the health care bill," he said.
"The 60 Democrats will stay together on procedural questions and then, on final passage, some may vote against it because it's got a public option. But I don't see that," he said. Brown added that at least 50 Democrats in the Senate support the public option.
That procedure will be made easier after Ted Kennedy's replacement, Paul Kirk, is sworn in to the Senate today.
And, according to Ryan Grim, opposition to the public option among House Blue Dogs is fading:
Blocking a public health insurance option is a relatively low priority for conservative Blue Dog Democrats, according to an ongoing survey of its members. The fading House opposition could clear the way for the public option to move through the chamber.
The Blue Dogs have been surveying their membership over the last several days; coalition co-chair Stephanie Herseth Sandlin (D-S.D.) has been collecting the responses. She listed the four top priorities that have emerged: Keeping the cost under $900 billion, not moving at a faster pace than the Senate, getting a 20-year cost estimate from the Congressional Budget Office and addressing regional disparities in Medicare reimbursement rates.
(These demands are actually quite reasonable, especially the last. Much of the burden for paying for Medicare expansion will fall on the states.)
And Nancy Pelosi has rejected the idea of a public option trigger.
In any case, voting in the Senate Finance Committee on the various amendments to Baucus' bill is happening today. Chris Bowers ( in a must-read post) crunches the numbers, lays the political landscape out, and singles out those on the committee who are the key votes to the existence of a public option on this bill: Baucus, Carper, Conrad (who says he opposes it in an Ezra Klein interview, while simultaneously lauding France's healthcare system), Lincoln, and Nelson. (Also, check out the Washington Indepedent's Senate Public Option Scorecard for who stands where on the public option. And it's shocking to see how many Democrats are ambivalent about real healthcare reform.)
In any case, by the end of the day, we should know a lot more about where the public option stands, and who stands against it.
Senate Finance Committee Chairman Max Baucus unveiled an $856 billion health-care reform plan Wednesday that would require nearly all Americans to carry health insurance while barring insurance companies from discriminating against people based on their health status or denying coverage because of preexisting conditions.
The plan does not call for a government-run insurance option, as advocated by President Obama and most Democrats, but would set up a system of nonprofit consumer-owned cooperatives to compete with private insurers -- a provision intended to appeal to Republicans who have railed against the "public option" in recent weeks.
The bill is what's called the "Chairman's Mark," a document that conveys the intent of legislation in accessible language. (Read it for yourself!) Once it's voted on in committee & etc, the actual legislation will be written...
Today's big news about healthcare reform: Olympia Snowe removes her support for Baucus' bill citing cost.
Frankly, she's not the only one. Chuck Grassley says he can't support Baucus' bill because he's worried about illegal immigrants and abortion. (And just when did Grassley take the crazy turn?) Mike Enzi doesn't think states should pick up any of the tab for Medicaid expansion, and doesn't like fees imposed on insurance companies to help defray the cost of reform. (Of course, Enzi's admitted his job is to block reform.) Ron Wyden thinks the subsidies are too low. John Kerry: "It's not going to be the bill we're going to vote on."
More importantly for the bill's future in the Senate Finance Committee, Jay Rockefeller despises the bill and claims "four to six Democrats" in the committee feel the same way. If true, Baucus will need to find four to six committee Republican votes to pass his legislation out of committee.
But let's be clear -- some of this is Baucus's chickens coming home to roost. When you make a unilateral decision to negotiate with only five other people from a 23-person committee and 100-person Senate, and two of those five people have clear electoral disincentives against supporting any plan that you might come up with, the negotiations are liable to end in failure far more often than not. The flurry of on-the-record statements against Baucus's reform plans -- not "leaks", not trial balloons -- points toward a defective process.
And that may suit Democrats just fine.
Without any Republican support, any health care bill that passes Congress now has a real chance of including effective and progressive reform. It'll be tricky dancing around a Senate filibuster, but it likely be easier than getting something out of the Senate Finance Committee with Republican support.
Bipartisan negotiations on the Senate Finance Committee are moving closer to eliminating two health care provisions favored by many Democrats - a mandate on employers to provide insurance or pay a penalty, and a government insurance option, a senator and health care insiders said Monday.
That could bring even greater pressure on Finance Committee Chairman Max Baucus (D-Mont.), who has been challenged by more liberal senators who say he is sacrificing key Democratic priorities on health care reform to win the votes of a few Republicans.
The AP may be right that Baucus's bill will cost less than $1 trillion, but it accomplishes that by shifting the burden to middle-income families, some of whom have poor balance sheets and will face a really tough choice between paying for health insurance they can't quite afford and facing some kind of penalty. Odds are that many of them will take the penalty, which is why coverage probably won't expand very much. Or, the enforcement mechanisms could be more stringent, in which case they'll have to buy health care, at the cost of reducing their spending in other areas -- and in probably being very teed off at the Democrats who passed the bill**.
This is a pretty poor combination of attributes for a health care reform bill to have. If Baucus & Co. wanted to get the cost below $1 trillion, they could have chopped the subsidies down to, say, 350 percent of poverty, while keeping the employer mandate and the public option. As a very rough guess, a bill like that might insure another 30-35 million people at a gross cost of about $850-$900 billion. The actual Baucus bill is going to cost about the same but will be lucky to insure half as many.
Silver also notes that about 15 million Americans, as a result of this bill, would lose their employer-provided insurance and be forced to buy an expensive individual policy or pay a fine. Silver's rhetorical question: "You think those 15 million people are going to vote for the Democrats again, like, ever?"
In short, this compromise bill is a big, steaming bowl of dogsh*t served up to the American people, and we are vastly better off with no bill and the status quo.
I'm not sure it makes sense to kick and scream about all of this right now. Getting a bill out of Finance, any bill, will move things along. There's always the Senate floor--where the FInance bill must be merged with the bill from Senate Health, Education, Labor, and Pensions Committee--and then confernece committee. But it's important to note just how skewed this group is.
