The state of the public option in the health reform bills

by: Chris Bowers

Fri Mar 05, 2010 at 12:23


Here is what I hope to be a comprehensive rundown of the state of the public option in the health reform legislative process:

1. Quick process overview
Here is the current process that the Democratic leadership is attempting:

  • Senate convinces House they have the votes to pass a reconciliation "fix" to the Senate health reform bill
  • The House will pass the Senate health reform bill by March 18th
  • President Obama signs Senate health reform bill into law
  • House then passes reconciliation bill to "fix" that bill
  • Senate passes that reconciliation bill
  • President Obama signs reconciliation bill into law before April 4th
The Senate appears to have convinced the House, thus completing step one.  The two main indications of this are that 51 Senators, including Robert Byrd, are publicly open to using reconciliation to finish health reform.  The second is that the House has nearly finished drafting a reconciliation bill, indicating that they have been convinced by the Senate.  Pelosi, yesterday:

Earlier today, outside of a caucus meeting, Pelosi said Democrats had already drafted much of a reconciliation bill, meant to amend the Senate package, and sent "a bunch" of its legislative language to CBO.

Given all of the various meetings that are taking place between President Obama and members of the House, every indication is that we are onto steps two and four, rounding up the votes for the Senate health bill in the House, and working on passing a reconciliation bill through the House.

2. Senate will not add a public option to House reconciliation bill
Tom Harkin has stated that if the House passes a reconciliation bill that lacks a public option, the Senate will not add one:

"If we have a bill sent to us from the House that does not have the public option here, if we were to add it here, it would sink the whole bill," Harkin said.

As such, in order for a new public option program to pass as part of health reform, it must be in the reconciliation bill that the House passes.

3. Pelosi isn't putting a public option in the House bill
On Sunday, Speaker Nancy Pelosi said that the public option was not currently on the table (emphasis mine):

Speaker Nancy Pelosi (D-Calif.) predicted Sunday that she would find the votes to pass a health care overhaul and said Democrats had already made major concessions to Republicans, including ditching the public insurance option.

"A year later, we're closer to what Republicans were suggesting at that time, an exchange and not a public option," she said on CNN's "State of the Union."

Pelosi said, "There is no public option on the table now."

This can only be taken to mean that the reconciliation "fix" to the Senate bill that the House is currently drafting does not contain a public option.  As such, the only way that one ends up in the bill is if someone other than the leadership proves that there are 217 votes for it in the House, and 50 votes for it in the Senate.  The leadership is not going to push for it on their own.

4. Outside groups haven't proven the votes are there--yet
An optimistic view right now would be that the House has the votes for a public option in the reconciliation fix bill, but the Senate does not.  President Obama reinforced this view yesterday, telling House Progressives that the Senate, rather than the House, does not have the votes.

In terms of rounding up the votes in the Senate, Whipcongress.com currently lists 35 supporters of passing a public option through reconciliation.  The Open Left whip count shows 37 supporters, with 4 possible supporters, for a maximum for 41.

So, even in the most optimistic view, outside groups are still 9 votes short of proving the Senate has enough votes to pass a new public option program through reconciliation.  As such, if there is going to be a new public option program in the health insurance exchanges, outside groups have at most two weeks to prove that the votes exist in the Senate.

That is some time, but not a lot.  It you want to help round up those votes, click here.

5. The public options already in the Senate bill
Even as we continue to work to expand the health options in health reform legislation, it is very, very important to remember that the Senate bill does contain expansions of public health insurance and of public health care.  It is simply false to say that there is no expansion of public health insurance or public health care in the Senate bill:

  • As many as 48% of the newly insured people in the Senate bill will be covered by a public option.  This is because the Senate bill increases the number of people who will be covered under Medicaid by 15 million compared to current law (CBO report, PDF, page 20).  With 31 million newly insured in the Senate bill, that means as many as 48% of the newly insured in the Senate health reform bill will be insured by a public option.

  • 25 million people will receive public health care in the Senate bill. Beyond insurance, Bernie Sanders managed to include expanded public health care in the Senate bill for 25 million Americans:

    A $10 billion investment in community health centers, expected to go to $14 billion when Congress completes work on health care reform legislation, was included in a final series of changes to the Senate bill unveiled today.

    The provision, which would provide primary care for 25 million more Americans, was requested by Sen. Bernie Sanders (I-Vt.).

    That is more than the number of people who will become new purchasers of private health insurance in the Senate bill.

Is this as many people who can, and should be covered by public health insurance and public health care?  Of course not.  However, it also shows that it is patently false to claim that there are no public options in the Senate health bill, and that progressives received nothing for their advocacy and efforts.

Now, with all that said, let's keep working to expand the public options in the bill even more.  Head over to whipcongress.com today, and contact an uncommitted Senator.

Chris Bowers :: The state of the public option in the health reform bills

Tags: , , , (All Tags)
Print Friendly View Send As Email
The state of the public option in the health reform bills | 24 comments
This post is just sad. Good luck Chris. (4.00 / 3)

I agree, I feel sad ...... (0.00 / 0)
[ Parent ]
Take comfort... (0.00 / 0)
Those feelings mean you really are a Progressive.  Isolated, abandoned and perpetually lied to - and those are just our perks!
[ Parent ]
I am actual a moderate. But that's not really the sad part (4.00 / 3)
It is how willfully the President and the leadership are able to manipulate the progressive side. I would like to see progressives as a force strengthened. My view is this- that a real center (closer to where the American public is) can return only with a strong left to respond to the overwhelming influence of the right. I just don't see that happening with a group that is just happy to be patted on the head. It is like some high school girl wanting to be in the in crowd. It is pathetic. More than that, what bothers me is that they know are being manipulated through the obsession over process. A process that they know to be a sham. Yet they play along anyway. It is truly sad and weird to read this.  
[ Parent ]
Must ready by Chris Hedges (0.00 / 0)
[ Parent ]
I'm curious what your definition of "moderate" is as it relates to health care (0.00 / 0)
If you were Emperor of America and could design any health care system you wanted for the whole country, what would you produce?
[ Parent ]
follow up point (4.00 / 5)
I agree with something that Bill Maher keeps saying a lot lately. There is not left and right in this country. Just a right of center party (the Democrats) and a far right batshit crazy party. Chris and others keep wanting us to compare ourselves to the batshit crazy party, but I have been paying attention long enough to know that the Democratic party leadership is not even left of center as a party. take the excise tax- which I don't see mentioned here. It derives from the Heritage Foundation's push for it and Reagan's push for it before them. It is based on right wing assumptions. The plan is basically the Romney plan. It is not going to reform the reasons why we are at a crisis in our health care system. It moves the chairs around the deck of the Titanic. Rather than admitting that's what we are doing, the "progressives" seem to have decided to just accept it because "well this is the best we can get and it does offer us something." Does that something seriously change the overall picture or offers us a way, even in terms of incremental reform, a way forward in the near future to address the systemic problems? Or does it just use the liberal mind set of throwing money at the poor and thus we have done something? The later point is why I am a moderate. Unlike Chris, I am unimpressed with bandaids when I know that there is a gap wounding that threatens the whole organism.  
[ Parent ]
hmmm (0.00 / 0)
It's interesting to read different people's perceptions of the same situation.  For me, everything you say about Progressives is what I consider to be the major failings of Democrats, and my perception of Progressives - the one that leads me to identify most closely with them - is that they distinguish themselves from Democrats precisely for that reason.  Maybe I'm totally off, who knows, but that's another reason I'm not a Republican - I'm willing to admit I might be wrong.
[ Parent ]
I see this as three groups (4.00 / 3)
a) Democratic Centrist/Conservatives pushing for status quo
b) Democratic progressives enabling group a)
c) Democratic progressives not enabling group a)

The problem is that the vast bulk of the party falls into groups a and b,  including many bloggers, with the largest group being group b.

 Group b is the most difficult to address because what they say sounds reasonable until you start to realize the systemic effect of what they are doing.

I liken their arguments to trying to save the life of a passenger who is suffering from a heart attack as the car that everyone is in is about to run over the cliff to kill everyone. Both the heart attack and the impending car crash are caused by far right wing action.

I doubt they even accept that they are driving in a car heading over a cliff so the reasonableness of saving the heart attack victim seems like the best choice.

The problem is there comes a tipping point where the car is moving in a direction heading over the cliff that you can't stop the forward emotion in time enough to prevent killing everyone.

Do you have enough time to deal with the heart attack victim or do you only have enough time to save the entire car?

Some think we have time to save the heart attack victim, and, if they are aware of the larger problem, that they have enough time to address the car crashing over the edge of the cliff.

The vast bulk of enablers see the tipping point differently than I do. I had this conversation with a friend about the risk of climate change. That it is not that I am certain about climate change, but that there are acceptable and unacceptable risks. The risk of being wrong here is too great. The risk that climate change is indeed caused by humans, and that now is the time to prevent it before the tipping point, says to me that our actions must occur now rather than later.

The same holds true of progressives who enable the president to do what he wants on policies like health care.

Can we go back to fix it later? Perhaps. Or, perhaps not. The assumption that we will always have a chance at some mythic  later date to change the moral arc of history is something grounded into liberal psychology.

The problem with the assumption is that history does not always work like that. Societies can and do collapse. The tipping point for when that occurs is not always clear. THus, I see all of this with a different sort of urgency.

There is this famous book from a decade or so ago that discusses how other cultures slowly destroyed themselves. That's kind of what i am looking at regarding the reasonableness of the arguments being made by progressives who enable what we are seeing. The next generation, for example, may be the first with shorter rather than longer life spans and quality of life in America. We may be facing  a declining middle class, and like with climate change, the time is probably now while we are not 100 percent to do something about it, because later it may be too late. Thus, their reasonableness is not all that reasonable as they tweak round the edges to get whatever they can get in the moment (as they see it).


[ Parent ]
Good analysis ( 3 groups ) but here' s a question.. (0.00 / 0)
how do the numbers shift among the three? You might think that c would increase over time with the failures of the leadership madeup entirely of group a.  but I think that the illusion that the Obama WH would be progressive, or at the least leaning to group b, has played havoc. The 2008 election has pulled many true progressives into the enabling mode, hoping to see progress on solutions to many critical problems. In the prior 8 years the ranks were larger and progressives fought harder for causes against a common foe. So instead of strengthing the effort and reinforcing the ranks, Obamas election has actually depleted the ranks because we're told that WH is fighting for our causes and pragmatism dictates that we go along and long term everything will get fixed. In fact this message can be used to placate a b and c all at once.
Our ranks are shrinking fast and it why I am feeling more lonely today.  
[ Parent ]
I often think the enabling occurs for the following 5 reasons (0.00 / 0)
a) partisanship (I support the Democrats)
b) identity politics (I Support the president because he's a person of color)
c) ideological (less likely to be a factor here)
d) personality (I like the president and trust him)
e) psychology (what I like to call What's the Matter with Kansas, the Left edition- where progressives act as they do because someone is manipulating expected emotional buttons in liberals. Like getting what you can get and hoping for the future. Hoping for the future is a good way to manipulate any given progressive. All you have to do is say "some day"and they will buy into whatever you are peddling. )

You mention one other- branding. More specifically, you mention what I like to call 'brand pragmatism." Not pragmatism based on what any given policy will mean for impact on the American electorate, and thus the party's ability to stay in power, but based on what is branded as "pragmatic." Victories that would have been won anyway such as medicaid expansion are rationalized as a big deal because people want to seem pragmatic.

 We have to accept the excise tax to be "pragmatic" about the medicaid expansion we would have gotten anyway. That way you rationalize concessions that were not necessary for things that the other side was never fighting against.

Just like people want to be branded as reasonable this is more like a branding of the outcomes than actually what was at stake in the negotiations.

It means about as much as centrism,  or process, that is to say, it means nothing at all, regarding understanding what happened politically so that the effort can be repeated for future success.

For another example, if pragmatic means whatever President Obama does then that's just another version of the 'emperor has no clothes" since the meaning is solely based on his personality.  Thus, the president saying "we don't have the votes" is supposed to , I am guessing, shut down an up or down vote.

This is the same president who claimed the same thing bout the drug re-importation bill as I remember, and when it looked like the bill would pass on the floor, he  twisted arms to make sure what he claimed was "possible" was exactly as he defined it although more actually was possible.


[ Parent ]
follow up point (0.00 / 0)
the hope for the future line is a sham because you never hear about any strategy for getting there. Just that one day it will happen like the clouds parting and a light floating down from god. Of course, the real answer is that if you want some day to happen, you need to start to find ground upon which you are going to stand.
[ Parent ]
Ass backwards (4.00 / 2)
It's not the job of outside groups to prove the votes are there.

Fuck, the votes aren't there for the entire bill yet--does that mean they shouldn't move forward with the bill.

You decide to vote for something, then you try to round up the votes for it. You do, I mean, if you want to pass something.  

I don't think the House is convinced (4.00 / 2)
Maybe Pelosi can pull 217 votes out of her hat on a promise from the Senate, but I doubt it.

If the House passes the Senate bill and Obama signs it, I think the chances of any reconciliation fix happening are about 10 percent.

Join the Iowa progressive community at Bleeding Heartland.

Republican Frame Alert (4.00 / 1)
"25 million people will receive public health care in the Senate bill."

No one will receive public health care in the Senate bill.  They'll receive public health insurance.  The GOP is blurring the distinction to further their rhetoric about a "government takeover of health care."

The emphasis on the word 'care' in the line right after the one I quoted suggests this might have been a typo.

You are incorrect. (4.00 / 2)
Bernie Sanders, in exchange for his vote, got $10 billion in the Senate bill to build clinics and staff them with doctors and nurses. This is not insurance; it is healthcare provided directly to the public. It's the best part of the bill. I personally think it is the best way forward. The VA healthcare system outperforms anything here and in most other countries as well. Let's stop fiddling with insurance and work toward single provider instead of single payer.

A doable first step would be to expand VA care to family members of veterans. Ask people who oppose it why they hate our troops. Pay for it by cutting military pork and a windfall tax on defense contractors. Let's get Grayson or someone to propose a bill and flood DC with phone calls.

miasmo.com

[ Parent ]
"Let's get Grayson or someone to propose a bill and flood DC with phone calls." (0.00 / 0)
Right after the current debacle plays out of course.

miasmo.com
[ Parent ]
That's a good idea and we should do it (0.00 / 0)
but I don't know if CHCs are enough to justify passing a PO-less Senate bill.
[ Parent ]
Medicaid is welfare! (0.00 / 0)
We expanded the number of people officially living in poverty just so we didn't have to provide health care to our own citizens.  What a sorry assed bunch of Democrats these jokers are.
Yeah, it's super lame. (0.00 / 0)
But the more I hear Republicans trying to frighten Dems into not passing anything, the more I think passing this mix of boloney and shit sandwich is better then not passing it. But we still have two weeks to try to make it slightly less sucky. Let's make some calls.

miasmo.com
[ Parent ]
If the Republicans won and killed it all, (0.00 / 0)
insurance companies would have their asses and the people who want a real public option (god, how I hate that stupid, stupid phrase) will thank them.  How's that for putting the shoe on the other foot.  
[ Parent ]
Medicaid Expansion (0.00 / 0)
I reluctantly have come to support passing national healthcare without a public option or Medicare expansion because not to do it would sink the Democratic Party,& thus progressives, in the upcoming elections. However, this argument that we would see a great expansion of healthcare services through Medicaid is inflated. Given the low reimbursement rates of Medicaid, the vast majority of doctors refuse to see Medicaid patients or set up offices in low income areas.
We really are on our own now (0.00 / 0)
We (as in the public and the non-leadership members of Congress) are really on our own now.  We have to do this without the help of the leadership in the House, Senate or White House.

I don't see why we should even still call them "leadership" at this point.  Barack Obama's title should be renamed to Submissive Follower of the United States (SFotUS).

At this point there's no way anyone can still plausibly claim that Obama still supports the public option, but the poor little President/Submissive Follower still can't get anything passed... but we have to reelect him anyway or else a Republican President will get elected and will somehow pass their agenda despite having to deal with the same kind of obstacles.

Lucky (0.00 / 0)
Lucky I only have to pay the fine for 2 years before I go on Medicare.
The state of the public option in the health reform bills | 24 comments
USER MENU

Open Left Campaigns

SEARCH

   

Advanced Search

QUICK HITS
STATE BLOGS

Home | RSS/XML Feed | Register | Contact

  © OpenLeft 2007-2010, Powered by SoapBlox

Powered by: SoapBlox