There are a lot of whip counts on the health reform bill right now. In the midst of the confusion, let me suggest a simplified metric on the progress of the health reform bill:
Tally the number of confirmed "No" votes who switched from voting yes in November;
Tally the number of confirmed "Yes" votes who switched from voting no in November;
Subtract #2 from #1.
If the resulting number is equal to, or less than, 1, then the bill looks good for passage. If the result is greater than 1, passage is in danger.
With droves of members of Congress still playing coy with the public, this should make things easy.
(Note: even if he is undecided, Cao will never cast the deciding vote in favor. As such, he should be considered a "Yes to No" for the duration of the vote count)
The results in a net of five votes for "Yes to No." That means the leadership needs to pick up four more "no" votes from November to pass the bill
Hopefully, that simplifies things, and makes it easier to understand the run of play. Then again, some of these supposedly "hard yes" and "hard no" votes have flipped before, so even this count is prone to confusion.
While it is true that there is a substantive difference between Medicaid and a public health insurance option tied to Medicare rates in the exchange, it is also true that the bill strengthens Medicaid in important ways. By moving most of the funding to the federal level--a $99 billion addition to the Senate Finance Committee bill--Medicaid recipients in red states are now in little or no danger of having their public health insurance taken away by local right-wing governments. Cutting Medicaid now becomes nearly as politically difficult as cutting Medicare.
Number of people receiving public primary care Additionally, there is $11 billion extra for Community Health Centers in the reconciliation bill over five years. At current rates of patients receiving care (20.27 million annually) to federal funding for Community Health Centers ($2.5 billion annually), that projects to an additional 17.8 million patients receiving public primary care from the bill. This compares to zero extra patients in the Senate finance committee bill, and 22.7 million extra in the House bill in November.
Since this concession was directly made to win progressive votes, again I guess it means Progs got nothing.
****
It is factually untrue that progressives won no concessions in this bill. People are free to debate over whether the concessions are enough either to support the bill or to demonstrate increased influence, but it is simply untrue that they won nothing in return for their support.
Rep. Stephen Lynch (D-Mass.) is a firm "no" on health care reform -- in large measure because he opposes the idea of any kind of excise tax on Cadillac plans, even one that's delayed for years and years.
That puts the vote count at 204 in favor, and 211 opposed, with leaners. Pretty dicey on passage, to say the least, especially when you look at the 16 undecided, non-leaning votes in the count:
Jason Altmire
Melissa Bean
Chris Carney
Travis Childers
Henry Cuellar
Kathy Dahlkemper
Brad Ellsworth
Bill Foster
Marcy Kaptur
Jim Matheson
Harry Mitchell
Solomon Ortiz
Earl Pomeroy
Nick Rahall
Zack Space
Harry Teague
Additionally, I now expect Stephen Lynch to receive loads of concessions on future legislation. By voting against this bill, be becomes more powerful in future negotiations, right? So, let's track his rise to power after this vote.
Comprehensive health care reform will cost the federal government $940 billion over a ten-year period, but will increase revenue and cut other costs by a greater amount, leading to a reduction of $130 billion in the federal deficit over the same period, according to an analysis by the Congressional Budget Office, a Democratic source tells HuffPost. It will cut the deficit by $1.2 trillion over the next ten years.
The source said it also extends Medicare's solvency by at least 9 years and reduces the rate of its growth by 1.4 percent, while closing the doughnut hole for seniors, meaning there will no longer be a gap in coverage of medication. The CBO also estimated it would extend coverage to 32 million additional people.
A million extra people covered is nice. That certainly seems like a lot of deficit reduction, too.
I had also heard a rumor of a Medicare buy-in being considered as a last-minute change to appease the CBO instead of / in addition to the excise tax change. Unfortunately, it was one of those situations where pushing for it would have been counter-productive (think about what happened when Sanders, Weiner, Dean and Kucinich celebrated the Medicare buy-in deal back in December). The center-right Democrats who were pushing for it would have withdrawn support if the DFHs liked it. Because, in the end, the key for many center-right Democrats is to only support policy that pisses you off (seriously).
However, since a leaked CBO score implies the bill is done now, I think it is OK to let the cat out of that bag. Doesn't seem like it is going to happen one way or the other.
Hoyer: we are going to do it as soon as we have "CBO numbers we have confidence in" "saturday and sunday are possibilities"
This would seem to confirm the rumors that the CBO score hasn't been released yet because it doesn't reduce the deficit enough.
Democrats will have to continue to change the bill until they can get an acceptable score, but time is running out. Since they need three days from the release of the CBO score to the vote, and since Sunday is the last day they can vote, that mean tomorrow night is the absolute latest the score can be released. So, they need to find ways to make the bill reduce the deficit more, and they need to do it in 24 hours.
It would seem that the White House is looking to increase the excise tax as a means of placating the CBO. Ben Smith reports that AFL-CIO chair Richard Trumka has been summoned to the White House to discuss:
AFL-CIO President Richard Trumka is headed into a meeting with President Obama this afternoon after the White House and Congressional leaders have begun to discuss a higher-than-expected excise tax on some health care plans, in order to maintain their claim that health care legislation will reduce the deficit, a source involved in health care talks said.
It was actually the demand to reduce the excise tax that forced the current plan for the House to pass the Senate bill, and then fix that bill through a reconciliation "sidecar." With the backing of labor, House Democrats of all stripes stood together very strongly on this, torpedoing attempts to just pass the Senate bill unchanged, or attempts to try a smaller bill (or series of smaller bills).
Demanding massive concessions on the excise tax was the actual "Progressive Block" in the negotiations, behind the scenes. With further concessions being demanded on that front, it will take the blessing of Trumka to make the deal work. And so, he has been summoned to the White House.
Of course, including a public option would solve the problems Democrats are currently facing with the CBO, but hey, that was never part of the plan. Or really, even without a public option, you could still finance it by increasing tax rates on high-income households. But I guess a pound of flesh must always be taken from any left-wing group in order for any victory to be allowed.
Today, Representative John Shadegg (R-AZ) took bad faith to a new level, claiming he supports single-payer in a discussion with David Shuster on MSNBC:
"The reality is, this bill is going to reward for-profit insurance companies that have done a disservice," Shadegg said. "This bill is going to give them exactly what they wanted. The insurance industry, the for-profit insurance industry, wanted an individual mandate and that's what they're getting out of this bill. The for-profit insurance industry did not want a public option because they don't like competition and guess what? They're getting that."
Then, after some back and forth with Shuster: "I would support single-payer."
"You would support a government-run medical system?" Shuster asked.
"Absolutely," Shadegg said. "I would support forcing American insurance companies to compete. Right now they have a monopoly.
But Obama is pushing a public plan that he claims will somehow co-exist with private insurance. Shadegg isn't buying it.
"Ultimately, that so-called public plan, or government plan, will run the private sector out of business, because the guys that are operating the public plan are setting the rules for the guys running the private plan," Shadegg says.
The congressman says Obama does not want people to think he will replace private health insurance. That's because of Democrats' bitter experience with the plan pushed by Hillary Clinton when her husband was president.
"I think Hillary figured out after the fact that when she proposed to dramatically change the healthcare system in America at a time when most Americans were relatively happy with their healthcare, she scared people," Shadegg says. "She wanted the same thing that Obama wants, but she was more forthright in proposing it, saying look, we need to go to a single-payer system. And she lost the fight."(...)
"The question is, through what mechanism do you deliver health insurance?" Shadegg says. "Do you put them in a government-run program that forces everybody into a one-size-fits-all kind of cookie cutter system and is run by the government and therefore not subject to the rules of competition, or alternatively, do you facilitate every American being in a system driven by choice, one that produces competition to hold down costs and drive up quality?"
And then, top up the ante, in October Shadegg described single-payer as the step before a Soviet-style gulag:
You know, it occurs to me, and I'll go through these other scandals very quickly, but what we're really getting here is we're not just getting single-payer care. We're getting full on Russian gulag, Soviet-style gulag health care.
So yeah, I believe Shadegg is being honest here. He isn't just cynically parroting left-wing complaints about the bill or anything. He really supports single-payer.
The base has fallen into line. And if Rahm was right all along that progressives, essentially, could be taken for granted, he's about to go from punching bag to hero in the eyes of many Democrats.
That statement is only supportable if you fail to remember what the actual health reform debate was like two months ago. In the wake of the Massachusetts special election, Rahm Emanuel wanted to scrap even the Senate health reform bill and pass something smaller:
Emanuel, for his part, is now pushing for a stripped-down health care bill that could be passed within a few weeks and force Republicans, for a change, to take a few tough votes.
The House should pass the Senate's health insurance reform bill - with an agreement that it will be fixed, fixed right, and fixed right away through a parallel process. [. . . ] The House and Senate must move forward together. And, there is no reason they cannot move forward together to make those changes through any means possible -- whether through reconciliation or other pieces of moving legislation.
Senior Congressional aides said that lawmakers and the White House were increasingly focused on a plan by which the House would adopt the health care bill approved by the Senate on Dec. 24, with any changes made in a separate bill using the budget reconciliation maneuver.
Instead of scrapping the Senate health care bill and passing something stripped down, Congress is moving to pass the Senate health reform bill with improvements through the reconciliation process. Which is what almost everyone except Rahm Emanuel wanted.
It beats me how someone can have the exact opposite of his recommended path forward come to pass, and still be vindicated. Emanuel wanted to water down the Senate bill further, but instead it will be getting stronger through the reconciliation process as progressives were demanding. Yeah, Emanuel really paved the way forward after the Massachusetts debacle.
1. CBO score still not out, deadline tonight. In order to pass the bill by the Easter recess, and avoid any further delays that could sink the bill, the Senate needs to take up the bill next week.
In order for the Senate to take up the reconciliation bill next week, President Obama has to sign the Senate bill into law before he leaves the country for a five day trip on Sunday.
In order for President Obama to sign the bill into law before he leaves the country, the House needs to pass the bill by Saturday night.
And, in order for the House to pass the bill by Saturday night, the CBO needs to release its score of the bill tonight, 72 hours before the House votes.
However, its Wednesday, and there is still no score. While one is expected tonight, the holdup is a pretty serious one. As Jonathan Cohn explains, the reconciliation bill might not reduce the deficit during the second decade after its enactment, which is required in order to pass the bill through reconciliation.
Hard to imagine that this is something which can be fixed in a single day, and without a public option.
2. Two "lean yes" votes move to undecided Reps Marcy Kaptur and Jason Altmire had been in the "lean yes" category of David Dayen's whip count. They don't sound like "lean yes" votes today, though.
Kaptur said she's spoken to Rep. Dale Kildee (D-MI), another pro-life Dem who's signed off on the Senate's abortion language, but didn't find his reasons persuasive.
Sounding more like a no than he was last week. On March 16, Altmire told Fox Business Network that he has major problem with Democrats' apparent "deem and pass" strategy, calling it "wrong."
Last night, there was a report that Speaker Pelosi had called an impromptu meeting at 10 a.m. this morning with all women in the Democratic caucus.
Speaker Nancy Pelosi (D-Calif.) is asking all female Democratic Members to attend a hastily called meeting Wednesday morning but isn't saying what the meeting is about.
Pelosi's office sent an e-mail out Tuesday evening requesting that all female Democrats come to the Members-only meeting at 10 a.m.
An aide to one Democratic Member said Pelosi's office said the topic of the meeting was "to be determined."
Lincoln Davis, Jim Matheson, Harry Teague, Travis Childers, John Barrow, Zack Space, Chris Carney, Brad Ellsworth, Jerry Costello, Henry Cuellar, Nick Rahall, Solomon Ortiz, Earl Pomeroy, Bill Foster, Harry Mitchell.
Of this group, only Bill Foster and Harry Mitchell opposed Stupak, and they are probably the easiest votes to get anyway. Given this, was Speaker Pelosi preparing for a final cave to Stupak in order to get the remaining six votes?
Fortunately, the answer is no. An aide to the leadership has confirmed to me that the following Roll Call story about the meeting is accurate. Speaker Pelosi is meeting with everyone, and in the specifici meeting with the women in the Democratic caucus this morning, and reproductive rights were not discussed:
Abortion provisions in the health care bill were not discussed during a hastily called Wednesday morning meeting between Speaker Nancy Pelosi (D-Calif.) and female Democratic Members. Instead, Pelosi ran through talking points on how health care reform benefits women, according to lawmakers who attended the meeting.
Just now, Representative Dennis Kucinich announced he would vote yes on the Senate health bill and the reconciliation fix to that bill. Greg Sargent:
"In the past week it's become clear that the vote on the final bill will be very close," Kucinich, who voted No last time because of the lack of the public option, said at a presser moments ago, adding that he would have to vote "not on the bill as I would like to see it, but as it is."
"However, after careful discussions with President Obama, Speaker Pelosi" and others, Kucinich said, "I've decided to cast a vote in favor of the legislation."
This brings the total "yes" and "lean yes" supporters of the bill up to 208. Eight away from passage.
Update: More from Greg Sragent. Kucinich switched out of "compassion," didn't receive any specific promises:
"I left it with a real sense of compassion for our president and what he's going through," he said. "We have to be compassionate towards those who are called upon to make decisions for this nation. It's not an easy burden that he's taken up.
Kucinich said Obama didn't make any promises to take up the public option later.
"What he committed to was to continue to work with me on the broad concerns that I have," he said. "He didn't make any specific commitment."
Donna Brazile flags an interesting quote from Kucinich:
"I have taken a detour in supporting this bill, but I know the destination."
MITCH MCCONNELL:
Since we can't let Obama succeed,
It's "a clean sheet of paper" we need.
We'll hem and we'll haw --
He'll change not one law! -- And the voters will say: "He can't lead."
HARRY REID:
McConnell must think I'm a dunce --
I've already passed this thing once!
I'll pass it once more! In November the score
Will embarrass that "genius" Frank Luntz.
Representative Dennis Kucinich is holding a press conference tomorrow at 10 a.m., eastern, to announce his vote on the health reform package. On Countdown tonight, Howard Fineman reported that Kucinich is now a "yes."
There is no guarantee this is true. But, if true, there are many implications:
Only eight away from passage. Given the three other Democrats who came out in support of the bill today (Maffei, Doyle and Kirkpatrick), the "yes" and "lean yes" totals on the package would rise to 208, only eight away from passage.
Kucinich told Obama that he wants a full ERISA waver and a public option in exchange for his vote. And if he actually gets an ERISA waver, it will be the biggest victory of the entire health care debate. As Jon Walker says, "ERISA is the 900 pound Gorilla that has fucked up America's health care system something good."
I definitely don't agree that it would be the biggest victory in the debate. After all, this is just the possibility of state single payer, not actual single-payer (and no, Pennsylvania is not close to enacting single-payer). By contrast, Bernie Sanders has scored public primary care for 22 million people. But, it would still would become another way that progressives strengthened the bill.
Does Kucinich bring anyone with him? While Kucinich is the last House Progressive holding out on the bill, and thus can't bring anymore votes with him, it is worth asking whether his support brings along any progressive activists. If Kucinich won at least one of his demands, such as the ERISA waiver, will any of the not insignificant amount of progressive activists supporting Kucinich come along with him? Or, will those activists reject Kucinich, too, because he didn't win all of his demands? (or many his demands were never enough in the first place for some).
This is certainly the most interesting vote update of the day. I wasn't going to watch before, but now Kucinich's press conference has become a must-see.
Representative Ann Kirkpatrick, who had been one of the key undecided votes, said she would vote for the health reform bills today: The Hill got her statement:
"In my first year in Congress, I have always put the needs of my district first -- that's why I stood up to the President and congressional leadership and opposed the auto and bank government bailouts, the cap-and-trade bill and billions in deficit spending. I am doing so again by voting for this reform package. Health insurance reform is critical to ending denials of coverage based on pre-existing conditions, making sure our children can get the care they need and protecting our seniors from unaffordable prescription drug costs. I will be working to improve the bill moving forward, including addressing the potential costs for AHCCCS and eliminating politics-as-usual special deals like the Cornhusker Kickback."
According to David Dayen's whip count, Kirkpatrick is the 207th "yes" or "lean yes" vote. That puts the bill nine votes from passage, although the final nine will not be easy.
Steve Hildebrand is threatening to run a primary challenge against Blue Dog co-chair Stephanie Herseth Sandlin if she votes against the health reform bill:
Senior Obama campaign official Steve Hildebrand is eyeing a Democratic primary challenge to South Dakota Rep. Stephanie Herseth Sandlin, a decision he said hinges largely on whether she votes against health care reform later this week.(...)
"I want to see how she votes on health care," Hildebrand said. "If the vote is very, very close and we lose it or come close to losing it, I will take a serious look at challenging her."
In response, Jane Hamsher argues that Herseth Sandlin's opposition to the health reform bill is because of choice (emphasis in original):
Stephanie Herseth-Sandlin holds down a tough seat for pro-choice Democrats. She's in an R+9 district, and that's a tough thing to do for a pro-choice woman.
But the Democratic establishment are now out to torpedo any woman who sticks up for choice. Steve Hildebrand - Obama's Deputy Campaign Manager, who called up rich donors and told them to cut off 527s during the campaign - is threatening to primary her if she defends a womans' right to choose from Ben Nelson's assault: (...)
Let's just be very clear about what's happening here. There were forty-one members of Congress who signed Diana DeGette's letter saying "We will not vote for a conference report that contains language that restricts women's right to choose any further than current law."
And now, if any of these women wants to keep that pledge to defend choice, Obama's deputy campaign manager - the guy that controls the cash - is threatening to run them out of office for doing so.
Um, Herseth Sandlin's opposition to the health reform bill has nothing to do with choice:
On January 20th, more than a month after the Nelson language was added to the Senate health reform bill, Herseth Sandlin issued a press release opposing the bill. Once again, reproductive rights and women's health were not mentioned in the release.
(H.R. 1388) On a motion to add language to a bill funding local community service and volunteer efforts that would prohibit the volunteers from discussing or promoting abortions, and from engaging in lobbying, union organizing, political activity, voter registration or religious teaching
Herseth Sandlin may have a decent record on choice, but she clearly isn't above compromising on it from time to time.
In the many instances where she stated her opposition to various health reform bills, Stephanie Herseth Sandlin has never even mentioned reproductive rights. In fact, she opposed the bill before the Stupak amendment passed or the Nelson language was added. She is not an outspoken defender of reproductive rights, and has compromised on it in the past.
If you oppose the health care package because of the reproductive rights language in it, great. But that is not why Stephanie Herseth Sandlin opposes it, and it is not the basis of Hildebrand's threatened primary challenge.
The most difficult potential votes remaining are the following thirteen:
John Barrow (GA-12)
Chris Carney (PA-10)
Travis Childers (MS-01)
Jerry Costello (IL-12)
Henry Cuellar (TX-28)
Lincoln Davis (TN-04)
Brad Ellsworth (IN-08)
Ann Kirkpatrick (AZ-01)
Jim Matheson (UT-02)
Solomon Ortiz (TX-27)
Earl Pomeroy (ND-AL)
Zack Space (OH-18)
Harry Teague (NM-02)
Unless it can scrounge up votes form the "hard no's" and "lean no's," the leadership will need the support of seven of these thirteen to pass the bill. It isn't going to be easy:
A very conservative group. The mean Progressive Punch score for these members on crucial votes in 2009-2010 is only 38.1%, and the median is only 34.3%. Only three of these thirteen had scores over 40%, and only two had scores over 50%. No one had a score over 60%.
These thirteen members vote more like Republicans than like Democrats.
It's a good thing that Stupak amendment can't be changed in reconciliation. Given the Representatives who are still on the fence, it is pretty easy to see the House leadership just cutting a deal on Stupak to pass the bill.
New to Congress 8 of the 13 were first elected in 2004 or later. Two were first elected in 2004 (Barrow and Cuellar). Three were first elected in 2006 (Carney, Ellsworth, Space). Three were first elected in 2008 (Childers, Kirkpatrick and Teague).
While that doesn't seem like money very well spent by the DCCC, it should also be a strong point of leverage. Any groups who helped them get elected can really put the hammer down this time.
Majority voted for the health reform bill in November. 8 of the 13 voted for the health reform bill back in November. Only Barrow, Childers, Davis, Matheson and Teague did not.
This is a pretty right-wing group, but securing a majority of them it possible. The key is probably for groups that supported them in 2008, including the White House, to throw the hammer down and make this vote a pre-condition for support in 2010. They vote more like Republicans than like Democrats, but only have the benefit of being in Congress due to support from Democratic and progressive groups.
One of the supposedly undecided members who voted for the bill last time, Representative Nick Rahall (D-WV), sent out a press release yesterday boasting about $1.8 million in federal funding for a local health care non-profit:
U.S. Rep. Nick Rahall (WV) announced today that the Community Health Systems, Inc. (CHS) DBA AccesHealth has been awarded $1.8 million in federal funds for operational expenses which will help citizens of Raleigh, Fayette, and Wyoming counties continue to receive quality accessible healthcare at affordable costs.
"Rural health centers like Community Health Systems extend medical services into isolated areas where the need for medical care is great and resources are often scarce," said Rahall. "This funding will help enhance the range of much-needed healthcare services available to the residents of Raleigh, Fayette and Wyoming Counties where accessibility to good healthcare remains a challenge to many residents."
Community Health Systems, Inc. is a Federally Qualified Health Center and a non-profit organization providing comprehensive primary health care to the citizens of Raleigh, Fayette, and Wyoming Counties and surrounding areas.
Also, expect Fox News to start decrying this move shortly. How dare Rahall get quality, low-cost, primary care for rural West Virginians! A truly unethical thing to do.
According to David Dayen's latest whip count, the 17 most important votes who are not leaning in one direction or the other are as follows:
5 undecided potential "No to Yes" votes John Barrow, Travis Childers, Lincoln Davis, Jim Matheson, Harry Teague
3 undecided potential "Yes to No" votes that are "Stupak-curious" Jerry Costello, Henry Cuellar, Brad Ellsworth
9 other undecided potential "Yes to No" votes Chris Carney, Mike Doyle, Bill Foster, Ann Kirkpatrick, Harry Mitchell, Solomon Ortiz, Earl Pomeroy, Nick Rahall; Zack Space
With leaners, the vote count currently stands at 205 in favor, and 209 opposed. That would mean the House leadership needs 11 of these to pass the bill.
In response to a third-hand report that he would vote against the Senate health reform bill because it lacked the Stupak language, Representative Tom Perriello just released this statement saying the report was not accurate. Here is a snippet:
"I have plenty of serious problems with the Senate bill and, until I see the final language, I cannot take a position on final passage. But the existing language on abortion in the current Senate bill meets the pledge I made to ensure no federal funding for abortion in this health care bill."
So, to everyone's surprise, a third-hand report from the National Review wasn't correct.
I have to wonder why The Hill doesn't just declare health reform dead. Their current whip count totals show 215 votes against, 158 in favor, with 58 undecided. If this whip count is accurate, it means that in order to pass health reform, the Democratic leadership needs to score all 58 of the undecided votes, and not lose a single current "yes" vote.
Given this, The Hill needs to ask itself a two-part question:
If they believe their own whip count totals, then why haven't they run a big news story on how health reform is near death? Scoring 58 unanswered undecided votes is virtually impossible. Why aren't they talking about the imminent death of health reform? their current headline implies Dems are close to passage:
If they don't believe their whip count totals, and as such don't think the bill is all but dead, then why are they still publishing their whip count totals?
Either The Hill doesn't believe their own whip count, or they think health reform is just about dead. They can't have it both ways.
