The Senate introduced its health care reform bill yesterday, and only four fricking members of the Democratic Senator caucus are standing in the way of passage. Joe Lieberman of Connecticut, Ben Nelson of Nebraska, Blanche Lincoln of Arkansas, and Mary Landrieu of Louisiana are the only four remaining "Democratic" Senators who have not ruled out joining with a Republican filibuster of health care reform.
What the #%@*!?!
What's worse, these four don't really give a rat's a$$ what you think, even though their vote affects you. Unless you are a resident of Arkansas, Connecticut, Louisiana or Nebraska, as far as they are concerned, you might as well live on Pluto.
Fortunately, Open Left is teaming up with SEIU to do something about it. Even if you do not live in Arkansas, Connecticut, Louisiana or Nebraska, SEIU has developed activist tools that allow you to contact voters in those four states, and tell those voters to tell their Senators to get on board with health care reform. Fight back and make a difference--sign up and tell one, or all four, of these "Democratic" Senators to pass health care reform with a public option:
All the efforts we made to retake Congress. All of the efforts we made to retake the White House. All of the efforts we made to find 51 Senators in favor of health care reform with a public option. It took us fifteen years to get to this point, and we still have to deal with four freaking Democratic Senators who might join with Republicans and filibuster health care reform? Aaarrgghhhh!
The Senate health care bill is now online. It is a lot to wade through, but I can tell you a few things right off the bat:
The opt-out public option in the bill will not begin until 2014. This is one year later than even the 2013 date included in earlier versions of the bill.
The opt-out mechanism is simply when states pass a law. So, that means both state legislatures (except in Nebraska), plus a Governor's signature. Now, even if the opt-out public option passes into law, conservatives have an extra year to try and organize against it.
The penalty for individuals not purchasing health insurance will be $95, and also will not start until 2014.
Also, while the Senate bill does not include Stupak language in the House bill, the public option will not cover abortion procedures.
Obviously, in a bill this large, these bullet points just scratch the surface. Consider them appetizers.
1. What's in the bill? The Senate Democratic caucus has just started their meeting on the merged senate health care bill. Wonkroom tweets, via CNN, that the bill will cost $849 billion, and reduce the deficit by $127 billion, over ten years. Via Quick Hits, it will only over 94% of Americans (31 million), which is up from 83%, but below the 96% (36 million) estimated by the CBO for the House bill. So, it actually has a higher cost per person covered than the House health care bill, with less generous subsidies to match.
Over at Fire Dog Lake, Dave Dayden breaks down what to expect in the bill. It appears that, at least for now, it will include the opt-out public option. The triggered co-op, not reconciliation, remains "Plan B.".
2. Will it get to the floor? Earlier in the day, majority leader Harry Reid gave Ben Nelson, Mary Landrieu and Blanche Lincoln a sneak peak of the bill. The only conclusion to draw from this is that these are the only three Senators who have not committed to vote in favor a motion to proceed on the bill.
Ben Nelson seems to be leaning in favor of voting yes, although he doesn't promise to support the bill in its final vote. No indication from Blanche Lincoln. May Landrieu claims to be leaning toward voting against, probably in an attempt to force concessions even before the bill hits the floor. If she does defeat the bill, it will delay the process in the Senate by at least two more weeks, and water it down even further.
3. What is the timeline and process? The motion to proceed vote is expected on Saturday, in order to give 72 hours between unveiling the bill and voting on it. Then again, I'm not sure why, given that this is the motion to proceed, rather than the vote on the actual bill. A complete description of the process required to bring the bill to the floor can be read here.
Really limping forward here. At this point, the best case scenario is that the debate and amendment process will begin on Tuesday, December 1st.
In addition to the release of the Senate health care bill this evening (Senate Democratic caucus meeting, 5 p.m. eastern, with CBO score), the buzz today is that Senate majority leader Harry Reid won't use reconciliation for health care reform. This would reduce the chances of passing a public option in the bill, given that Ben Nelson, Joe Lieberman, Blanche Lincoln and Mary Landrieu have to committed to voting for cloture on a bill with a public option.
However, the actual article reporting that Reid won't use reconciliation this isn't quite so definitive:
In a meeting Nov. 16 with Democrats who support a Medicare-like public option, Majority Leader Harry Reid, D-Nev., indicated that he did not plan to try to move a health bill through reconciliation, other Democrats said.
"I'm not going to quote him, but suffice to say, after the meeting was over I thought it was unlikely," said Bob Casey, D-Pa.
Regan LaChapelle, a spokeswoman for Reid, said, "We are not ruling anything out, but Sen. Reid is continuing to work to put together a bill that will garner the 60 votes needed to overcome a Republican filibuster.
Not sure how much this actually changes anything. "Unlikely" isn't the same thing as "never." Reconciliation rarely came to the forefront in public discussions of health care, which almost always made it pretty "unlikely" that the Senate would use reconciliation. In fact, back in April, the Senate did not even include an option to use reconciliation health care in the budget, and only added it later on at the behest of the House.
The remaining questions are reconciliation are two-fold:
If the current bill reaches an impasse as the final vote nears, is Reid more willing to make concessions to Landrieu, Lieberman, Lincoln, Nelson and others than he is to use reconciliation? The answer is probably "more willing to make concessions."
How late in the game can the bill still be split into two, with the regulatory measures passing through 60 votes and things like the public option passing with only 51? The answer here, I believe, is as late as the conference committee between the House and Senate. Right up until the very end.
Really, it was never very likely that the Senate would use reconciliation, so I'm not sure this changes much. Then again, it was never very likely that the Senate would include a public option of any sort in the health care bill, and that did happen.
There is still a long time to go in this process--a minimum of three weeks until the conference committee, for example. If it is apparent that reconciliation is the only way to get a good bill, it still doesn't seem impossible that it can be used. It is a longshot, but it wlways was a longshot.
I thought it might be useful to summarize the big battles ahead, as well as the list of things that are good policy changes that seem likely to be in the final legislation. I have two lists of both in the extended entry.
Update (Adam): An amazing thank you to those who have chipped in so far. I am always heartened by everyone's support to keep us going.
If folks are on Twitter, Raven Brooks, Executive Director of Netroots Nation, pledged to donate $2 for each retweet of this tweet (up to $100) over the next 24 hours. Let's empty Raven's wallet by retweeting, and thanks Raven! :)
RT @ravenb Support Open Left! http://bit.ly/3TbUXw Pledging $40 and an additional $2 every time this gets RT'ed next 24 hrs up to $100 #p2
Six months ago, Open Left held a fundraiser to keep us from shutting down operations. Because of your incredible support at that time, we were not only able to keep going, but to expand our capabilities and make a real impact on the legislative process.
In particular, with the assistance of over 35,000 members of the Open Left community, we played a major role in pulling together enough votes to pass a public option through the Senate. Proving there were over 50 votes for the public option in the Senate, and helping to educate the grassroots on both Senate process and the progress of the campaign, were essential to Harry Reid including a public option in the Senate bill.
Now, against the predictions of virtually all pundits, a health care bill with a public option will reach the Senate floor next week. This is a monumental achievement, and through your financial support of Open Left, as well as your activist participation in whipping Senators, you helped make it happen.
In order for Open Left to keep operating and make an even bigger impact over the next six months, we once again need your support. If you value the information we provide, the activist campaigns in which we engage, and the strategic analysis that we offer, then please, join our fight for a progressive governing majority, and contribute today.
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With your help, we are going to keep working to bring the public option over the finish line, to engage the fight for marriage equality wherever it is being waged, and to prevent conservative Democrats from instituting new, sweeping restrictions on reproductive rights. Down the road, we are going to keep pushing the progressive envelope with efforts to end the filibuster in the Senate, to institute a new millionaire's tax in next year's budget, and to turn remaining bailout funds into a second stimulus for the rest of America.
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Even as he is bringing a health care bill with an opt-out public option to the Senate floor next week, Harry Reid is making it clear that he is open to a triggered co-op if he is unable to find 60 votes for cloture:
Even as Senate Majority Leader Reid seeks votes for a healthcare bill with a public option that states can opt-out of, Reid has allowed Sen. Thomas Carper, D-Del., to work on what one aide called a "Plan B" if Reid cannot line up 60 votes for cloture.
Carper said he and some other senators, whom he declined to name, are working on an alternative public option if the opt-out falls short.
In states where private insurers fail to offer affordable coverage, Carper said the alternative would permit them to set up a non-profit board, likely appointed by the president, to offer insurance.
Yikes! A triggered co-op!
If there is any bright side to this, it lets us all know what is at stake in the Senate fight over the next few weeks. Either we round-up the five problem Senators--Evan Bayh, Mary Landrieu, Joe Lieberman, Blanche Lincoln and Ben Nelson--to vote for cloture, or else the Senate will bring a triggered co-op to the conference committee. Those are pretty high stakes.
In addition to applying pressure on the five problem Senators, one move we need to make is to push for reconciliation, not a triggered co-op, as the fallback plan. Right up until the end of the process, the bill can still be split into two parts: one with the new regulations that requires 60 votes to reach cloture, and one with the public option and subsidies that can be included in the budgetary process and which cannot be filibustered.
Senate Majority Leader Harry Reid will send a health care bill with an opt-out public option, and without Stupak amendment language, to the floor of the Senate next week. From The Hill:
Senate Majority Leader Harry Reid (D-Nev.) late Tuesday laid the groundwork for the Senate's healthcare reform debate to start next Tuesday.
Reid filed a motion to introduce the bill on Monday, Nov. 16. Anticipating a Republican objection, the bill would be pushed onto the Senate calendar.
"A motion to proceed to the bill would be in order the next legislative day," said Reid spokesman Jim Manley.
Given the 60-vote culture in the Senate, it will take 60 votes either to remove the public option from the bill, or to add the Stupak language to the bill. This makes either pretty unlikely (especially the addition of the Stupak language).
This does not mean Reid has secured the votes to pass a public option. It does mean that Reid has likely secured the votes to start the amendment and debate process on the health care bill.
Unless the Senate uses the reconciliation process, or unless it uses the nuclear option (which it won't), it will have to pass three, 60-vote threshold, cloture votes on the health care.
The first will be to start debate. The second will be to end debate and proceed to a simple majority vote on the bill. The third and final vote will happen after the conference committee with the House, to end debate on the bill once again and proceed to one last simple majority vote. TNR summarizes the process here.
It is likely that Reid has secured the votes to start the debate and amendment process on the floor of the Senate. There was always minimal opposition to starting debate, even among the five "problem" Senators on health care: Evan Bayh, Mary Landrieu, Joe Lieberman, Blanch Lincoln, and Ben Nelson.
The significance of this is not that Reid has secured the votes to start the amendment and debate process so much as it pushes the timeline for passage of the overall bill forward. If Reid had not filed a motion to introduce the bill this week, then the earliest floor debate would have started in the Senate would have been the Tuesday after Thanksgiving. This ups the process by at least two weeks, and gives real hope that the bill will be passed into law by the end of the year.
After two weeks where most health care attention has been on the House, we now return to Senate. Here's where things stand:
Five Problem Democrats The only barriers to health care reform at this point are Senators Evan Bayh, Mary Landrieu, Joe Lieberman, Blanche Lincoln, and Ben Nelson. There are fifty-one Senators who support health care reform with a public option, and four--Max Baucus, Mark Begich, Kent Conrad, and Mark Pryor--who have made absolutely no threats to filibuster. The same cannot be said of the five "problem" Senators listed above.
Three cloture votes--threats are on the second and third There are three votes where the problem Senators could potentially join with Republicans to block the bill. First, on the cloture vote to bring the bill to the floor for debate and amendment. Second, on the cloture vote to end that debate and bring up a floor vote on the overall bill. Third, on the cloture vote to end debate and bring up a floor vote on the overall health care bill after the health care bill is returned from conference.
Right now, most of the threats to block the bill are on the second of these votes. Evan Bayh and Joe Lieberman have said they are likely to allow the floor debate. Ben Nelson has not said he will bock the floor debate, and Mary Landrieu senses a compromise is close. Blanche Lincoln recently had a one-on-one with President Obama.
So, a floor debate will likely go forward. However, that will not mean the five problem Senators have been forced into line.
Timeline The current, vague timeline for the Senate is "the end of the year."
Since Harry Reid announced that the merged Senate bill would contain a public option, the process in the Senate has slowed to a crawl. The hold-up appears to be that Reid is waiting for CBO estimates which will not be completed until the end of this week.
This means, at the earliest, floor debate and amendments will start for the health care bill one week from tomorrow. If it does not start next week, then it will start the week after Thanksgiving.
Harry Reid is also telling Senators to get ready for Saturday sessions in December.
Stupak moves to the Senate(more in the extended entry)
Another example showing that Versailles conventional wisdom is crap. And that Dems face real problems if they further weaken health care reform, rather than strengthen it. Something to help strengthen our resolve in fighting back against the Dems who voted against us last night. We're going to need a lot more polling like this next year.
Here's a summary of our poll of 800 Virginia Democrats and Independents who voted for Obama in 2008 but didn't turn out for gubernatorial candidate Creigh Deeds in 2009:
Creigh Deeds seen as "not progressive enough" by huge margin. 64% of Democratic Obama voters and 58% of Independent Obama voters said Deeds was "not progressive enough" compared to only 8% of Democrats and 16% of Independent Obama voters who said he was "too far to the left."
Obama's voters want the public option. 88% of Democratic Obama voters and 80% of Independent Obama voters favor a public health insurance option to compete with private insurance plans. 93% of those polled said health care is "very" or "somewhat" important when they vote.
Creigh Deeds hurt by opposition to public option. When asked, "Before the election for Governor, Democratic candidate Creigh Deeds said he would side with conservatives and push for Virginia to 'opt out' of the public insurance plan. Did this make you more excited or less excited to vote in this year's election, or did it have no impact?" 41% of those polled said it made them less excited, only 6% said it made them more excited (7 to 1).
Without a public option, Obama voters will continue to drop off in 2010. 43% of Democratic and Independent Obama voters said they are less likely to vote at all in the 2010 general election if Congress does not pass a public option as part of health care reform, compared to only 8% who are more likely to vote. If they do vote, by 46% to 6%, they will be less likely to vote for a Democratic candidate if Democrats do not pass a public option.
The House Committee on Rules has set the mark-up of the House health care reform bill for 2 p.m., this Friday. Having posted the manager's amendment (aka, final changes to the bill) last night, this means that a vote is likely to take place on Saturday evening. This is because the Committee on Rules must pass the bill before it goes to the floor, and also because the Speaker had promised 72 hours between posting the final version of the bill and the vote on the bill.
An aide to House Speaker Nancy Pelosi (D-Calif.) said Wednesday that a vote could happen at 6 p.m. on Saturday, a schedule House Rules Committee Chairwoman Louise Slaughter (D-N.Y.) suggested in reports Wednesday afternoon.
"It could happen at 6 p.m. on Saturday, but no final decisions have been made," said Nadeam Elshami, a spokesman for Pelosi.
The only possible way that a vote won't go forward this weekend is if Representative Bart Stupak is able to round-up enough votes to block the bill from going to the floor on the "motion to recommit" vote. Given that virtually no Republicans will oppose the bill, that Stupak has as many as 30 Democrats backing him, and that a few other Democratic members might oppose the bill for other reasons, it is possible that Stupak could still prevent the vote from taking place this weekend.
The Congressional Quad-Caucus (Black Caucus, Hispanic Caucus, Asian Pacific-American Caucus, and Progressive Caucus) sent a letter to Speaker Pelosi asking for improvement to the bill before it is passed by the House. However, it is unlikely there will be a chance for them to address their concerns via floor amendments, given that the Committee on Rules has not given a deadline for members to submit amendments. This means there will not be any amendments offered to the bill on the floor--no single-payer, no strengthening amendments of any kind--expect a single, Republican substitute amendment for the entire bill. That substitute amendment will be handily defeated.
This is a broken promise from the leadership, which had originally agreed to allow a single-payer substitute amendment. However, Stupak unfortunately left them with no choice. If members had been allowed to submit amendments, then Stupak's amendment would probably have passed through the Rule Committee, probably passed on the floor, and then probably have defeated the entire bill because it would have caused dozens of pro-choice votes to defect. So, in the end, the floor vote on single-payer was another casualty in Bart Stupak's war on reproductive rights.
The House released a final version of the health reform bill. It has a public option all right, but not the robust version progressives were hoping for. The public plan would only cover 2% of Americans and premiums will cost more than anticipated.
Meanwhile, Sen. Joe Lieberman (I-CT) continued to threaten to join a Republican filibuster of a health care bill with a public option. A lot of people still think he's bluffing. Realistically, the public option probably faces more serious threats from inside the Democratic caucus. It's been whittled down at an alarming rate.
Nick Baumann of Mother Jones asks "What now for the public option?"
The Congressional Budget Office has estimated that public option premiums will actually be higher than the premiums for private plans on the health insurance exchanges. That doesn't mean it's going to cost the government more money-the public option is paid for by premiums, not taxes; it actually cuts the deficit. But it will be more expensive than some private plans. Wasn't part of the point of the public option to prove that a government-run program could compete successfully with privately-run plans? Well, yes, but here's the problem: that was all based on the idea that the public option would pay health care providers at Medicare rates.
Baumann predicts that insurers will do everything they can to drive the sick people off private insurance onto the public plan, a phenomenon known as "adverse selection." Hopefully some of the proposed insurance reforms will curb their worst excesses, like kicking people off the rolls for misspelling their preexisting conditions on their application forms.
Mike Lillis of the Washington Independent reports that the House health care bill would eliminate the popular and cost-effective Child Health Insurance Program (CHIP) and shift its low-income beneficiaries onto private health insurance exchanges.
This looks like a stealthy preemptive strike on the prospect of single-payer health care. CHIP is a single-payer program that progressive health policy types envisioned as a prototype for a future single-payer system for all kids, or even eventually for everyone.
As Lillis points out, abolishing CHIP is also a gimme to insurance companies. Generally speaking, kids are cheap to insure because they're healthy. Private insurers would love to stock their risk pools with kids on federal subsidies. It's like getting paid to stock your pond with delicious trout. We worry about adverse selection making the public plan more expensive. Well, CHIP is the reverse of that because this public program is keeping the good risks for itself.
Suzy Khimm argues at TAPPED that killing CHIP could be a good thing, provided the kids continue to enjoy the same legal protections that they get under the public plan. Khimm suggests that moving low-risk kids into insurance exchanges could help keep costs down for everyone by making the risk pool healthier on average:
That being said, if CHIP's dismantling ended up moving more folks into the health-insurance exchange, it wouldn't simply be a boon for "the insurance lobby and moderate Democrats." It could strengthen one of the most fundamental parts of the Democratic reform package -- a robust insurance exchange with a pool of participants that's large enough to drive down costs precisely because insurance companies have an incentive to jump in and compete for customers. Moreover, folding CHIP into the exchange would add a younger, healthier pool of participants to the exchange, offsetting its potential of becoming a dumping ground for the sick and elderly. Finally, CHIP has always suffered from under enrollment -- about 6 million children aren't insured in the program who should be -- and by bringing whole families in under the same plan, more children will be covered.
That's a nice idea, but it seems foolish to scrap one a popular and successful social program in favor of an untested insurance exchange system.
The frustrating thing about so-called health care reform is that legislators don't really want to change the system. They want to make the system work better while catering to all the established interests that made it suck in the first place.
Politicians aren't the only ones to balk at fundamental change. The Real News Network interviews Sam Gindin (video below), a former assistant to the Canadian Auto Workers Union, now a professor at York University. Gindin says that, over the years, labor conceded too much on health care and thereby failed to reestablish itself as a leading force for progressive change in the United States. Helping elect Barack Obama was a step in the right direction for labor, he maintains, but it's not nearly enough.
As John Nichols of the Nation put it, when the House finally wrote the bill, the compromise was even more compromised than expected.
This post features links to the best independent, progressive reporting about health care by members of The Media Consortium. It is free to reprint. Visit the Pulse for a complete list of articles on health care reform, or follow us on Twitter. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit, The Mulch, and The Diaspora. This is a project of The Media Consortium, a network of leading independent media outlets.
Creigh Deeds on October 20: I'm against the public option.
Voters on November 3: We're against you.
That's an oversimplification, but not by much. Here's some data:
In the eight October polls taken before Deeds' comments about the public option he trailed Bob McDonnell by 11 points with 8 percent of voters undecided. Deeds' support was at 40.25 percent in those polls
In the 11 polls taken after Deeds' comments he trailed McDonnell by 14.3 with 4.5 percent undecided. Deeds' support was at 40.7 percent in those polls.
On election day, with no more undecided voters, Deeds lost by 17 percent. He won 41.2 percent of voters.
Summary: In the aftermath of Deeds' comments on the public option, his support, even as undecided voters finally decided, never really climbed. Either a lot of Democrats stayed home or the vast majority of undecided voters broke for McDonnell.
There are plenty of Democrats in Virginia these days. President Obama won the state by a margin of more than six percent. Recent Democratic Governors include Tim Kaine and Mark Warner. Both Senators are Democrats. But you have to get them to show up and you have to give them reason to be excited about your campaign. Also, when a policy is very popular and will actually help people in a time of great need, you should probably not oppose that policy. Just a thought.
The House bill would expand access to the new health insurance exchange fairly rapidly. In year one, 2013, only individuals without employer provided insurance and the "smallest" employers (25 or fewer employees) would have access to the exchange. In year two, 2014, "smaller" employers (50 or fewer employees) could access the exchange. By year three, 2015, all "small" employers (100 or fewer employees) would gain access to the exchange, and the exchange Commissioner could permit larger employers (greater than 100 employees) to be eligible for the exchange.
In theory, by 2015 all employers, and therefore all Americans not on Medicare or Medicaid, could start using the new health insurance exchange for health care. This would give nearly everyone the ability to choose the public option if they wanted.
Much of this would depend on the commissioner of the insurance exchange, but it is still very good news. If a public option is part of the final bill, and if this provision is also included, then we would only be a couple of steps from achieving something very close to Jacob Hacker's original vision of the public option. Those steps would be:
Convincing the insurance exchange commissioner--which would really mean convincing President Obama--to open the exchange to everyone in America in 2015.
Tying the public option to Medicare rates sometime between now and 2015. On this front, Representative Grijalva is pushing for a floor vote on an amendment for the Medicare +5% public option. If he succeeds in getting this vote, then we will at least know how many more votes we need to reach 218.
So, it is actually still possible that we can pull off the original vision of a public option, tied to Medicare rates, that is available to everyone in America.
So yes, we suffered a setback in the House, but the campaign is far from over. If we can get a public option, a provision that potentially allows it to become available to everyone in America by 2015, and a floor vote telling us how many more votes we need to tie it to Medicare rates, then we will have a clear path to achieving a truly robust public option.
Last night in Quick Hits, art3 alerted the Open Left community to the ugly repercussions of the defeat of the Medicare +5% public option. Now, it appears quite possible that even if the negotiated rates public option passes as a part of the final health care bill, it will not cost any less than private health insurance plans. From the CBO analysis of the House bill (page six, PDF):
Roughly one-fifth of the people purchasing coverage through the exchanges would enroll in the public plan, meaning that total enrollment in that plan would be about 6 million.
That estimate of enrollment reflects CBO's assessment that a public plan paying negotiated rates would attract a broad network of providers but would typically have premiums that are somewhat higher than the average premiums for the private plans in the exchanges. The rates the public plan pays to providers would, on average, probably be comparable to the rates paid by private insurers participating in the exchanges. The public plan would have lower administrative costs than those private plans but would probably engage in less management of utilization by its enrollees and attract a less healthy pool of enrollees. (The effects of that "adverse selection" on the public plan's premiums would be only partially offset by the "risk adjustment" procedures that would apply to all plans operating in the exchanges.)
Ouch. That is pretty awful. In plain English, it means that the public health insurance option won't cost less than private health insurance options because, on average, the people purchasing it will be sicker and less well-off. So, even though it will save on administrative costs, its risk pool will force it to charge rates very similar, and possibly even higher, than private insurance companies.
After such a loss of momentum, at this point the public option campaign is just about getting a legislative architecture in place that will allow the public option to be improved later on with only 50 votes in the Senate. Unfortunately, however, any such improvement will be dicey, given that we apparently lack simple majorities for a stronger public option in both the House and Senate. So, in addition to still struggling just to get the public option in place, we are going to have to struggle down the road to get a better group of people elected to both the House and the Senate.
In this bleak environment, yesterday the House Tri-Caucus (Congressional Black Caucs, Congressional Hispanic Caucus, Asian Pacific American Caucus) and the Congressional Progressive Caucus all met with President Obama to voice their frustration. The White House simply described the meeting as productive:
It was a productive meeting that lasted for about an hour. The President congratulated the members on working so hard to get a meaningful reform bill put together in the House.
In a post-meeting interview with Democracy Now!, Progressive Caucus co-chair Raul Grijalva used much stronger language:
[We] basically brought out that now that we're in this stage of having to deal with this negotiated rates that came out of the House, and something much worse coming out of the Senate, on a public option, that we felt-set some parameters of what we felt very strongly about, that the bill still needed to be strengthened; that there had to be cost controls on the private insurance companies, especially with negotiated rates, because they get to set the rates and we have to chase those rates with taxpayers' dollar; and no triggers and no opt-outs, that we feel those are detrimental to the public interest and certainly to constituencies that have lacked the ability to access healthcare in this country for so many years.
That is just for starters, as Grijalva also criticized the White House for catering to Olympia Snowe, and not being a strong enough advocate of the public option. Grijalva also indicated that he would not work to defeat the bill, given that he criticized Senators who have threatened to do the same:
We're facing the most historic vote that any of us are going to take in our careers. And for procedural reasons or for other reasons, to threaten to filibuster, to threaten to scuttle, whether it is Senator Bayh, Senator Snowe, Senator Lieberman, I think they're missing their opportunity with history, and I think the White House and leadership shouldn't allow them to be absent in this fight.
This may be a tough bill to swallow, but with language like this, it sure doesn't sound like Grijalva is looking to round-up Progressives to vote against it anymore.
This bill may very well provide a lot more people with coverage, we may well still get some sort of public option passed, and the Progressive Caucus does appear to have increased its influence. However, the cost of premiums will continue to rise beyond what are already unacceptable levels, and even without the filibuster we apparently still do not have a good enough Congress to pass transformative legislation. It is a hard pill to swallow, and a very frustrating day.
With the Republicans becoming locked into being the party of No/Hell, No/Not Ever/Nada/Absolutely Not/Never Ever, Democrats are going to need to seriously consider revising the rules of the Senate at the beginning of next term. The gritty reality of the Senate rules minefield is making the passage of health care reform way too complicated. But it's virtually impossible to change the Senate rules in the middle of a term, so we are stuck with getting this thing done with the rules we have.
Fortunately, the Democratic leadership on Capitol Hill and at the White House are completely bound and determined that they will pass a health care reform bill by any means necessary. We have come too far, spent too much time and political capital, to turn back now. I think almost everyone in the party (except maybe 3 or 4 Senators) understand the disastrous consequences of not getting a bill passed.
There are, however, two realities that in combination make getting the deal done really complicated.
The first is that the progressive wing of the party is as dug in as I have ever seen them on having some form of a public option in this bill. This reality, which has been building for months now because of stronger progressive leadership in Congress and a powerful grassroots campaign to push for the public option, has been slow to dawn on the Washington elite, but my sense is that progressives are getting more determined on the issue every day , not less, and that with their rhetoric, their promises to activists, their signatures on letters promising to oppose anything without a public option, that their willingness to give on the issue has gone out the door.
The other reality is that getting the final four or five moderate Senators to vote to let this bill get passed at the end of the process- whether to take it to conference committee or for final passage- is extremely difficult. Between a range of factors including genuine policy and ideological concerns, worries about conservative home state politics, fears about money being cut off from the insurance industry for their campaigns, desire to extract every possible concession on every possible subject, and the egos of being a Senator, getting every last Democratic Senator is a massive challenge. This would be true, by the way, with or without the public option, but the high-profile symbolism of the public option just raises the degree of difficulty with some of these Senators.
I actually think Harry Reid is doing a remarkable job working with the holdouts. He has gotten a lot of criticism over the past few months, but given the Senate rules, he is doing a remarkable job working every last angle to get this bill moving (beginning of next term, you gotta get the rules changed, though, Senator). He is now really close to getting the 60 votes to get this bill to the floor for debate, and I think that will happen.
The biggest question, though, is what happens next. No one wants to go the reconciliation route because given those ugly Senate rules, it is just a convoluted mess to do things that way. It would take more time, create enormous logistical hassles and tie-ups, and almost certainly force the bill to be broken into two parts, one that would go through the reconciliation process and one that could not because its provisions aren't directly related to the budget. I can understand why Reid and the White House would rather not go down that path unless they absolutely must.
Unless all 60 Democrats stick with Harry Reid, though, that's what they will have to do. Getting this omelet done may require breaking a few Senatorial eggs. Having talked with some Senate staffers, I know they are preparing for every contingency, including reconciliation, and that's a very good thing, because I think that's what this will probably come down to in the end. I know it's a messy, irritating, uncomfortable way to get the deal done. But if any of those Senators decide they want to say no, and don't want to be players on the most important piece of legislation in at least 50 years, so be it. This legislation is too important not to pass.
The House Democratic leadership unveiled its health care bill this morning. Some details:
The bill -- a combination of versions passed by three House committees -- includes what is termed a "negotiated rate" public option. It will cost $894 billion over 10 years and extend insurance coverage to 36 million Americans, according to House Speaker Nancy Pelosi's office.
The bill guarantees that 96 percent of Americans have coverage, Pelosi's office said. The figure is based on an analysis by the nonpartisan Congressional Budget Office.
One of the main differences between the House bill and the Senate Finance committee bill is that a significant portion of funding comes from a surtax on wealthy households, rather than on high-cost health care plans (which mainly target unions)
The new bill, like an earlier version, retains a surtax on high-income people, but increases the thresholds. The tax would hit married couples with adjusted gross incomes exceeding $1 million a year and individuals over $500,000 - just three-tenths of 1 percent of all households, Democrats said.
"I will insist on a Medicare-plus-5 [percent] amendment on the floor so that the full caucus can vote on it. We are hopeful that the Rules Committee will allow this amendment, which has tremendous public support, to be voted on for the record."
They will also get a chance Thursday to press their case for a public option in the final bill to Obama in a White House meeting. Many liberals have been irritated by Obama's wavering on the necessity of a public option.
Asked if her caucus would be prepared to balk at supporting a public option with negotiated rates - a threat they made in writing at the beginning of July - Grijalva's fellow co-chairwoman, Rep. Lynn Woolsey (D-Calif.), said: "When we see what the bill says, we'll decide if we can support it."
Woolsey added that while Progressives don't intend to sign off on just anything that's handed to them, "this isn't walk-away time."
The problem with an amendment strategy is that the House leadership will likely not allow many, if any, amendments to be offered on the House floor. The reason is because of Bart Stupak, who is trying to defeat the entire bill by rounding up 40 House Democrats to demand that none of the insurance plans receiving subsidies in the exchange are allowed to cover abortions. If such an amendment passes--and the leadership believes that it would if offered on the floor--then the entire bill goes down to defeat, since it will lose the votes of dozens of pro-choice Democrats. As such, the leadership is going not going to allow any amendments, and make Stupak's only move to try and prevent the bill from going to the floor at all. It is unlikely he will succeed.
Floor amendments are approved by the House Rules committee. As such, the next step in the fight will be fought there. The committee is generally thought of as an extension of the leadership, so those fights may already be a foregone conclusion. Still, look for Representatives Stupak, Grijalva, and Weiner to try and get their amendments on restricted abortion funding, a vote on Medicare +5 rates, and single-payer to the floor.
Tomorrow at 10 a.m., the House Democratic leadership unveil their health care bill. It is highly likely that it will include a public option with negotiated rates, rather than the more robust public option tied to Medicare (+5%) rates. There are many other details of the plan to discuss, but for now I will wait until the bill is actually unveiled to discuss them.
The remaining barriers to passage of the health care bill in the House are two-fold:
Bart Stupak's Regressive Block. Representative Bart Stupak is still looking to round-up forty votes to prevent he bill from going to the floor unless abortions are not covered under all health care plans that receive subsidies in the new insurance exchanges.
The leadership is convinced that if Stupak is able to offer an amendment to that affect on the House floor, that it will pass. If the amendment passes, it will kill the entire bill, because dozens of pro-choice Democratic votes would be lost. As such, the leadership will not allow any amendments to the health care bill on the floor. This means that once the bill hits the floor, that is the bill that will go to conference committee.
The Tri-Caucus Progressive Block. For months, the Progressive Caucus, the Black Caucus and Hispanic Caucus (and, I think, the Asian-American Caucus) have been trying to round up House Democrats who would vote against a health care bill unless it included the Medicare +5% option. Now that the bill will not include the Medicare +5% public option, the tri-caucus is sounding noncommittal about the bill. They are also meeting with President Obama tomorrow:
Some liberals were prepared to accept the negotiated rate structure. Others were still withholding support, even while pointing to Reid's inclusion of a government insurance plan in the Senate bill as a victory in itself.
"We were laughed at in August. Who would have thought that the Senate bill would have a public option?" said Rep. Lynn Woolsey, D-Calif., a co-chair of the Congressional Progressive Caucus.
Woolsey was noncommittal about whether progressives would accept the negotiated rates. "This is not walkaway time and it is not acceptance time," Woolsey said.
Members of the progressive caucus, along with lawmakers from the black and Hispanic caucuses, were scheduled to meet with Obama at the White House on Thursday, she said.
The Tri-Caucus does not appear to have won this time, but they do seem to have improved at playing the influence game. Threaten to vote against a must-pass bill, withhold your support even after a deal is apparently reached, and viola! You end up with a meeting at the White House. Not bad for a caucus that was the last to meet with President Obama at the start of his term.
Given both the Progressive and Regressive blocs, the passage of any bill will be by a narrow margin. No matter the disproportionate attention the Senate has received, there has always been just as much drama in the House.
It is time to start seriously asking whether the House of Representatives can pass any health care bill whatsoever.
First, while the final meeting deciding the fate of the robust public option is taking place as I type this, the likely outcome is that a public option with negotiated rates will be included in the bill:
In the end, Pelosi, D-Calif., and other House leaders were unable to round up the necessary votes for their preferred version of the government insurance plan -- one that would base payment rates to providers on rates paid by Medicare. Instead, the health and human services secretary would be allowed to negotiate rates with providers and the program would be optional for states, the approach preferred by moderates and the one that will be featured in the Senate's version.
This is going to anger quite a few members of the Congressional Progressive Caucus. Some of them might not vote for passage now, because they consider the public option too weak.
This matters because there are around 18-25 Democrats who will vote against the bill from the right, pretty much no matter what at this point. With every Republican likely to vote against the bill, this means that opposition from 15-22 Progressives would sink the entire bill.
Even though all eyes are on the Senate, the House is far from decided. Right now, it simply is not guaranteed that there will be enough votes to pass any health care bill through the House of Representatives, due to opposition from both flanks of the Democratic Party.
The Democratic leadership in the House is in the final stages of putting together their health care reform bill. As I already mentioned, they are meeting at 2:45 p.m. eastern, to go over the whip counts, and determine what sort of public option to include in the bill.
We will know their decision for certain at 10 a.m., eastern, tomorrow morning. This is because, according to an email sent to Democrats on Capitol Hill today, "Speaker Pelosi, Leadership and Members of the House Democratic Caucus" are holding "an event tomorrow on health insurance reform" at 10 a.m. at the West Front of the US Capitol.
That event can only mean one thing: they are unveiling the bill which they will send to the floor. The odds are not great that they will include the Medicare +5% public option, but we are still giving it one last shot anyway.
