Is it time to break up?
I should say, at the outset, that I’m not a fan of this idea. But there’s no denying that breaking the health-care bill into different pieces is receiving serious consideration. Nothing is decided, but according to House aides, there would be at least four bills: one containing tax credits to help people up to 400 percent of poverty purchase insurance and insurance regulations; a second focusing on changes to Medicare, everything from pilot programs to the closing of the doughnut hole; a third including the Medicaid expansion; and a fourth with miscellanea like the health-care workforce and wellness and prevention programs and IT. Funding would be scattered across the bills in order to satisfy pay-go requirements.
Brian Beutler at TPM:
Nearly four dozen of the nation’s leading health care luminaries–including Jacob Hacker, the man who brought the public option to light–are urging the House of Representatives to pass the Senate health care bill, and quickly pass a separate bill to modify it: an approach favored by some members of Democratic leadership, major unions, and reform advocates.
In a stark message to Speaker Nancy Pelosi, and her health care lieutenants–Reps. Charlie Rangel (D-NY), Henry Waxman (D-CA), and George Miller (D-CA)–the experts say it’s time for the House to act.
“Both houses of Congress have adopted legislation that would provide health coverage to tens of millions of Americans, begin to control health care costs that seriously threaten our economy, and improve the quality of health care for every American,” reads a letter, obtained by TPMDC. “These bills are imperfect. Yet they represent a huge step forward in creating a more humane, effective, and sustainable health care system for every American. We have come further than we have ever come before. Only two steps remain. The House must adopt the Senate bill, and the President must sign it.”
Harold Pollack at TNR:
Yesterday, Tim and I crafted a simple letter (shown below), which we emailed other health policy experts we know. Some are progressives who identify with a single-payer approach. Others are more politically moderate economists, sociologists, and political scientists. Still others identify with organized labor, medicine, or public health.
Within several hours, many outstanding scholars, activists, and practitioners signed on. Signers include Henry Aaron, David Cutler, Jon Gruber, Theda Skocpol, Paul Starr, and many others, including Anna Burger, Secretary-Treasurer of SEIU.
Some people we contacted could not sign on, but reported that they are seeking the same goal through more private means. Virtually no one we contacted disagreed with this letter on either political or policy grounds. Our letter represents a broad consensus of those supporting health care reform.
We are so close to enacting a historic reform. Now is the time for calm and resolute Congressional action. The Massachusetts election was a setback. Democrats still have large majorities in both the Senate and the House. We’ve heard worse. It’s time to act.
In a candid assessment of the politics of health care, DCCC chief Chris Van Hollen said in an interview that the Senate bill’s brand may be irrevocably tarnished, particularly among independents — and confirmed that partly for this reason, Dem leaders may pass a new set of reforms via reconciliation, which could be repackaged free of the Senate bill’s taint.
Van Hollen also added that it would be a mistake for Dems to pretend the unpopularity of the Senate reform proposals wasn’t a factor in the Massachusetts loss.
Van Hollen’s comments provide perhaps the clearest glimpse yet into the thinking of Dem leaders and the options they’re considering, and illustrate why they may be reluctant for the House to pass the Senate bill, as some want.
“Because of provisions like the Nebraska deal, the Senate bill has been branded in a way that understandably makes it unacceptable in its current form to many voters, especially independents,” Van Hollen told me, adding that Senator Ben Nelson has acknowledged this provision is problematic and must be changed.
He said this was a lesson of Tuesday’s loss: “The Massachusetts election turned on lots of factors. One factor was health care reform,” he said, referring to the Senate bill.
Van Hollen stressed that all options remain on the table, including the House passing the Senate bill with significant legislative changes. But he said the Senate bill’s image problems had led Dem leaders to give serious consideration to assembling a new package and passing it through reconciliation.
Politico reports that Harry Reid and Nancy Pelosi are working on a strategy that just might save health care: get the House to pass the Senate bill, while the Senate uses reconciliation — a process that avoids the need for a 60-vote supermajority — to address some of the concerns of House Democrats.
That’s very good news.
Of course, if they do this, there will be howls of protest — they’re defying the will of the 41-59 Republican majority in the Senate! This violates
the spirit of the Constitutionthe very strange rules the Senate has imposed on itself. But I hope Democrats have learned by now that the public doesn’t know or care about such things.
As recently as last week, in the midst of lengthy discussions at the White House, a wide variety of changes were agreed upon by House and Senate negotiators. The idea, of course, was to craft a final bill to be approved by both chambers. Voters in Massachusetts have since made this approach impossible.
But if Reid and Pelosi can package those already-discussed improvements, and agree to approve them through reconciliation after the House passes the Senate bill, then there’s still hope that a fiasco for the ages can be avoided.
The changes being considered track closely with the agreements House and Senate leaders made in White House meetings last week, according to a source. They include the deal with labor unions to ease the tax on high-end insurance plans, additional Medicare cuts and taxes, the elimination of a special Medicaid funding deal for Nebraska and a move to help cover the gap in seniors’ prescription drug coverage. Pelosi is also working to change the Senate provision that sets up state insurance exchanges. The House prefers a single, national exchange.
Discussions, a Pelosi spokesperson said, “are ongoing … but no final decisions have been made.”
Once more with feeling: Pass. The. Damn. Bill.
