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Kicking Off A Busy Week

The week opened with bloggers critiquing the Democrats’ strategy to pass a health overhaul bill sometime this week.

Time’s Jay Newton-Small has a day-by-day time line to help track events.

The New Republic’s Jonathan Cohn wonders, “What’s been taking so long?”  According to Cohn, “The broad outlines of the eventual House-Senate compromise on health care reform have been clear for a while now. But nailing down the details isn’t easy, as the excerpt above suggests. And it’s particularly difficult because lawmakers don’t yet know what the Senate parliamentarian will rule outside the bounds of reconciliation. Throw in the need to get acceptable Congressional Budget Office estimates, and you can see why this process has taken as long as it has.”

The American Spectator’s Philip Klein writes, “Shortly before midnight on Sunday, Democrats released a 2,309 page health care bill that will start the process of reconciliation — but don’t let that fool you, it’s not the actual reconciliation bill with all the changes you’ve been reading about. Instead, as Rep. Paul Ryan, the ranking Republican member on the Budget Committee, explained to me last week, this is just the ’shell’ bill — the vehicle that Democrats need to get moving on health care.”

Although the action today was in the House Budget Committee, the National Journal Online’s Robert Costa says the House Rules Committee “is where the real reconciliation package will be hammered out, probably later this week.” Costa interviews the top Republican on the Rules Committee, Rep. David Dreier of California, who said, ” ‘Our committee’s meeting won’t be the fait accompli…The real fait accompli will be when the bill is scheduled for a vote on the floor. I’m convinced that [Democrats] will pretty much get it done if they can get it there. Having been in that position before, I’m sure they will roll the dice if they’re three or four votes short.’”

TPMDC’s Brian Beutler reports from a meeting with Speaker Nancy Pelosi, who said, “‘Time is important for us here, because this city is the city of the perishable and every special interest group out there who doesn’t want this to pass–including the entire Republican party–benefits from any delay,’ Pelosi told those in attendance. ‘Delay is our enemy.’”

The Washington Post’s Ezra Klein explains, “Pelosi doesn’t have votes for the Senate bill without the reconciliation package. But the Senate parliamentarian said that the Senate bill must be signed into law before the reconciliation package can be signed into law. That removed Pelosi’s favored option of passing the reconciliation fixes before passing the Senate bill. So now the House will vote on reconciliation explicitly and the Senate bill implicitly, which is politically easier, even though the effect is not any different than if Congress were to pass the Senate bill first and pass the reconciliation fixes after. This is all about plausible deniability for House members who don’t want to vote for the Senate bill, although I doubt many voters will find the denials plausible.”

And Hot Air’s Ed Morrissey reacts to news that the White House may change its stance on special deals for individual states in the reform bills, saying, “In case you want to play The Price is Right with Bob Baracker, here are the new rules.  Single state deals are verboten, so no Cornhusker Kickback for you.  If two states get together to demand special deals, well, come on down!”

Monday, March 15th, 2010

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Talking Strategy

Bloggers are trying to keep up with rapidly shifting strategy options under consideration to pass a final health overhaul bill.

The Weekly Standard’s Matthew Continetti thinks Democrats are “making one of the biggest political gambles in American history. They’re betting that overhauling one-sixth of the American economy against the public’s wishes and by a partisan vote is going to pay off in the end. They have doubled down, and are hoping the house busts.”

The New Republic’s Jonathan Cohn details a Democratic memo that lays out a timeline for passing reform: “The gist is pretty simple: The House takes up the Senate bill and passed it by March 19. A few days later it passes a reconciliation bill and sends it over to the Senate, which starts the voting process on March 26.”   Cohn warns that schedules “remain in flux” and the GOP has  the option to offer endless amendments during a reconciliation process, even though the debate time is limited.

But The Huffington Post’s Sam Stein reports that there might be a way around endless votes: “Two experts in the arcane rules of the Senate said on Monday that, as president of the Senate, Biden has the capacity not just to overrule any ruling that the parliamentarian may make but also to cut off efforts by Republicans to offer unlimited amendments.”

Keith Hennessey lists seven challenges Democratic leaders would face by following a “two bill strategy,” including the sequence of votes (House or Senate first?) and a “voterama” where senators will have to vote up or down on proposed amendments.

Heritage’s Conn Carrol thinks a House passage is still up in the air, saying Speaker Pelsoi doesn’t currently have enough votes for reform, and “if you were watching the television yesterday it quickly became apparent that the leadership in the House has no idea how they are going to get them.”

Critical Condition’s Jim Capretta argues that Democrats can pass a smaller bill, despite talking points that stress the opposite.  Capretta continues, “Still, the very existence of the Obama team’s fallback plan should embolden those Democrats who are now resisting their leadership’s pressure to take up the full Obamacare package in coming weeks and pass it.

And The Washington Post’s Ezra Klein takes a thorough look at claims from Rep. Paul Ryan, R-Wisc., that the health care porposals won’t control rising health costs or reduce the deficit.  Klein says, “before we dive so deep into the weeds that we’re seeing earthworms, here’s the basic conclusion: Ryan’s critique scores some clean points and also deploys a couple of dirty tricks, but it doesn’t damage the bill’s claim to reduce deficits and doesn’t even engage whether the bill controls costs.”

Tuesday, March 2nd, 2010

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Health Summit Still Reverberating

Bloggers continue to analyze the health care summit, while others look at what’s next.

The Heritage Foundation compiled a “four-minute guide” video to last week’s summit.

The Daily Caller’s Jon Ward reports that “President Obama has taken a new line of attack against Republicans to neutralize their argument that his reforms would pose a government takeover of the health-care sector, arguing subtly that the GOP is committed more to the insurance industry than they are limited government.”

Hot Air’s Allah Pundit links to videos of Obama’s weekly address and the Republican response from Sen. Tom Coburn, R-Okla. They both spoke about the health care bills.

Health Beat’s Maggie Mahar looks at comments from a North Carolina college student about why she opposes the health reform bills and says, “These are the ‘philosophical differences’ that Obama acknowledged at the summit. I think it is important to recognize that not only Republican politicians but a fair number of our fellow citizens share this point of view.”

Time’s Karen Tumulty surveys a New York Times article looking at the vote count in the House and declares, “I think a major health care bill is more likely than not to pass. After what [Speaker Nancy Pelosi] managed to get her caucus to do last year, I would never, ever bet against the Speaker on a vote. And she is looking pretty determined on this one.”

The Washington Post’s Ezra Klein takes a look at budget reconciliation, including use in the past on health issues: “The Children’s Health Insurance Program was created in reconciliation, and so too was COBRA. The law stating that hospitals who take Medicare and Medicaid money have to see all patients who walk into their emergency room was also passed in reconciliation…”

Wonk Room’s Igor Volsky looks at  a proposal by Sen. John McCain, R-Ariz., to exclude Medicare from the budget reconciliation process and concludes, “But on the whole, this is really a cynical move (and highly unlikely, since any rule change would require 67 votes). Republicans have consistantly supported far larger cuts to the Medicare program than what Democrats are currently proposing and are always complaining that the Medicare “entitlement” program will bankrupt the nation.”

 And The Incidental Economist’s Austin Frakt posts an analysis and graph visualing over-payments to Medicare Advantage plans.

Monday, March 1st, 2010

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The Future of Reform

Bloggers are trying to figure out what’s next for health overhaul legislation, with little success.

Time’s Kate Pickert thinks there could be “momentum building” to resuscitate the Democrats’ efforts. She looks at President Barack Obama’s comments from a speech in Tampa, Fla. yesterday and says, “Tipping point? No. But is there definite life there? Yes.”

The Washington Post’s Ezra Klein says “Rahm Emanuel makes me very pessimistic about health-care reform.” He looks a New York Times article suggesting the administration may wait to do more on a health overhaul bill until after addressing jobs and financial reform. He continues: “Is Emanuel really suggesting that he expects Congress to return to health-care reform in the summer before the election? Forgetting whether there’s political will at that point, there’s no personnel: Everyone is home campaigning.”

Hot Air’s Ed Morrissey has a skeptical take on an interview with Sen. Jon Kyl, R-Ariz., who said that Senate Democrats are ready to make a deal using reconciliation: “What’s odd about this is that both Landrieu and Mark Pryor made it sound this morning like the bill was in coma and on the verge of death. Any reason to believe them instead of Kyl? Well, Kyl’s claim could simply be a feint aimed at goosing conservatives into launching a hopefully final salvo against the bill and finishing it off.”

The New Republic’s Jeff Davis gives a detailed explanation of exactly how the Senate would use a budget reconcilation process to keep amending the bill.

Wonk Room’s Igor Volsky notes that Sen. Jay Rockefeller, D-W.Va., may be looking ahead and wants to propose using the jobs bill to keep the increased federal contribution to the states for Medicaid from the stimulus bill.  However, Volksy says, “it’s not clear that Rockefeller’s proposal will garner significant Congressional support.”

However, Heritage’s Margeurite Higgins isn’t sure the bill is dead, saying Obama’s health care “agenda is stalled, but still alive. But there is a huge change.”  Higgins says public support for the Congressional health care bills contiunes to dwindle, looking at a new Kaiser Family Foundation tracking poll from earlier this month.

Friday, January 29th, 2010

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Mass Revolt?

Health reform is in serious jeopardy. Its advocates appear shell-shocked. Opponents are far from sleeping easy. And bloggers are bickering about the meaning of Republican Scott Brown’s victory in Tuesday’s special election to fill the late Ted Kennedy’s Senate seat. And there’s no agreement on what comes next, either.

Bob Laszewski, who doesn’t support the health bills in Congress, proclaims, “Stick a fork in it! The Democratic effort to pass a health bill is dead.”  He blames public opinion, and continues, “For goodness sakes—they rejected it in Massachusetts! On the political shocker scale this rivals “Dewey Defeats Truman” and the ‘94 elections.”

The Washington Post’s Ezra Klein suggests there is a way forward through a reconciliation bill, though he says it would be much more “limited” than the current proposed bills: “If you go that route, you admit the whole thing seemed too opaque and complex and compromised. … So you make it real simple: Medicare buy-in between 50 and 65. Medicaid expands up to 200 percent of poverty with the federal government funding the whole of the expansion. Revenue comes from a surtax on the wealthy. And that’s it.”

Heritage’s Brian Darling says the election “sent a thunderbolt from Boston to Washington that may push ObamaCare into the critical list.” According to Darling, because the seat has been held by Democrats for more than 50 years, the election is “evidence” that “the American people are angry and dissatisfied with Washington’s direction on health care reform.”

The New Republic’s Jonathan Cohn tries to inject some sense into panicked Democrats, arguing that a vote can take place quickly and the House, by agreeing to vote on the Senate-passed version of health care “could put health care reform on the president’s desk for signing. One lousy vote. One lousy, stinking roll call vote. That’s the only hurdle in the way of health care reform.  Are Democrats really willing to give up now?”

Hot Air’s Ed Morrissey looks at tepid support from Democratic caucus members for continuing to push their reform bill but cautions, “For the moment, it seems as though ObamaCare has been stopped.  But that doesn’t mean that it’s dead.”

Critical Condition’s Benjamin Zycher is cautious as well, and says Democrats may try to pass a smaller version of reform that focuses on “insurance reform.”  Zycher argues that Republicans should still oppose this kind of legislation because, “this path would lead inexorably to the nirvana of health-care socialism that the Left has been dreaming about for decades.”

And labor groups have announced one tactic they’ll support, TPM’s Brian Beutler reports: “The most influential labor organizations in the country have arrived at a common solution to the Democrats’ health care conundrum: Move forward, pass the Senate bill through the House, but only if a separate, filibuster proof bill codifying a crucial changes is passed post haste.”

Wednesday, January 20th, 2010

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Deals Taking Shape

The deals keep coming following a marathon meeting Wednesday.  Reports have also emerged of an apparent deal is taking shape, and it looks like collectively-bargained benefits will be exempt for a period of time from the new excise tax on high-value insurance plans.

The Washington Post’s Ezra Klein looks at the makeup of yesterday’s informal conference meeting between the White House and congressional leaders.

NPR’s Julie Rovner says the deal “marks the beginning of the endgame” in House and Senate negotiations. She cautions that there’s still several steps to go: “So whether or not President Obama gets to sign a bill by end of this month or the first week of February, however, is still anyone’s guess.”

Hot Air’s Ed Morrissey thinks an exemption for union-negotiated health plans runs afoul of the Constitution: “A sliding scale?  That would mean that the tax would not be applied universally to all citizens, which could run afoul of Article I, Section 8 of the US Constitution.  Specifically, that states that Congress has the power to levy taxes, ‘but all Duties, Imposts and Excises shall be uniform throughout the United States[.]‘”

Heritage’s Conn Carroll isn’t happy with what was reportedly negotiated: “Now Big Labor will get all of the big government health care spending they always wanted, but they will not have to pay for it. And Obamacare’s Big Labor handouts don’t end there. The legislation also sets aside $5 billion to subsidize the costs of employer health benefits for early retirees.”

Jay Cost of Real Clear Politics analyzes a count of undecided House Dems and says, “Still, I think it is far [too] hasty to say that this reform is inevitable. Minimally, the margin in the House is going to be razor-thin either way. We know that for sure, which in turn suggests that we shouldn’t take final passage for granted.”

Wonk Room’s Igor Volsky looks at statements from legislators pledging to overturn parts of the health overhaul bills so as not to implement them, and says, “For reform to work, lawmakers who have pledged to “roll back provisions” of reform should not be responsible for implementing it. House and Senate negotiators must adopt the House bill’s more centralized approach or develop a compromise that establishes a national exchange but allows states a certain level of flexibility.”

And the American Spectator’s Philip Klein, who says he is “absolutely in favor of any efforts to repeal” cautions that such efforts are unlikely to be successful: “At the same time, however, I think that if the health care bill gets signed into law, it’s highly unlikely Republicans will be able to repeal it, or even major portions of it. Most Democrats won’t be eager to overturn the greatest domestic achievement of their party since 1965 — and you’d need to pass the repeal through the House, through the Senate with 60 votes, and then have the President sign it. … … So, while I think it’s certainly worth aiming for, opponents of Obamacare must also be thinking about ways to reform the system if the repeal effort isn’t successful.”

Thursday, January 14th, 2010

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Election Year Meets Health Care Debate

Pundits and bloggers are closely watching how the health overhaul debate could affect local races across the nation.

The brand new political Web site founded by Tucker Carlson, The Daily Caller, is covering health care politics, reporting today that “President Obama’s chief of staff, Rahm Emanuel, said Monday [on MSNBC's Daily Rundown] that the White House has inadequately communicated with Americans about health-care reform.”

DC’s Jon Ward writes: “Pressed on why poll numbers show such low support for the administration’s reforms, Emanuel said that “part of it is the message not getting through, part of it is people not watching the legislative process very good.”

The Washington Independent’s David Weigel writes that Rep. Larry Kissell, D-N.C., is faring well so far in a reelection campaign in his swing district, in part because of his ”no” vote: “Kissell’s advantage, according to Public Policy Polling, is his vote against the health care bill.”

And Huffington Post’s Glen Johnson and Liz Sidoti report: “The race to succeed the late Sen. Edward M. Kennedy has turned into a proxy battle over the fate of President Barack Obama’s health care overhaul.” 

Elsewhere, others continue to look at the shape of a final bill.

The Washington Post’s Ezra Klein says his sources are tracking with E.J. Dionne’s column Monday, where Dionne reported that the final health bill are likely to dump the public option entirely, but opt for a national health insurance exchange.  Klein adds, “The precise mix of insurance regulations might shift as well, as the House has a stronger set than the Senate does. But broadly speaking, people aren’t expecting much in the way of surprises.”

Heritage’s Rob Bluey reports on comments from AFL-CIO President Richard Trumka opposing the ‘Cadillac tax’ and notes there are other issues that could strain relationships with labor leaders:

The tax issue is just one factor that could sour Big Labor’s relationship with the White House. Trumka clearly favors the more liberal House bill, which includes a public plan and employer mandate. But for House and Senate leaders to strike a deal, lawmakers would almost certainly need to make concessions that agitate leaders like Trumka. Other major issues up for negotiation include penalties of an individual mandate, expansion of the Medicaid entitlement and taxpayer funding for abortion.

Merrill Goozner doesn’t like the ‘Cadillac tax’ either.  He looks at the number of Americans likely to be affected by the tax and concludes, “If the Democrats adopt this plan, a political disaster of epic proportions awaits them.”

And on a different note, Insure Blog’s Hank Stern wonders if the Amish will receive a religious exemption to the individual mandate, noting that they purchase vehicle insurance.

Tuesday, January 12th, 2010

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Wonk It Out

Congress hasn’t returned to the Capitol yet, but bloggers have been busy detecting the fault lines in the House and Senate health overhaul bills.

Hot Air’s Ed Morrissey looks at a news report that House Democrats gave a chilly reception to the the idea of including the Senate’s ‘Cadillac tax’ in the  final  health overhaul bill, and predicts trouble if different source of funding  comes into play: “It’s another opportunity to kill the bill, and given the political damage the last round did to red-state Democrats in the upper chamber, Harry Reid may not be able to bargain his way around those cloture votes again.  The unions may wind up killing the bill, thanks to their self-serving opposition to paying taxes for a program for which they have been lobbying for months.”

Over at the New Republic’s The Treatment, Peter Harbage argues for more funding in the Senate bill: he says states need a $1 billion fund to keep an eye on potential price gouging.  The provision currently exists only in the House version.

The New York Times’ Catherine Rampell looks at new employment numbers released today, noting, “Even as overall payrolls continue to plummet, the health care industry keeps truckin’ along.”

Politico’s Ben Smith interviews MIT economist Jonathan Gruber over controversy that Gruber had a contract with HHS during the time he made public comments supporting health overhaul plans.

And since it’s Friday, how about some multimedia on your favorite health wonks?

The talk of the beltway health policy world this week was revelations surrounding Office of Management and Budget Director Peter Orszag’s personal life. CNN’s Jeanne Moos investigates whether women of the world think nerdy is sexy:

Cato’s Michael Cannon has a podcast that focuses on if there are price controls under proposed health reform legislation.

And The Washington Post’s Ezra Klein and White House Communications officer Linda Douglass appeared on The Colbert Report to talk health care:

The Colbert Report Mon – Thurs 11:30pm / 10:30c
Drag Me to Health – Ezra Klein & Linda Douglass
www.colbertnation.com
Colbert Report Full Episodes Political Humor Economy

Friday, January 8th, 2010

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What To Expect In The First Six Months Of Health Reform

This post is in collaboration with NPR.

As the Senate inches closer to passing its health overhaul bill, some are pointing out that many changes, including a requirement that most Americans get insurance, won’t kick in until 2014.

If health overhaul legislation passes, expect some things to shrink, and some things to expand.  But a handful of new rules and benefits kick in much earlier — six months after enactment. Here’s what you can expect sooner rather than later:

A Shrinking Medicare “Doughnut Hole”
Starting in 2010, the coverage gap for prescription drugs in seniors’ drug plans would shrink by $500 a year. Starting in July, brand-name drugs would be discounted by 50 perceny for many seniors in the coverage gap.

New Rules On Insurance Coverage
Within six months of enactment, insurers would be required to:

  • Cover preventive care and wellness benefits — which insurers wouldn’t be permitted to count toward enrollees’ deductibles. 
  • Cover children with preexisting conditions, including asthma and cancer.
  • Let young adults stay on their parents’ plans until age 26 — which is longer than the current rules in most states.

There’s one big caveat: All of the above changes only apply to new health insurance plans.

What exactly is a “new plan?” Any health insurance plan that you or your employer buys after the six months following enactment. Renewal of existing plans doesn’t count, but all plans would be subject to the new rules starting in 2014.

A New National High-Risk Pool
Currently offered in many states, these plans are meant to provide coverage for people who are uninsurable for medical reasons. Under the Senate bill, some uninsured Americans, as well as legal immigrants with preexisting conditions, would be able to buy coverage through the pools.

Limits On Limits
There’s some changes to the kinds of limits insurers can apply to your policy. “Lifetime maximum benefits” — or how much they pay out for your care as long as you’re a member — are nixed, effective six months after enactment.

At the same time, the secretary of Health and Human Services will determine acceptable annual limits on insurers’ coverage.

In addition, insurers wouldn’t be permitted to cancel, or rescind policies, unless there’s evidence of fraud or willful distortion of your medical history, effective six months after the law is enacted. But again, these requirements apply only to new plans for the first few years.

Tax Credits For Small Businesses
Some small business would be eligible for tax credits for 35 percent of their health-insurance premiums, starting in 2010. Amanda Austin, director of federal public policy at the National Federation of Independent Business, estimates the credits will apply to slightly more than 12 percent of businesses. While saying NFIB “is thankful the coverage was improved,” Austin points to a Congressional Budget Office report that found the credits won’t help reduce the overall cost of premiums for small businesses.

Information For Consumers
Finally, the Senate bill provides help to states to set up new offices for appeals and complaints against health insurers. And it calls for the creation of a new Web site that will help “facilitate informed consumer choice of insurance options.”

The most expensive — and most controversial — parts of the new law don’t start for a few years. So patients with preexisting conditions will have to wait; low-income Americans don’t get expanded Medicaid coverage just yet, and other big changes — like the doling out of billions of dollars in subsidies to people who need help buying insurance — are still to come.

Tuesday, December 22nd, 2009

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Reactions To Hectic Senate Weekend

The Senate voted early this morning to file cloture, or move forward, in the final steps toward passing its health overhaul bill.  The vote was not certain when the weekend began, and only after Sen. Ben Nelson, D-Neb., announced his support did the action proceed. Reid is now saying a final vote will take place by Christmas.

Bloggers were recovering from a busy weekend, trying to make sense of the big picture as the legislation moves forward.

Wonk Room’s Igor Volsky notes, “The Senators voted from their desks — a customary practice reserved for the most significant votes. Once the presiding president read the final tally, Democrats rushed over to congratulate Majority Leader Harry Reid (D-NV).”  He posts video of the vote, below:

The Washington Post’s Ezra Klein compares the Senate’s version with President Obama’s campaign health plan.  Klein notes that the public plan was dropped and Obama didn’t initially include an individual mandate,

But whether you love the Senate bill or loathe it, whether you’re impressed by Obama’s effort or disappointed, it is very hard to argue that the bill Congress looks likely to pass is fundamentally different from the approach Obama initially advocated. “The Obama-Biden plan both builds on and improves our current insurance system,” the campaign promised, and on that, for better or for worse, they’ve delivered.

Despite Klein’s conclusion that the plan isn’t very different from Obama’s campaign promise, Heritage’s Conn Carroll says the Senate bill’s passage “is only the beginning of a much larger health care fight.”  He continues, “This bill will only make every single problem with out health care system worse: higher spending, higher deficits, and worse care. Former-Democratic National Committee Chair Howard Dean said on Meet the Press yesterday, ‘[This bill] simply sets us on a track in this country which is expensive and where we’re going to have lots more political fights.’ Dean is dead on. President Barack Obama’s signature on this health care bill settles nothing.”

Jacob Goldstein of the Wall Street Journal’s Health Blog looks at Congressional Budget Office estimates released this weekend that found certain provisions are estimated to make little difference: “During all the last-minute action this weekend, CBO put out its estimates on the latest version of the Senate bill. As it turns out, replacing the public option with private plans overseen by a government agency — a sort of “public option lite” that was a key part of the compromise — makes almost no difference to how the bill would work in the real world, according to CBO.”

Grace-Marie Turner lists 12  “constituencies that will be gored, to which senators will have to answer next time they go before the voters.”  She includes “everyone.”

Huffington Post’s Drew Westen is disappointed with Obama’s leadership, saying his actions “soured” young people to politics:

Somehow the president has managed to turn a base of new and progressive voters he himself energized like no one else could in 2008 into the likely stay-at-home voters of 2010, souring an entire generation of young people to the political process. It isn’t hard for them to see that the winners seem to be the same no matter who the voters select (Wall Street, big oil, big Pharma, the insurance industry). In fact, the president’s leadership style, combined with the Democratic Congress’s penchant for making its sausage in public and producing new and usually more tasteless recipes every day, has had a very high toll far from the left: smack in the center of the political spectrum.

The American Spectator’s Philip Klein notes that some health insurance stocks are rising this morning.

James Capretta takes a closer look at the final version and says it’s “still a budget buster.”

And from the other perspective, Health Beat Blog’s Maggie Mahar has a series of posts looking at the details, including potential affordability challenges for older Americans, Ben Nelson’s abortion compromise and the “glass half empty/glass half full” viewpoints.

Mark Trahant reports that the Indian Health Care Improvement Act is in both the Senate and House versions.

And in the wake of the coming vote, Bob Laszewski wonders, “Is there anyone left, on either side of the political spectrum, who wants the Senate health care bill to pass?”

Monday, December 21st, 2009

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