Now Comes the Hard Part
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July came late this year.
In all the euphoria over the news that the Senate Finance
Committee has approved its version of health care legislation,
some context was missing. With a 60-vote majority in the Senate
and a 79-vote advantage in the House of Representatives, it was
all but assured that some sort of health care bill would clear
the Democrat-dominated committees. It just wasn’t supposed to
take this long.
Back in June, the Washington Post
published an internal memo that was written by Senate
Democrats plotting out the Finance Committee’s timeline for
passing health care legislation. Originally, the vote to report
the bill out of the committee — which took place Tuesday — was
supposed to occur in mid-July, and by October 1st, President
Obama was supposed to sign a final bill.
Thus, while the Finance Committee’s vote will obviously provide
forward momentum for President Obama’s health care push, the
reality is that the easy part took much longer than expected, and
now Democrats are left to deal with all of the thorny issues that
they’ve deferred over the past several months.
With health care legislation now having cleared the relevant
committees, Senate Majority leader Harry Reid, along with Finance
Committee Chairman Max Baucus and Sen. Chris Dodd, will begin
merging the Finance Committee bill with the more liberal bill
approved by the Senate Health, Education, Labor and Pensions
(HELP) Committee. This is easier said than done.
The Finance and HELP committee bills have many similarities,
including a requirement that insurers offer coverage to those
with pre-existing conditions at an affordable rate; a mandate
that forces individuals to purchase insurance or pay a tax; a
significant expansion of Medicaid; subsidies for individuals to
purchase insurance; and new government-run insurance exchanges.
But there are also significant differences between the two bills.
The most crucial difference is that the HELP bill includes the
creation of a new government insurance plan, which is opposed by
at least 6 and by as many as 8 Democratic Senators, but seen as
an essential part of reform by liberals. While Sen. Jay
Rockefeller voted the bill out of the Finance Committee, in his
remarks, he pressed the case for integrating the government plan
into the final package, lamenting that in its current form the
bill represented “too sweet a deal” for the insurance industry.
Beyond the issue of the government plan, the HELP bill offers
more generous subsidies and expands Medicaid eligibility more
widely than the competing Finance Committee bill. In addition,
the HELP bill includes a mandate requiring employers to offer
insurance to all workers, whereas the Finance proposal has a
weaker measure to tax employers who don’t offer insurance to
workers who qualify for government subsidies.
Liberal activists have already made it clear that they don’t view
the Finance Committee bill as genuine reform.
“The end of the Senate Finance Committee’s process marks the
beginning of the next phase — crafting a strong bill that goes
to the Senate floor,”
declared Richard Kirsch, National Campaign Manager of Health
Care for America Now, a coalition of liberal groups. “The HELP
Committee bill offers a better path forward in the Senate than
the Finance Committee bill.” He added that “The Senate Finance
Committee bill falls short on making insurance affordable to
America’s families, gives employers a ‘free ride,’ and does not
create meaningful competition in the insurance market with a
strong national public health insurance option.”
Meanwhile, before the vote in the Finance Committee was even
final, 30 unions
revealed plans to take out ads in national newspapers on
Wednesday opposing the bill. Labor leaders are particularly
dismayed that one at the proposal to finance the bill by taxing
high-end health plans, which will affect many union workers.
“The Senate Finance Committee bill remains deeply flawed,” said
Gerald W. McEntee, president of the American Federation of State,
County and Municipal Employees, noting the tax on health plans,
lower subsidies, and the lack of a government plan or employer
mandate. He warned, “Senate leaders must make major improvements
in the bill before it moves to the floor of the U.S. Senate.”
The problem is that addressing such concerns by liberals would
mean a far costlier bill that is likely to add to the federal
deficit, and thus violate a key pledge of President Obama. Moving
the bill to the left will also undermine months of delicate
negotiations that enabled Baucus to attract support of moderate
Democrats as well as a lone Republican, Sen. Olympia Snowe.
In explaining her decision to vote for the bill in committee,
Snowe cautioned that it shouldn’t be used to predict whether she
would support the final merged bill. “My vote today is my vote
today,” she
said. “It doesn’t forecast what my vote will be tomorrow.”
Liberal writer Noam Scheiber
worried that “if you alienate her during the forthcoming
negotiations, her defection from the final bill would be
disastrous. Just imagine the atmospherics of Olympia Snowe
getting up on the Senate floor and saying she was so serious
about passing health care reform she voted for it in committee,
but that she can no longer support the bill because it’s moved
too far to the left. It would be absolutely devastating.”
In a potentially more worrisome development for Democrats, Sen.
Joe Lieberman revealed
on Tuesday that he couldn’t even support the Finance Committee
legislation as it was, because he was “afraid that in the end,
the Baucus bill is actually going to raise the price of insurance
for most of the people in the country.”
And none of this even takes into account the fact that even if
Reid can come up with a formula to attract the support of 60
Senators needed to block any filibuster, any bill still has to
secure passage in the House.
By creating a bill that passed muster with the Congressional
Budget Office and attracted the support of a Republican, the
Finance Committee emboldens Blue Dog Democrats in the House to
oppose a more costly bill that includes a government plan.
Meanwhile, House liberals still maintain that they will not
support a bill that does not include a government plan modeled
after Medicare.
“While I applaud the Finance Committee for completing its work on
the bill, I remain concerned that it does not include a robust
public option,” Rep. Raúl M. Grijalva, co-chairman of the
80-member House Progessive Caucus, said in a statement via email.
“I remain committed to getting the best bill in the House that we
can get so that we have a strong negotiating position in
conference. Today’s Senate action does not reflect the country’s
high approval ratings for a public option, and I believe that any
meaningful health care reform must include that vital element to
increase access and bring down costs.”
While on Tuesday the media was eager to declare the Finance
Committee vote a momentum shift in the health care debate, the
sense of victory may prove short-lived.
