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.
Another day brings another lecture on negotiating strategy from Big Tent Democrat. Once again, we are told that the right-wing of the party has received more concessions in health reform negotiations because right-wing Democrats were more willing to defeat the whole bill than were progressive Democrats:
The question was how to bargain with the people who wanted a bill passed (the White House) to maximize your bargaining position. Unfortunately, that required being willing to do something progressives simply were not willing to do - create the real possibility that no bill would be passed because of their opposition. Without that commitment, the progressives were sure to be the first rolled. And they were.
Well, duh. As though this is some kind of deep insight that has escaped the feeble mental powers of the "village bloggers" that Big Tent Democrat so loathes and stands so superior over.
Since we are in the business of stating the obvious, let me state something else that is obvious: it order to be the party more willing defeat the bill if your demands are not met, then your base of support needs to be more willing to defeat the bill if your demands are not met. No matter how easy it is to be cynical, political power still flows from appropriate leveraging of popular support rather than some Nietzschean struggle over the will to power.
A necessary condition for the success of the Progressive Block strategy is for voters in the districts of Progressive Block members to demand the defeat of legislation more than voters in districts of Regressive Block members. With, at most, 17-18% of the country (that is the highest number ever recorded in any poll on the subject) demanding health reform legislation be defeated (not just improved, but actually defeated) from the left, lefties demanding the defeat of health reform legislation fail to form a majority of even the Democratic primary electorate in any House district in the entire country. That such voters form a minority of the primary electorate in every single district in the country provides a willing Democratic leadership with enormous leverage over Democrats who seek, or threaten, to defeat the bill from the left. And yes, we are dealing with a White House that is willing to crush Congressional Progressives who cross them.
Now, since the majority of Democratic primary voters in every district in the country want to pass health reform legislation, there is an opportunity to put real pressure on right-wing Democrats who are extorting demands out of the health reform legislation. However, the White House has taken a complete pass when it comes to pressuring right-wing Democrats in such a fashion. Further, not a single left-wing group has declared it will run primary challenges against right-wing Democrats who vote against health reform legislation overall. (Primaries for opposing the public option, yes. Primaries for opposing health reform overall, no). This means there is effectively no pressure on right-wing Democrats to pass the bill, and only pressure on right-wing Democrats has come from corporate groups, large donors, right-wing media, tea partiers, and red district voters to defeat it.
To repeat: no matter how easy it is to be cynical, political power still flows from appropriate leveraging of popular support rather than some Nietzschean struggle over the will to power. Popular support for killing the bill if it lacked a public option never rose to the level necessary to overcome a Democratic leadership willing to leverage the Democratic electorate against the Progressive members demanding a public option. At the same time, popular support among Democrats for passing the health reform bill without right-wing demands was never leveraged against the Democrats making those right-wing demands. Those two dynamics were at the very heart of the Progressive Block negotiation, and why it ultimately failed.
(Note: The level of opposition to health reform because it does not go far enough is actually very impressive. This is the case even if, at most, it only rose to 17-18% of the population. Just over one-sixth national support for a position like that is quite an achievement for the lefty organizations and media outlets who were advocating that position, given both the resources of the opposition groups they faced and the historically low percentage of Americans who say Democrats are not left-wing enough. I personally was no longer engaged those efforts as of late September, focusing instead on other, different, strategies which also didn't work very well.)
Last night I produced a list of changes in health reform legislation that progressives have, so far, been able to make to the most right-wing health reform policies that passed through either a Congressional committee or a full branch of Congress. It is a pretty decent list, but the overall analysis still makes it clear that the more conservative Democratic proposals largely won the day.
Why do conservative Democrats hold more sway over the party's policy than progressives? That is certainly a question that not only needs a lot of justification (try this post by Matthew Yglesias for starters), but which also has a wide range of possible, and largely unprovable, answers.
Still, I think it is fairly safe to venture that one reason for the relatively greater success of conservative Democrats in shaping Democratic legislative policy is that, generally speaking, a Democratic President has a lot more potential leverage over progressive members of Congress from blue states / districts than over conservative Democrats from red states / districts.
Consider the case of the Progressive Block, a strategy I wrote a lot about over the summer. The goal of this strategy was to get the White House and the Congressional leadership to pressure right-wing Democrats into supporting a couple of key progressive demands. The plan was to threaten to join with Republicans and block "must-pass" legislation, such as health reform, unless one or two specific progressive demands, such as the public option, were met.
However, there was a serious flaw in this strategy: it was never the path of least resistance for the White House to apply more pressure to right-wing Democrats than left-wing Democrats. Consider the choices facing the White House when threatened by both Progressives and Blue Dogs to comply with their various demands on health reform:
First, the White House could pressure Progressives to support health reform even if it lacks key progressive demands. These members of Congress generally come from districts where both President Obama and health reform are popular.
Second, the White House could pressure right-wing Democrats, who generally come from districts where neither President Obama nor health reform are popular, to support health reform even it lacks key conservative demands.
If you are just looking to pass a health reform bill at all costs, as it seems like the White House has been trying to do all along, by far the easier move here is to apply more pressure against Representatives from districts where both the White House and health reform are popular. And by "pressure," I mean things like OFA, primary challenges, popular opinion, and more. Compared to Blue Dogs, it is easier for a Democratic White House to a Progressive member's constituents against him or her.
The only way to have reversed this situation would have been if health reform was more popular within Blue Dog districts / donor groups than among Progressive districts / donors groups. While some left-wing opposition to the bill materialized, those seeking to defeat the bill from the left never rose above 12-13% of the population (this is a smaller group than the roughly 35% of Americans who think the bill does not go far enough--most of whom don't actually want to see the bill defeated). Thus, it is likely that those seeking to kill the bill from the left were a minority of Democratic primary voters in every Congressional district in the country.
It is virtually impossible for a member of Congress to have leverage over the White House when the White House is on the side of the majority voters in that member's district, but that member of Congress is not. To truly have had leverage over the White House, and have received much bigger concessions, any member of Congress blocking the bill for left-wing reasons needed to convince a majority, or close to a majority, of his or her constituents that the bill should be defeated without large, left-wing concessions.
To put it a bit more crudely, one reason Progressive members of Congress have relatively less influence over Democratic White Houses is because Democratic White Houses--and their legislative proposals--tend to be very popular in blue states and blue districts. That just makes it easier for Democratic White Houses to get concessions out of Progressives than out of Blue Dogs, at least on a general level. Because of this, we raised about as much hell as we realistically could have done, and still only achieved this list of concessions.
While this is not the only cause of relative Progressive legislative failure compared to Blue Dogs, it is still an important factor.
In terms of progressive activists, it is clear that they have been completely rolled in this process and were given absolutely nothing. The good parts of the bill (Medicaid expansion, theoretically, the better regulations, though I have no confidence in the enforcement mechanisms) were not controversial and should not be seen as concessions to progressives. Indeed, I expect they would be passed separately if the Senate bill fails. In short, progressives got nothing in the political bargaining.
Now, pardon my exasperation, and please don't anyone talk anything I am about to write personally, because it is a generalized rant. But...
Bullshit. This is just wrong. Its bullshit like all the other bullshit out there in the blogosphere about how progressive activists who want to pass the health reform bill got nothing and have been forced into their "veal pens" or some other offensive formulation. That entire line of "argument" is just demonstrably false, and either intellectually dishonest or blinded by egregious cynicism
Here are two huge public option concessions that ended up in the Senate bill as concessions to progressive activists and members of Congress (more in the extended entry):
If Ben Bernanke is not reconfirmed by the Senate this week to another four-year term as chairman of the Federal Reserve, then the stock market will be sent into a tailspin so dire that it is likely our children, and their children, will all work as chimney sweeps in the ensuing century of Dickensian poverty.
If a left-right coalition of 40 Senators blocks his confirmation, then it's hard to see what other candidate would be more to their liking. You'd have gridlock. But Bernanke's term as a member of the Fed's Board of Governors is actually a 14-year term that doesn't expire for a long time. Consequently, the same Open Market Committee that's making decisions right now would just go on making decisions. Bernanke would, however, be unable to perform the formal responsibilities of the Chairman, so that role would devolve to Donald Kohn, the Vice Chair.
The truth is, functionally, that defeating Bernanke might not change that much in terms of Federal Reserve policy. However, it would still have some positive effects, including sending a strong message, opening up the possibility for change at the Federal Reserve and, as I discuss in the extended entry, empowering the left-wing of the Democratic Party in the Senate.
It is both small comfort, and an important lesson, for public option advocates that Joe Lieberman and Ben Nelson have become the most unpopular and electorally imperiled members of the entire Senate. This has happened largely because of their hostage-taking actions on the healthcare bill.
Joe Lieberman's actions on the health care bill antagonized constituents both for and against it, and in the wake of that he finds his approval rating at just 25% with 67% of voters in the state disapproving of him.(...)
It's clear that his actions on the Senate health care bill have made a large contribution to his falling popularity. 68% of voters say they disagree with how he handled the issue to just 19% giving him support. Among people who support the health care bill 84% say they disapprove of Lieberman's actions but even among those opposed to the initiative 52% say they disagree with how Lieberman handled himself.
This isn't the first poll showing that Lieberman took a big hit over his backstab on the public option. Two weeks ago, CNN polling showed the exact same results, much to the mystification of D.C. political writers.
Lieberman's actions appealed to no one. Now, he is toast, even among Republicans. A warm body will defeat him in 2012.
If Governor Dave Heineman challenges Nelson for the Senate job, a new Rasmussen Reports telephone survey shows the Republican would get 61% of the vote while Nelson would get just 30%. Nelson was reelected to a second Senate term in 2006 with 64% of the vote.
Nelson's health care vote is clearly dragging his numbers down. Just 17% of Nebraska voters approve of the deal their senator made on Medicaid in exchange for his vote in support of the plan.
Nelson, like Lieberman, did not make himself more popular among those who oppose the health care bill, or the public option, with his actions. Both supporters and opponents of both the health care bill and the public option were largely disgusted with what they viewed as personal power aggrandizement.
Their actions earned both Nelson and Lieberman featured appearances on Sunday D.C. talk shows, but it also made voters of all sorts loathe them. It would appear that people don't like members of Congress who take enormous pieces of legislation hostage for personal reasons. Nelson and Lieberman are now the most unpopular Senators in their home states in the entire country, far more unpopular than even Harry Reid, Chris Dodd or Blanche Lincoln.
All of this makes it quite amusing that ongoing hostage-taker, Bart Stupak, is strongly considering a run for Governor of Michigan. What a fool. It seems that he really believes that the only people who hate his hostage-taking actions are from New York City. The Nelson and Lieberman polling quoted above shows that very few people, whether in your home state or nationally, and whether among people who agree with your positions or not, like it when members of Congress take hostages in this manner.
Man, I hope Stupak does run for Governor. It would be an easy way to get him out of elected office altogether. It would also be nice to see another health care hostage-taker go down in flames, mystified about why people don't like him anymore.
Finally, I think this is a lesson for public option advocates, and our high-profile hostage-taking strategy called The Progressive Block. It seems clear to me now that a strategy like that only works if you build up public support for it (which we most definitely did not do among the Democratic primary electorate), or if the fight is far more low-profile (such as IMF funding in the Afghanistan supplemental). High-profile hostage taking just doesn't work from the left (or, as polling shows, from the right or the center, either) Voters of all sorts, including those on the left, just don't like it, and they will punish you given the opportunity. It is indeed small comfort that the mendacious hostage-takers who stopped us are now wildly unpopular both at home and around the country, but it is also a warning that we would have been in the same position if we had become the hostage takers ourselves.
When thinking about how to make the health care bill better, at this point there are two main questions:
What can be done to make either Lieberman or Snowe support better legislation? At this point, it appears we only need either Lieberman or Snowe to achieve a health care deal with vast Medicaid expansion, smallish Medicare buy-in, moderate subsidies, and a new regulatory regime. Keeping in mind that there are many fights left to be had, and Mike's warning that no deal is final until it lands on the President's desk, for all intents and purposes only one more vote is needed to pass this bill. That vote, unfortunately, needs to come from either Lieberman or Snowe.
OR, if that fails
What can be done to circumvent the need for 60 votes altogether? If the current framework of the Senate compromise is not good enough for you, and you would only be willing to support something better, then you need to figure out a way to circumvent the need for 60 votes altogether. A 51-vote Senate would produce a bill comparable, and perhaps even better, than the one produced by the House. Achieving a 51-vote Senate requires either reconciliation or nuking the filibuster entirely.
Of all the critics of the various campaigns for better health legislation, they don't advance the campaign unless they offer solutions for the current predicament we face. We can save the broader post-mortems on how the fight could have been waged differently from the beginning for later. Right now, we need to deal with the problem at hand, rather than look into the past.
I personally don't have particularly comprehensive answers to either of those two questions. In the extended entry, I describe what strategies I can think of for getting to 51 votes, and for pressuring Lieberman and Snowe. Hopefully, the discussion that ensues can lead to something more comprehensive.
The largest public option in the health care bills is, and has always been, the significant expansion of Medicaid. In terms of the number of people it covers, this expansion dwarfs any other public option expansion currently on the table in Congress. In terms of the type of people it covers, the Medicaid expansion includes a much higher percentage of Americans who are uninsured, and a much higher percentage of Americans who are in poverty, than any other public option expansion on the table in Congress.
The CBO report on the bill passed by the House (PDF, page 11), and the CBO report on the bill that was sent to the floor of the Senate (PDF, page 20), both project that the bills will add 15 million more Medicaid subscribers than current law. All of those 15 million are at 150% of the national poverty level or lower in the House bill, and 133% or lower in the Senate bill. Also, virtually all of the new people who will be covered by Medicaid in both bills are uninsured.
By comparison, the Medicare +5% public option was projected to cover 10 million people, the negotiated rates public option that passed the House was projected to cover 6 million people, and the opt-out public option was projected to cover 3-4 million people. Even in the July version of the House bill, the Medicaid expansions were projected to cover 11 million new people (PDF, page 17), larger than any of the other public option expansions reviewed by the CBO. As such, at all times, the Medicaid expansion was the largest expansion to public health insurance in the various bills that passed through Congressional committees.
Providing 15 million low-income, uninsured Americans with public health insurance is also why so few House Progressives carried through on their earlier threat to sink any health care bill without a new public option program tied to Medicare rates. After all, House Progressives both want to help people in poverty, and they disproportionately represent districts that would have been impacted by the new Medicaid coverage. It would have been difficult for House Progressives to explain to their constituents why they denied them health care, especially when the only electoral pressure most Progressives face comes from primary challenges.
There is another reason any Progressive explanation for defeating the bill would have been difficult. In their July 30th letter, House Progressives were advocating for a Medicare +5% public option, which would have covered 10 million people, to be added to a bill with a Medicaid expansion that, at the time, covered 11 million people. Such a bill would have increased the number of people with public health insurance by the exact same amount as the bill that eventually passed the House (15 million through the Medicaid expansion and 6 million through the negotiated rate public option in the exchange). In both pieces of legislation, 21 million more people are covered with public health insurance.
Defeating the vast Medicaid expansion is the pill House and Senate Progressives have been unable to swallow. If you want to know why Progressives in the House and Senate are not blocking the bill, Medicaid expansion is the reason.
In their quest to get votes, the Democratic leadership seems to have accurately calculated that a Medicaid expansion would lock in Progressives throughout the process. It would have been nice if they could have figured out something palatable that would have locked in all the Blue Dogs and Conservadems from the start, too.
There is a rumor going around the intertubes that I have given up on the public option. The rumor is based on a post I made yesterday.
It isn't true. I have not given up on the public option. Let me set the record straight:
I still support the public option. In fact, my ideal is either the original Jacob Hacker public option, or a national single-payer system. Really, either way.
I am still organizing for the public option. Among the many campaigns Open Left has engaging in on behalf of the public option, the most recent was getting several thousand people to sign up for SEIU's Adopt-a-State campaign designed to put pressure on Mary Landrieu, Joe Lieberman, Blanche Lincoln, and Ben Nelson. In conjunction with SEIU, we started that campaign only two weeks ago. Sign up, if you haven't already.
I am not organizing, or advocating, for the bill to be defeated if it lacks a triggerless public option. In fact, the last time I can remember doing that was nearly three months ago. Even then, I still framed the Block largely as a negotiating tactic.
In case anyone somehow missed it, the Progressive Block, which had been threatening to defeat a bill without a public option tied to Medicare rates, folded on October 30th, at the latest. That was the day when the Block's organizer, Representative Raul Grijalva, indicated that he would no longer work to defeat the bill if it lacked such a public option. Only eight days later, all but two of the original sixty members of the Progressive Block voted for a bill without a public option tied to Medicare rates.
That Block / bloc folded on its own, not because of me. I still the Block did a helluva lotta good in this fight though, and I'm not going to blast its members or organizers for their efforts.
Never once did I attack any member of Congress for not joining the Progressive Block. I just never did that.
If the Progressive Block is still operational, great. I am in favor of pushing it right up until the conference committee reports a bill, and then determining our options from that point. However, the only Blocks / blocs I see at this point are Representative Diana DeGette's Pro-Choice Block and Representative Bart Stupak's Coathanger Block. Each of them have issued threats, with a list of names, to Speaker Pelosi that they will defeat the health care bill if their demands are not met. There has not been a threat like that from the Public Option Progressive Block since, at the very latest, mid-September.
If I am wrong, and the Progressive Block threat around the public option still exists, then please let me know.
The only thing I have changed on is an expanded definition of a "win" on the health care bill. For a while, I argued that a victory was only about the public option and increasing Progressive influence. Now, I have an expanded definition that also includes saving thousands of lives by making it easier for them to purchase health insurance.
I hope this clears everything up.
Update: FWIW--I am working on a piece that weighs the arguments for and against killing the bill in its current form, and also depending on the provisions that might be added or removed. Any information you can provide on that front would be very useful.
I'm taking a five day break from blogging for the holiday. There will be plenty of content in my absence, I just won't be writing it. Be sure to check in, if you need an escape from your holiday.
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)
The healthcare battle is the first time we've tried to deploy the inside-outside Progressive Block strategy. It will certainly not be the last opportunity we have. So in addition to thinking about the impact of our actions on the battle we're currently engaged in, it's worth thinking about their impact on future battles.
The choices we make in the coming weeks will determine whether we come out of this stronger or weaker than we were when we came into it.
So here's my basic question: what do we need to do in the endgame of the healthcare battle to ensure that progressives - including the CPC in the House, the progressive Senators, and all of us progressives outside of Congress - are stronger for the next battle because of the way this one played out?
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.
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.
Senator Dick Durbin, who was in charge of counting votes on the health care merger in the Senate, is now saying that the public option was included in the Senate bill because of a Progressive Block of Senators who refused to support a health care bill otherwise. From The Huffington Post:
Democratic leaders were forced to include a national public health insurance option as part of health care reform by progressive Democratic senators who refused to support anything less, Senate Majority Whip Dick Durbin (D-Ill.) said on Monday.
Durbin's assessment was made to a handful of reporters following the announcement by Senate Majority Leader Harry Reid (D-Nev.) that after weeks of talks with his colleagues he had determined that including a public option that states could opt out of was the best way to go.(...)
"It's a zero-sum situation," said Durbin, who is in charge of counting votes in the Senate. "If we thought that just putting the trigger in meant that we'd end with 61 votes," he explained, then that's what leadership would have done.
"But there were some [senators] that felt that that just didn't go far enough moving toward a public option," said Durbin, who is himself a backer.
Quite a few Democrats did not like it that Congressional Progressives were threatening to defeat a health care bill without a public option. However, without that threat, there is simply no way that the public option would still be alive, much less near victory. Making that sort of threat on a piece of must-pass legislation was necessary both in order to make the legislation better, and also to finally make Congressional Progressives as relevant to the legislative process as Blue Dogs and Conservadems.
Darcy Burner summed this up pretty well today in an article from The Hill. (More in the extended entry)
Following up on Monday's article "President Burris," yesterday I talked over the phone with Jim O'Connor, a spokesperson for Senator Roland Burris. In regards to Burris's statement that he would vote against any health care reform bill that does not include a public option, I had two questions:
1. Will Senator Burris deny unanimous consent on a motion to proceed with a health care bill that does not have a public option?
(Such a motion is required for a bill to be sent to the floor for debate and amendment. If a unanimous consent motion fails--and it only takes one Senator to object for it to fail--then a cloture vote is required for a bill to be sent to the floor for debate and amendment.)
2. Will Senator Burris vote against cloture on a health care bill that does not have a public option?
(This is the logical follow-up to question #1. Given that Maine Senators Susan Collins and Olympia Snowe are the only two Republicans who would even theoretically vote for cloture on any health care bill, if three Democratic Senators say they will vote against cloture on any health care reform bill that lacks a public option, then it will be impossible for such a bill to reach the floor of the Senate.)
O'Connor's response to both questions was that Senator Burris stood by his statement to vote against any health care bill without a public option, bit that the Senator was still working on his floor strategy when it came to procedural votes. O'Connor stated that Burris did not seek to be an obstructionist, but to build consensus around the public option, which is good legislation and which polls show to be popular.
So, Burris is committed to voting against final passage of any health care bill that does not include a public option, but he has so far not committed himself to using procedural motions to block any such bill. As such, it is entirely possible he would still give unanimous consent, or vote for cloture, on a bill that does not contain a public option. Then again, he hasn't ruled that out, either.
Overall, this means that there is not even one Democratic Senator who has committed to blocking a health care reform bill without a public option. It would only take three, but right now the number is still zero.
For Democrats determined to get a health care bill, Sen. Roland Burris is like the house guest who couldn't be refused, won't soon be leaving and poses a plausible threat of ruining holiday dinner.
Suddenly, he can no longer be ignored.
The Illinois Democrat, appointed by disgraced former Gov. Rod Blagojevich, says he'll only vote for a bill to provide health care to millions more Americans as long as it allows the government to sell insurance in competition with private insurers.
And he says he won't compromise.
"I would not support a bill that does not have a public option," Burris, 72, said in a recent interview with The Associated Press. "That position will not change."
Can we start saying President Burris? Not just yet.
First, you would think that a proclamation like this from a Democratic Senator would get more attention. However, Roland Burris is only listed in 18 news stories on Google today, compared with 68 for Olympia Snowe (as of 4:15 pm eastern). Such a discrepancy strongly indicates that the national media simply doesn't believe Roland Burris--or really any other progressive, for that matter--when they claim they will bring down Democratic legislation because it isn't strong enough. If reporters and political types actually believed Burris, this would be a banner headline for dozens of national news outlets.
Second, one Democratic Senator opposing any health care reform bill without a public option is not enough to defeat any such bill, even in the 60-vote culture of the Senate. Given that President Snowe is still dangling the prospect of her support before the Democratic leadership, it would take two Senators (and, given Susan Collins, arguably three) for this to be an effective block. So, Roland Burris isn't enough, but if he were joined by another (hopefully more credible) Senator, then maybe we would really have something.
Of course, even if another Dem was to vow to vote against any health care bill that lacked a public option, it is still actually possible to pass a health care reform bill without a public option through the Senate. Reconciliation only requires 51 votes, is very much on the table right now, and can be used for non-public option health care bills, too.
Part of me would actually kind of like to see a bill without a public option pass through reconciliation. If this happened, it would simultaneously destroy the 60-vote process lie, and also clarify that the Democratic leadership simply wasn't pushing hard enough for the public option (right now, it remains unclear to me whether or not they are with us on this). Then again, we also wouldn't have a public option in that scenario, and satisfied recriminations are a poor substitute for potentially transformative legislation.
As the Senate Finance Committee winds its way toward finally getting a bill out on health care, attention is starting to turn to how Sen. Reid will end up marrying the Finance and HELP Committee bills. He has some really challenging things to think through in terms of how to move things forward. One important point I do want to make, before we see either the merged bill, or what the Senate floor fight brings us, is how important the conference committee will be on the health care bill this year.
As I do from time to time, I want to suggest again how wrong conventional wisdom is, both from the traditional media and from some of my progressive friends, relating to the importance of the conference committee on this bill. This conventional wisdom does have a reason for its existence, which is that House progressives have quite a few times in the past been rolled. Because of this, there is an expectation that it will happen every time. A classic example: this Politico piece which asked the question "when it comes to health care, does the House even matter?" The answer is only no if House progressives give up and let the Senate conservatives decide the nature of this legislation.
Here's what is different this time, though: House progressives are showing some muscle, some guts, and some cohesiveness. They have pledged in writing that they will not get rolled this time, and I think that their leadership is whipping and organizing this thing in the right way. I had a progressive friend awhile back ask me, "Has a bill ever gotten better in conference?" And actually, the answer is yes. The 1993 budget bill the 1994 crime bill, the S-CHIP bill in 1998, and even several of the budget bills in the 1990s after the Republicans took control of Congress all got better in conference in some significant ways. It's up to House progressives to make this a strong bill. This legislation is too important to the White House for this to die, so if they stick together and negotiate well, House progressives can make this happen.
Now don't get me wrong: what happens on the Senate floor is incredibly important. We need to get the best possible bill out of the Senate. But progressives should not panic if the language on the public option, or any other major issue in the bill, is not great. No matter what happens in the Senate the first time around, I am convinced that how good this bill is will ultimately come down to how good the House negotiators are on the bill. Sen. Reid has some tough choices on how to approach the Senate strategy, and Senate progressives and all of the pro-health care reform movement need to work together to get the best possible bill in the Senate floor fight. But don't give up on the conference committee process: this time, the House (and House progressives) will be a player.
I have done some checking on whether Representative Grijalva's claim in The Hill this morning that 46 members will vote against a bill without a public option represents the final count from the Progressive Caucus's whip count from three weeks ago.
It turns out that they never finished that whip count, and 46 was simply the number they were at when they dropped the effort. At the time they stopped, they were actually running above the 60 members who signed the letter opposing health care reform without a public option back in August. At least two other members had signed on.
The effort was dropped, however, in order to begin a new whip count of the entire Democratic Caucus on support for a public option with Medicare +5% rates (aka, the "robust" public option the Progressive Block had been demanding). This new whip count was begun at the request of Speaker Pelosi, who had challenged the Progressive Caucus to demonstrate sufficient support to pass such a public option.
The preliminary stage of that whip count has been completed, with a tentative number submitted to Speaker Pelosi. I do not know what that number is, but it probably is not 218. But even that whip count has not been presented in the formalized manner associated with whip operations, so it is still ongoing in some form.
More when I have it.
Update: Greg Sargent says the preliminary number is 170 members of the House in favor of a public option with Medicare +5%.
Update 2: I hear from a different source that Sargent's numbers are low. The whip count isn't at 218, but it is higher than 170.
