Health Care For America Now

In an on-the-record roundtable with bloggers and journalists this morning, Speaker of the House Nancy Pelosi was extremely confident that health reform will pass and pass quickly:

I have no intention of not passing this bill. I have faith in my members that we'll be passing this.

If we don't' pass the bill, how do you explain that to Americans? There is incredibly urgency in cost and the health and well-being of American, and yet we as Democrats, with two Houses [of Congress] and White House, couldn't make the historic decision to go forward?

The same forces that are aligned against Medicare are against this bill. This is what what they believe. I'll give them credit for staying true to their beliefs - they don't believe in health care for all Americans and a government role in that. The budget that they have [Rep. Paul Ryan's budget] privatizes social security, offers vouchers instead of medicare, and gives block grants to states instead of Medicaid. That is what they believe.

We want to take it to the American people and say, "This is the choice you have. This is their vision, and this is ours." [The Democratic members of the House] are strong enough and courageous enough to take that message out there.

There is a legitimate political debate happening in our country - what role should government have in bringing down health care costs, increasing accessibility and coverage, holding insurance companies accountable. We welcome that debate.

This is the most important initiative most of us in Congress - Congressman Dingell who was here for Medicare notwithstanding - will ever do in our legislative lifetimes.

Throughout the meeting, Pelosi continually referred back to this language, stressing that it's time to move forward and that the legislation is historic progress. At one point, she said that her "biggest fight" was against doing a small, incrementalist bill instead of addressing the entire system. "We've won that argument," she said, "And we can now take the country in a new direction."

Pelosi said she is asking members of the Democratic caucus to think about what is in the bill that they support, not what's not in the bill that might lead them to oppose. She says the bill does three transformational things, the "triple A" as she puts it:

We're proud of what's in there. Affordability for the middle class, access to health care for 31 million Americans, and accountability for insurance companies. The reconciliation package will change the pay-for [the excise tax], increase affordability, and correct the inequities in the states [the Nebraska deal]. The reasons we [in the House] didn't like Senate bill are corrected in reconciliation bill.

The biggest lever is to prevent insurance company abuses is the ability to prevent them from doing business in the exchange. That's a really big deal for them. If they raise rates they can be barred from the exchange. If they don't abide by anti-discrimination rules, they can be barred.

And, between now and implementation, if insurance companies don't follow the law, they'll be prevented from participating in the exchange. The Secretary [of Health and Human Services] can establish fines, and the Attorneys General can take action if they're discriminating. That's in the legislation.

Of course, we want to pass more. That's why we passed the insurance industry anti-trust repeal, and we'll revisit some other issues in the future.

As for how reform will pass, the Speaker stressed that it's hard to get a vote count before you have a bill. As of today, she is waiting for the final CBO score to release the language, then they can begin counting votes. "Time is important," she said, "every special interest against the bill benefits by delay."

She said there were three options for passing the Senate bill and the reconciliation improvements through the House. The first - having the House and Senate pass the reconciliation bill before the House passes the Senate bill - was ruled out by the Senate parliamentarian. The second option - having the House pass both the Senate bill and a package of reconciliation fixes - is available. And there is a third option, one that the Speaker said she and her members are leaning towards. Under the plan, the House would vote only on the reconciliation bill based on a rule that says once the reconciliation bill passes the House, the Senate bill would be "deemed" passed in the House as well:

We don't have the votes yet because we don't have a bill yet. People just haven't made a commitment because they haven't seen the bill. The vision and specifics will get us the votes.

There is no easy vote around here, but I have confidence we'll be fine if we keep eye on the ball and have members be completely familiar with final bill. This is historic.

The Budget Committee is marking up last year's reconciliation instructions today - a "shell bill" - in preparation for putting in the real reconciliation bill as soon as the CBO scores come out. The Rules Committee will meet shortly thereafter to decide how the bill or bills comes to the floor. By all accounts, the House is still on target for a vote late this week or this weekend, and Speaker Pelosi is confident she'll have her votes.

Yesterday, President Obama endorsed finishing health care reform with an up-or-down vote:

…I believe the United States Congress owes the American people a final vote on health care reform. We have debated this issue thoroughly, not just for a year, but for decades. Reform has already passed the House with a majority. It has already passed the Senate with a supermajority of sixty votes. And now it deserves the same kind of up-or-down vote that was cast on welfare reform, the Children's Health Insurance Program, COBRA health coverage for the unemployed, and both Bush tax cuts - all of which had to pass Congress with nothing more than a simple majority.

By calling for an up-or-down vote and referencing welfare reform, CHIP, COBRA, and the Bush tax cuts - all of which got their up-or-down votes using the reconciliation process - the President was very clearly asking the Senate to use the same process for health reform.

The Senate agrees.

Just over one month ago today, 15 Senators were in favor of or very open to the idea of finishing health reform using reconciliation. I reported their statements here.

As of today, 46 Senators either support or are open to using reconciliation to secure an up-or-down vote. Click here for the chart and links to their statements. If you add in the few other Senators who are listed as maybe, you bring the total up above 50.

The movement, fueled in a large part by dozens of Senators signing on to a letter from Senator Bennett calling for a public option to be passed through reconciliation, is striking. And, as reported in today's Roll Call, the last five Senators, coming from the moderate wing of the party, are likely to come on board soon:

Senate Democratic centrists aren’t saying “yes” just yet, but when it comes to passing a crucial piece of the health care reform puzzle, party leaders have reason to be optimistic that enough of their most fickle Members will put them over the top.

With few exceptions, Democratic moderates interviewed Wednesday revealed little resistance to the idea of using controversial budget reconciliation rules to clear the final health care reform package and deliver it to the president’s desk. Given their strong opposition to embracing this strategy when health care was being debated last year, their fresh openness could prove significant even if some moderates ultimately vote “no.”

“There are plenty of people in our caucus who would like to not vote for reconciliation, but my guess is 51 is something [leadership] can get,” said one Democratic Senator of the simple-majority vote needed for passage. “This is like a box canyon, and reconciliation is the only way out.”

One person who's not on the list is the new spokesperson for the Senate Democratic Communications Center, Republican Senator Judd Gregg:

This is the way health reform will be finished. The reconciliation process will allow fixes the Senate bill to make health care truly affordable for everyone and hold the insurance companies accountable. And there will be the votes in the Senate to do it.

The White House Health Care Summit has concluded. Unsurprisingly, Republicans continued to hit on tort reform as the way to lower our health care costs all afternoon. And they continued to be wrong. But a few more themes came up that are worth debunking.

First, Republicans kept insisting that if only average Americans had more "skin in the game" when it came to health care costs, those costs would go down. In particular, they tout health savings accounts as a solution.

In reality, health savings accounts are junk insurance, nothing but insurance company sponsored scams, good for the rich, like the Republican Members of Congress at the summit, but not for the rest of us:

Health savings accounts by definition favor the wealthy and/or the healthy. For those that never go to the doctor, or who can afford the high out-of-pocket costs incurred when using health savings accounts (you need to pay $1,050 as an individual or $2,100 for a family before your insurance will cover the rest), health savings accounts are great. Wealthy and/or healthy individuals can put a bit of money away, tax free, into their health savings account and then draw from it to pay their astronomical out-of-pocket costs when they decide to go see a doctor. If you're healthy, the doctor's visit doesn't happen very often. If you're wealthy, who cares if it happens very often, you can afford it.

For the rest of us, however, health savings accounts don't work. If we get sick and see the doctor often, we have to pay those huge costs often; that means we have to save a lot of money in that health savings account. For those on fixed incomes, or even those just barely scraping by (and that's a lot of us in today's economic climate), putting away even $4,000 in a health savings account is out of the question. Health savings accounts don't work for the same reason tax credits don't work: Those who don't have a lot of cash to save are forced to put away money they don't have a bit at a time to pay for their care. With tax credits, they get repaid at the end of the year. With health savings accounts, they don't pay taxes on that money. But either way, they need to save over the course of a year to get that payoff. For a lot of folks, this just isn't a realistic option - there's simply nothing to spare.

As the President pointed out, Republicans might feel differently about health savings accounts if they made $40,000 per year instead of the hundreds of thousands they make as Members of Congress.

Another perpetual Republican talking point was the wonders that would occur if only we could buy insurance across state lines.

In the Republican fantasy land, consumers would be able to buy cheaper or better insurance from another state. Here's what reality would look like:

Insurance is currently regulated by states. California, for instance, says all insurers have to cover treatments for lead poisoning, while other states let insurers decide whether to cover lead poisoning, and leaves lead poisoning coverage — or its absence — as a surprise for customers who find that they have lead poisoning. Here's a list (pdf) of which states mandate which treatments.

The result of this is that an Alabama plan can't be sold in, say, Oregon, because the Alabama plan doesn't conform to Oregon's regulations. A lot of liberals want that to change: It makes more sense, they say, for insurance to be regulated by the federal government. That way the product is standard across all the states.

Conservatives want the opposite: They want insurers to be able to cluster in one state, follow that state's regulations and sell the product to everyone in the country. In practice, that means we will have a single national insurance standard. But that standard will be decided by South Dakota. Or, if South Dakota doesn't give the insurers the freedom they want, it'll be decided by Wyoming. Or whoever.

This is exactly what happened in the credit card industry, which is regulated in accordance with conservative wishes. In 1980, Bill Janklow, the governor of South Dakota, made a deal with Citibank: If Citibank would move its credit card business to South Dakota, the governor would literally let Citibank write South Dakota's credit card regulations. You can read Janklow's recollections of the pact here.

Citibank wrote an absurdly pro-credit card law, the legislature passed it, and soon all the credit card companies were heading to South Dakota. And that's exactly what would happen with health-care insurance. The industry would put its money into buying the legislature of a small, conservative, economically depressed state. The deal would be simple: Let us write the regulations and we'll bring thousands of jobs and lots of tax dollars to you. Someone will take it. The result will be an uncommonly tiny legislature in an uncommonly small state that answers to an uncommonly conservative electorate that will decide what insurance will look like for the rest of the nation.

It's a race to the bottom, selling our health to the lowest insurance company bidder. It's not a solution that makes us more healthy or lowers our cost - CBO said selling insurance across state lines wouldn't expand coverage at all and would only save $12 billion over 10 years, a fraction of what real health care reform would save.

Finally, Republicans continually made the point that the American public doesn't want health reform. As Nancy Pelosi said, there have been so many lies about the health care bills, it's a wonder anyone likes them. And it's important to stand up for popular things - like a public option - to make it better. But that doesn't mean the American people don't want reform.

By huge majorities, they want the major parts of health reform, and they want Congress to plow ahead and pass a good bill:

The latest Kaiser Health Tracking Poll is only the latest in a series showing the elements of health reform are popular:

Other parts of reform are really popular too, like the public option.

And majorities want comprehensive health reform passed:

And even more will be disappointed or angry if reform doesn't pass:

The Republicans didn't bring a plan to the summit today. Instead, they brought stale, easily-debunked talking points. They tried to prove that giving good health care to Americans was a bad idea, but they failed. And in the end, they resorted to the same slogans they've been repeating for a year now - start over, blank slate, incremental reform.

We've heard from the other side and found they have no plan to solve the greatest problem facing the nation. Now it's time to finish the job and finish it right.

The White House summit has started. Follow it live here:

Yesterday, Republican leaders finally confirmed that they weren't going to bring a health care bill to the President's summit tomorrow. Why? Because they don't actually want to reform health care (emphasis added):

The Senate GOP leadership is brushing off Dan Pfeiffer’s demand this morning that Republicans clarify whether they’ll produce a bill in advance of the summit, and won’t put forth a “comprehensive proposal,” aides say.

This morning on the White House blog, Pfeiffer challenged GOP leaders to say whether they’d be bringing a bill to the summit. “The Senate Republicans have yet to post any kind of plan,” Pfeiffer wrote, adding that “we continue to await word from them.”

Asked for comment, a senior Senate GOP aide emailed:

We fundamentally disagree with a comprehensive proposal to reform health care. We think a step by step approach on areas where we agree is the best path forward. We will not be posting a comprehensive alternative to commence a staring contest.

Of course, health care advocates have known this all along. Republicans have no solutions to the crisis in our health care system because they don't view it as a system in crisis.

However, the position that health care in this country doesn't need fundamental reform is a dangerous position to take. Never mind that every day we go without reform, 6,821 more people lose their health insurance [pdf], 2,548 more people file for bankruptcy because they got sick, and 60 more people die [pdf] because they don't have the coverage they need. Declaring that as a party Republicans "fundamentally disagree with a comprehensive proposal to reform health care" is radically out of step with the American people.

The latest Kaiser Health Tracking Poll is only the latest in a series showing the elements of health reform are popular:

Other parts of reform are really popular too, like the public option.

And majorities want comprehensive health reform passed:

And even more will be disappointed or angry if reform doesn't pass:

If Republicans think going with nothing is going to win them broad support, they haven't been reading their polling.

Democrats need to work to make sure the reform that passes works for everyone in America and has the popular elements in it - they must pass health care that works for us and pass it now. Today, we're helping to put in 1 million message to Congress to send them that message, and Melanie's March is arriving in DC to a huge rally with Senators attending the summit, so we'll get to tell that message to these Senators in person.

Getting health reform done right is more than good policy for the country, it's popular, too. And it will show America that Democrats won't accept the party of NO's strategy.

Over the past few weeks, House and Senate Democratic leaders have been working to craft a compromise between their two health care bills that were passed over the last few months. Today, President Obama has released what Dan Pfeiffer, Communications Director at the White House, is calling the administration's "best shot" at bridging the differences between the House and Senate.

The proposal comes in advance of the planned health care summit on February 25th where Republicans and Democrats will meet and talk about the health care proposals on the table. The White House thought it would be most productive to "come to the table with one proposal," as Pfeiffer put it.

Over the last few months, we've been fighting to finish health reform right under the rubric of two main goals. By making health care affordable we mean making sure insurance is affordable for individuals, making sure insurance is affordable at work, and making sure middle-class health plans aren't taxed. By holding insurance companies accountable we mean giving regulators a national exchange so insurance plans in the exchange are subject to the same stringent rules and creating a public health insurance option to hold private insurance companies accountable.

So, what does the President's plan do?

(Note: The plan starts from the Senate bill as a foundation so any changes listed in the overview of the President's plan [pdf] are changes to the Senate bill.)

Every passing day brings more Senators saying their open to using the budget reconciliation process for finishing health reform. So far, nobody has compiled these statements into a comprehensive list, so here they are.

Senator Specter (D-PA) came out strong:

I believe we ought to pass comprehensive health care reform and we ought to do it now and there is a way to do it. I provided the 60th vote. We passed it in the Senate. Let the House accept it, simultaneously with a bill to make certain changes through reconciliation and 50 votes. There will be no disagreement about taking away the giveaway to Nebraska and Louisiana and the other inappropriate measures but let's move ahead and let's move ahead now.

Senator Franken (D-MN) was also pushing for the move:

The best way for that to happen, and as far as I can see – the only way for that to happen – is what I’m calling 'pledge and pass. If we in the Senate pledge to fix those elements through reconciliation – a budget process that requires only 51 votes, the House of Representatives should pass the Senate Bill.

Senator Ben Nelson (D-NE) walked back his earlier critisisms of the process and is open to reconciliation:

I’ve been asked about whether I’d support using the process known as reconciliation now. So, I want to make it clear: If I support a bill, then I will vote for it regardless of whether it takes 50 votes to pass or 60 votes to pass. My position doesn't change just because the House or Senate decides to change the process.

Senator Baucus (D-MT), who chairs the crucial Senate Finance Committee, says it's the only way:

Approving the Senate bill through the procedure, known as reconciliation, “is the only solution,” Baucus said, adding the Senate “was close” in getting enough votes to pass it.

Senator Conrad (D-ND), who chairs the other crucial commmittee in the process, the Budget Committee, says he would be open to fixes:

If the House passed the Senate bill, could reconciliation, that process, be used to fix things that might be improved upon? Yes. Would I support it? I can’t know that without knowing what would be included in the package.

Senator Bingaman (D-NM) said in a recorded call with reporters that reconciliation is an option (click for audio):

10:01 – Bingaman says that using the reconciliation process is an option for getting portions of the health care reform bill passed in the Senate.

Senator Carper (D-DE) has been reaching out to moderates in the House to convince them that the reconciliation "sidecar" option is the way to go:

Sen. Tom Carper, a centrist Democrat from Delaware who played an active role in Senate healthcare talks, said he would reach out to House Democratic centrists to persuade them to vote for the Senate-passed bill along with a sidecar.

“We’ve had some conversations with some of them already,” he said.

Senator Durbin (D-IL), the Senate Majority Whip, said reconciliation is an option:

We could go to something called 'reconciliation', which is in the weeds procedurally, but would allow us to modify that health care bill by a different process that doesn't require 60 votes, only a majority. So that is one possibility there.

Senator Pryor (D-AR) said he's open to it:

According to the Arkansas News, Pryor said reconciliation was not his first choice but "he was not necessarily opposed to the idea."

Someone familiar with Senator Feingold (D-WI) has said the Senator is open to the idea:

I spoke to someone from Feingold's campaign about his position on reconciliation in light of the Massachusetts special election. She informed me that while Sen. Feingold is no fan of reconciliation, now that it's reconciliation or nothing (apparently), he would be willing to support reconciliation if that's what it took to get a good bill passed. It wasn't the slightest bit equivocal or hedgy; it was a straight "yes". So that's a bit of good news. Hopefully the House can get their act together.

Senator Kerry (D-MA) says reconciliation is his preferred route to passing health reform:

Senator John Kerry said today his preferred route to completing health care reform is for the House to pass the Senate bill, and for the Senate to make it more digestible to the House by approving fixes through the reconciliation process, which allows legislation to pass the Senate by a simple majority instead of 60 votes.

Senator Klobachar (D-MN) is also open to the move:

Whether it's going to be [reconciliation] or whether it's going to be taking some of the main initiatives for the self-employed and small business to allow them to get better rates of insurance, and insurance reforms and prevention, and the Medicare cost reforms — which, some of us can't even imagine voting for health care without having some Medicare cost reform — the bill will move forward, and I think something will get done….

Senator Sanders (I-VT) definitely supports it:

Sen. Bernie Sanders, I-Vt., said he favors using a parliamentary maneuver known as reconciliation to get health care reform passed. Such a move would require only support of a simple majority of the Senate, not the 60 needed to prevent a filibuster threatened by Republicans.

"I support the reconciliation process or any other way we can get the votes we need to go forward," Sanders said in a statement.

Senator Menendez (D-NJ) supports it as well:

I’m not sure how we get where we want to be if reconciliation is not the process.

More statements will no doubt come in as the process moves forward, but for now there is building support for finishing health care reform using the reconciliation process. Of course, we need to encourage them not just to finish reform, but to finish it right by making health care affordable to all and holding the insurance companies accountable.

Update

@ProgressOhio points me to Senator Sherrod Brown (D-OH) and his support of reconciliation:

Brown said didn’t yet know for sure whether Reid would commit to the reconciliation fix approach, but added that there’s a widespread sense in the caucus that this is probably the only workable route forward.

“I can’t imagine another scenario,” Brown said. “We can’t start anew, and we can’t do piecemeal.”

The mainstream media has been speculating whether President Obama and Democrats will fail at reforming our hopelessly broken health care system since the reform process began. And they've been speculating whether that failure, like President Clinton's before it, will mean another election like 1994, which gave Republicans control of Congress for the first time in decades and curtailed the rest of Clinton's term. The latest in this storyline is a piece today in Politico from Carrie Budoff Brown and Chris Frates, complete with interviews from operatives around back then examining statements by Members of Congress that seem to say health care is moving to the back burner.

It's not 1994 all over again right now, but it could be if things go in a certain direction. What Ezra Klein said last week is true:

It is very, very, very important to be clear on what the death of health-care reform looks like. It is not a vote that goes against the Democrats. It is not an admission that the White House has moved on from the subject. It is continued statements of commitment from the key players paired with a continued stretching of the timetable. Like everything else in life, policy initiatives grow old and die, even if people still love them.

The danger is there, and the parallels of 1994 are an important warning. Things are different right now then they were. We don't have to go down that road again.

It's incumbent on Democrats to finish health reform and finish reform right, but it's also worth remembering that Republicans still have no health care plan.

In his State of the Union address, President Obama told lawmakers that if they had a health care plan that met his goals, they should speak up:

As temperatures cool, I want everyone to take another look at the plan we've proposed. There's a reason why many doctors, nurses, and health care experts who know our system best consider this approach a vast improvement over the status quo. But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know. Here's what I ask of Congress, though: Do not walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people.

Predictably, House Republican minority leader John Boehner piped up and claimed that the Republican alternative health care bill his caucus offered last year when the House was passing their health care bill fit the requirements.

Of course, Boehner's wrong. The bill doesn't fit the requirements, not even close.

First, the plan, according to the CBO [pdf], doesn't nearly cover the uninsured:

By 2019, CBO and JCT estimate, the number of nonelderly people without health insurance would be reduced by about 3 million relative to current law, leaving about 52 million nonelderly residents uninsured.

Unlike the House plan Democrats passed, it doesn't hold insurance companies accountable. It would still allow denials of care based on pre-existing conditions, and because these abuses aren't reigned in, premiums for the sickest Americans will skyrocket.

The Republican "alternative" also saves less money, because it fails to really tackle the health care crisis.

Democrats still must finish the job right, but judging by the ideas Republicans have offered thus far, they'll have to proceed on their own.

Speaker of the House Nancy Pelosi led the charge yesterday:

The quote is so good it's worth repeating in writing:

We'll go through the gate. If the gate's closed, we'll go over the fence. If the fence is too high, we'll pole-vault in. If that doesn't work, we'll parachute in. But we're going to get health care reform passed for the American people, for their own personal health and economic security, and for the important role that it will play in reducing the deficit.

Pelosi was joined by a chorus of Democrats yesterday saying the same thing. House Education and Labor Committee Chairman George Miller:

We're going to get it done this year.

House Energy and Commerce Committee Chairman Henry Waxman:

I think we will pass a big health care bill. I think the president will insist that we keep the promise. We're going to have to figure out a different route now that we dont have 60 Democrats, but the Republicans are not helping us.

Senate Majority Leader Harry Reid:

We're going to do health care reform this year. The question is, at this stage, procedurally, how do we get where we need to go.

Senator Max Baucus:

We're not going to put it down. We're moving expeditiously. And expeditiously means quickly, solidly, thoughtfully.

President Obama's senior adviser David Axelrod:

There were plenty of people who said before the speech last night, just stand up there and say 'It's over.' Say 'We tried,' and move on because it's too politically difficult. And that's not what he did and we are working closely with folks on the Hill to develop the way forward and get this done and that's all we're focused on, on health care, is getting it done.

These are the leaders who have the power to pass health reform. Now, it's our job to make sure they finish reform and finish reform right.

Both houses of Congress must pass comprehensive health care reform by majority vote as quickly as possible. They have the tools to make it happen. As Axelrod said, "Reconciliation is a tool that is there to be used." And the human toll of waiting is simply to high. Health reform must be finished, and it must be finished right.