HealthCareForAmericaNow

Some folks may have not yet noticed the "Steps to Win" section at the top of our site. It's a section of the site managed by our legislative team, and has the best information on the process by which we'll pass health care reform this year, broken down into six easy-to-understand steps.

For the last few months, we've been in step two, where committees in Congress that have control over health care have been holding hearings and drafting legislation. Now, with legislation set to be introduced in the Finance Committee in the Senate and the tri-committees in the House, and with HELP already marking up a bill, we're firmly in the third step towards passing health reform: Committees passing bills.

Here's what's going to happen:

Because health reform legislation is so complicated, five different committees – three in the House and two in the Senate – are entitled to have some say in the legislation. Each House and Senate committee in charge of different parts of health care reform has been holding hearings and drafting legislation. Committees consider their first draft, usually called the Chairman’s mark, in a process called "mark-up." During these committee meetings, members propose changes to the Chairman’s mark (amendments) and then vote on final approval in their committee. The committees may consider hundreds on amendments in the process.

Once each committee completes its process, the two Senate committees will combine their bills and work out any differences to bring one bill to the Senate floor. The same process will be happening among the committees working in the House. The committees involved in health care reform have pledged to work together to minimize differences and make this process easier.

And, because we're a campaign after all, here's what you can do to help this process:

• Call your Senators in support of a public option - Call your Senators in support of a strong public health insurance option, not "co-ops" or other proposals that won’t do all the things a strong public option can.
• Ask your Senators about the public option - Ask your Senators where they stand on the public health insurance option and what kind of public option they stand for.
• Sign the petition for a public option - Senators Leahy, Durbin, and Schumer have created a petition you can sign in support of a public health insurance option.
• Call your Members of Congress - This is by far the most important thing you can do. Members take calls from constituents very seriously, much more seriously than faxes or emails. Please take a moment and call, even if your Members of Congress are already supporting our efforts.
• Spread the word about our campaign - When President Bill Clinton tried to pass health care reform back in 1993, he didn't have a grassroots army behind him to hold Congress' feet to the fire and fend off opponents. That critical mistake eventually doomed his efforts. This time will be different, but we need your help to recruit your friends and family. Please send a message to anyone you know who supports President Obama and his promises of health care reform and ask them to join our campaign.
• Volunteer in your state - Health Care for America Now has grassroots offices in 42 states and grassroots supporters in all 50. Get involved in the effort in your state and in your community to help us pressure Congress and win quality, affordable health care for all in 2009.

So, hooray for progress! Things are indeed moving. A little historical note: If we make it pass step three onto the full House and Senate considering a bill for a vote, we'll have officially made it farther in the process than President Clinton did in the '90s. That'll be a real milestone.

Now, all we have to do is pass a bill out of committee, pass a bill out of both Houses of Congress, get them to agree on a bill, and have the President sign it - all while preserving our principles for health reform. Not easy, but we'll get there.

The HELP Committee has released their final version of a health care bill, including a public health insurance option and a provision for shared responsibility:

Democrats on a key Senate Committee outlined a revised and far less costly health care plan Wednesday night that includes a government-run insurance option and an annual fee on employers who do not offer coverage to their workers.The plan carries a 10-year price tag of slightly over $600 billion, and would lead toward an estimated 97 percent of all Americans having coverage, according to the Congressional Budget Office, Sens. Edward M. Kennedy and Chris Dodd said in a letter to other members of the Senate Health, Education, Labor and Pensions Committee. The AP obtained a copy.

By contrast, an earlier, incomplete proposal carried a price tag of roughly $1 trillion and would have left millions uninsured, CBO analysts said in mid-June.

You got that cost number right - $611 billion. If you'll remember, the last version of the HELP bill - without a public option or shared responsibility - came in at $1 trillion. Clearly, these changes saved money. (And remember when John Boehner, Republican leader in the House, said the public option would cost over $1 trillion? He's dead wrong.)

On the conference call announcing the measure, Senators Dodd, Brown, and Whitehouse said that all 13 HELP Democrats would be voting for this bill. That's right, every single one.

Richard Kirsch, our national campaign director, had this to say:

The HELP Committee’s bill will give Americans all across this country what they want - a choice of a strong public health insurance option that will provide lower costs and keep the insurance companies honest. The public health insurance option included in the HELP bill will be available on day one, giving Americans a new alternative to the private insurance industry. It will also encourage the delivery of better health care at a lower cost. The public health insurance option, combined with other key sections of the HELP Committee legislation, makes this bill a good prescription for health care reform. More specifically, the bill invests enough resources to make good, affordable health care available to middle-class families and includes strict rules to stop insurance company abuses.

We urge the Senate Finance Committee and the full Senate to follow Senator Kennedy and his fellow Democrats’ lead in giving everyone a choice of keeping their current health insurance coverage or selecting a new public health insurance option. That public health insurance option would be a real alternative to the private insurance companies that have failed to make health care affordable while regularly delaying and denying needed care.

I concur. The HELP Committee is standing up today and doing the right thing for the American people, and indeed, doing something they deeply support. Finance should follow suit.

If all questions were created equal, you might think that Americans were badly divided on health care reform. According to CNN, only "a bare majority of Americans support President Obama's health care plan."

But when pollsters ask Americans point blank if they want a strong public health insurance plan option as part of health reform, a large - not a "bare" - majority of us say yes.

Just today, Quinnipiac released polling results that showed that support was as high as ever. When Quinnipiac asked, "Do you support or oppose giving people the option of being covered by a government health insurance plan that would compete with private plans?" 69% said they support the public option.

Need more? When the Washington Post and ABC asked, "Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans?" 62% said they support the idea.

And when the Wall Street Journal and NBC asked, "In any health care proposal, how important do you feel it is to give people a choice of both a public plan administered by the federal government and a private plan for their health insurance––extremely important, quite important, not that important, or not at all important?" 76% said it was extremely or quite important (.pdf).

A variety of other polls, asking similar questions, have found similar levels of support for the public option.

So what's the deal with CNN? Their poll, it turns out, asks a very different question, which is why it gets a different answer. When CNN asked, "From everything you have heard or read so far, do you favor or oppose Barack Obama's plan to reform health care?" 51% said they supported it, while 45% said they opposed it. Rasmussen, asking roughly the same question, gets a similar answer: 50% say they support "Barack Obama's plan," while 45% say they oppose it.

I'm no pollster, but I'm not surprised that levels of support change based on whether the pollster explains the policy they are asking about or simply associates it with a political figure.

It's more valuable to ask about attitudes toward specific policies. President Obama will not single-handedly determine the shape of health reform. Congress is the body that will take primary responsibility for drafting, amending, and ultimately passing legislation. Many individuals - Edward Kennedy, Max Baucus, Christopher Dodd, and Nancy Pelosi, to name a few - will have a profound impact on the final bill. That's why we need to know how Americans feel about the proposals being made, not the people who propose them.

I am concerned that media narratives about public opinion will become distorted as a result of polls like CNN's, and that observers - or ordinary Americans - will look at polls and say, "Well, we see 76% support for the public option here, but only 50% there. So who knows what Americans really want?"

But I am even more concerned that opponents of health reform will exploit confusion over polls to alarm members of Congress and weaken legislation. "Look at how divided Americans are over the public option," a crafty spinmeister might say. "The President's honeymoon is over, and support for health reform is dropping." If opponents of reform succeed in tying the issue to a person (see "Hillarycare"), they've laid the groundwork for some nasty attacks on reform proposals.

Americans tend to balk at the idea that one powerful individual could reorganize the health system in our country. That's why we all have to keep in mind that the reform proposals on the table have been shaped and supported by many qualified leaders and thinkers, from the President to the Democratic leadership in Congress to intellectuals like Jacob Hacker and analysts in a broad array of major think tanks like the Center for American Progress, the Economic Policy Institute, and the Campaign for America's Future.

The public option is a good proposal, and a necessary one, and that's why Americans support it when you explain it to them in a straightforward manner. So don't let polls that ask different questions trick you into thinking the forces of reform are losing ground. On the contrary, we're gaining steam - and Congress will pay attention.

Some text for the HELP Committee's public health insurance option leaked last night. The language includes:

–HHS-based plan: The community health insurance option would be run by HHS. The government would pay for the first three months of claims as a way to capitalize it; this would be a loan to be repaid over time. For the first two years and longer if necessary, the option would also qualify for “risk corridor protections” which offset or reclaim excessive losses and gains which could result during the start-up period (identical to those in Medicare Part D). Subsequently, its premiums would be set to make it self sufficient. This would make the health insurance option quickly available in all areas of the country.

–Plays by the same rules: The option would be one of the Gateway choices. It would follow the same rules as private plans for defining benefits, protecting consumers, and setting premiums that are fair and based on local costs. The only difference between this option and others is that the Secretary would set the reserve requirements for this plan rather than states.

–Provider payments and participation:

• Negotiated rates within limits: The payment rates paid by the option would be no more than the local average private rates – but could be less. The Secretary would negotiate these rates.

• Input from Advisory Councils: Each State would create a Council of provider and consumers to recommend strategies for quality improvement and affordability. States would share in the savings that result.

• Purely voluntary: Health care providers would have the choice of participating in this plan; there would be no obligation to do so.

Why It Will Make Health Care Affordable:

–Pooled purchasing power: This health insurance option can pool the purchasing power of its enrollees nationwide to leverage lower prices to compete with private plans. Similar negotiation power has been used by states to get drug rebates in Medicaid beyond the statutory minimum. It has been used by large businesses to drive delivery system change. This negotiation would be backed by a ceiling of paying no more than average local rates.

–Flexibility and incentives to innovate: Unlike administered pricing, the negotiation for payment rates gives the Secretary the ability to quickly and aggressively promote payment policies that promote quality and best practices. In addition, the State Advisory Councils would tailor delivery system reform for the plan, with a financial bonus for success.

–Lower administrative overhead: The community health insurance option would not need to raise premiums to support shareholder profits, extensive marketing, and extra risk reserves required by require to protect enrollees from plan insolvency or mismanagement of funds.

This fulfills the broad requirements for a public option: Available everywhere and on day one, and accountable to Congress and the voters, as well as rate flexibility. Of course, things are still very much in flux and these details could all change, for better or for worse. But so far, so good.

Chris Bowers has been keeping track of the answers you all have gotten from the Senate over the last few weeks. For those just joining the campaign, we, along with Chris at OpenLeft and Democracy for America, are asking Senators to answer for questions on the public health insurance option:

• Do you support a public healthcare option as part of reform?
• Do you support a public healthcare option that is ready on day one?
• Do you support a public healthcare option that is national, available everywhere, and accountable to our government?
• Do you support a public healthcare option that has the clout to establish rates with providers and big drug companies?

The answers are starting to trickle in, and we're going to publish them all this week. But we want to make sure we've gotten all the responses so our count is accurate. So, if you've gotten a response from your Senator, click here to report it.

Of course, if you haven't gotten an answer yet, keep asking. As Chris says (and I concur), if there's one thing he's learned from blogging, it's that you have to keep asking Senators over and over until you get the answer you want. So, click here to email you Senator.

And of course, tell your friends about this campaign, so we can turn up the pressure.

Stay tuned for the answers!

As Health Care for America Now's report on affordability issues in the health system shows, Americans in every state face exploding health care costs. That's one reason why strong majorities of Americans, in poll after poll, say they want a strong public option.

Americans all over the country are speaking out, but the past week has seen major pressure on elected officials from out West. Reform advocates demonstrated in Las Vegas this weekend. Last week, California Senator Dianne Feinstein faced strong pushback from grassroots groups in response to her skepticism that the Senate will support a public option.

The Western state where grassroots pressure is most likely to move a skeptical Democrat, though, is Washington. A local outlet, The Columbian, says Washington's congressional delegation "has muscle to flex over health care":

Washington's top elected officials — Gov. Chris Gregoire and Sens. Patty Murray and Maria Cantwell — have key roles in the national debate.

Gregoire was among five governors who met with President Obama Wednesday to discuss the states' perspective on health care reform. She said later that she advocated "a hard look" at a government-run plan, but suggested that it could be run by the individual states — with the federal government footing the bill.

Cantwell and Murray serve on the two committees that are writing the Senate bill. Both will be in the state this week to talk health care with constituents.

Though Rep. Brian Baird does not serve on any House health care committee, he has a long-standing interest in the issue. In 2007, he introduced legislation that would de-link health coverage from employment and provide private health insurance coverage for every uninsured American.

All have offered measured support for creation of a government-run "public option" that would compete with private insurance plans, by far the most contentious issue in the health care debate.

Both Cantwell and Baird have come under fire from advocates of a public option for failing to take a stronger stand.

One example of the fire directed at Sen. Cantwell by Washingtonians is this piece in Seattle's The Stranger, bluntly titled "What's Up with Maria Cantwell?" Author Eli Sanders writes,

Seattle congressman Jim McDermott supports it. Washington senator Patty Murray wants it. So does President Barack Obama. So does the often conservative Seattle Times editorial page. So do 72 percent of Americans, according to a recent poll. So what's going on with Washington's junior senator, Maria Cantwell? Why doesn't she want Congress to include a public option—a new government-run health-care plan that will be available to everyone and will compete with private insurance companies to bring down costs—in its health-care-reform package?

"I don't think that's something we can get through the United States Senate," Cantwell told KUOW on June 22. It's an odd bit of circular logic: Because Cantwell can't yet count enough votes to pass the public option, she won't add her vote in favor of the public option—which, of course, makes it even harder to find enough votes to pass the public option.

Sanders goes on to share his frustration - and the frustration of a Washington small business owner he interviewed - at Cantwell's lack of clarity on her positions regarding a public plan or various proposed compromises.

For one more Washingtonian voice on health reform, I looked up the Seattle Times editorial that Sanders references. This line stood out to me:

After so many false starts and clever ads from opponents of health-care reform, the public is serious about change. Politicians notice.

Judging from the diversity and seriousness of the voices in Washington pushing for meaningful reform, if Cantwell hasn't yet noticed the hunger Washingtonians have for real change then she will soon. With nearly three-quarters of a million people in Washington uninsured, nearly one in ten unemployed, and health premiums rising over five times faster than median earnings in the state, it's clear Cantwell's constituents are suffering under the current system. With Murray and others in Washington's delegation on board for real reform, it's also clear that Cantwell will have plenty of company if she joins the ranks of reformers. Here's hoping she'll put a finger to the wind and feel the change that's taking place in Washington, in the West, and across the entire United States.

Just so we're clear, we know Republicans aren't going to vote for health reform that actually does anything right?

Via the New York Times:

Representative John A. Boehner of Ohio, the House Republican leader, said he was unaware of any House Republican inclined to support the Democrats’ proposed legislation.

Asked how many Senate Republicans could sign on to developing Democratic plans, Senator Richard M. Burr of North Carolina, author of a Republican alternative, said: “I think right now, none. Zero.”

So, the question becomes, how far are you willing to push this "bipartisanship" thing? Will you go for bipartisanship at the expense of getting a bill that does what President Obama and the American people want it to do - lower costs, make health care affordable, and increase coverage?

Because it's possible to get, say, one or two Republican votes in the Senate, but that might not even be enough to satisfy Republicans:

Hoping to lessen the divide, a handful of senators from the two parties who sit on the Finance Committee have been meeting privately, trying to find some consensus. But they left for the weeklong Fourth of July recess without any firm agreement, though they pledged to keep trying. Even a senator at the center of those talks among four Republicans and three Democrats, Charles E. Grassley of Iowa, the senior Republican on the committee, indicated a reluctance to back any legislation unless it was constructed to attract more than a handful of Republicans.

“This is not going to be a bipartisan bill with just three or four Republicans,” Mr. Grassley said. “This is a bill that gets broad bipartisan support or it is not going to be a bipartisan bill.”

Now you tell me: What kind of bill do you think more than a few Republican Senators would vote for? Do you think it would do any good? Do you think it would be anything but the status quo? Do you think it would lower your costs instead of bailing out the insurance industry with taxpayer dollars?

If I had to guess, any bill Senate Republicans support would do nothing for the American people. The health care crisis is too great - bipartisanship isn't worth the price we'd pay.

In response to Health Care for America Now's posting and petition and MoveOn's advertisement wondering why Senator Feinstein is naysaying on health care in the face of huge momentum for real reform, Feinstein's office emailed the following statement to TPM and other news outlets:

I support:

1) Reducing costs and expanding coverage

2) Prohibiting the denial of insurance because of pre-existing conditions

3) Moving toward either a non-profit model of medical insurance or to one where premium costs can be controlled, either through competition in a public or cooperative model or through a regulated authority.

4) Assuring the financial survival of Medicare, because it is slated to run out of money in 2017.

5) Preventing the transfer of Medicaid costs to states, which could result in billions of dollars of additional loss to the State of California.

6) Establishing means testing for programs like Medicare Part D, which pays for prescription drugs

Clearly, the individual mandate - and how it is funded - is the critical, and as yet unanswered, question.

Huh? Let's look at this more closely.

Feinstein wants to:

• Control costs
• Expand coverage
• Stop insurance industry bad practices
• Move towards non-profit insurance
• Save Medicare and Medicaid
• And support comparative effectiveness research

With the exception of that last point, all of the outcomes Senator Feinstein wants to see from reform are things that are most easily accomplished - indeed, perhaps can only be accomplished - with robust health reform that includes a public health insurance option.

Feinstein wants to control costs? The Commonwealth Fund estimates a health reform bill with a public health insurance option will save an extra $2 trillion over 11 years.

Feinstein wants to expand coverage? Jacob Hacker argues [pdf] that the public health insurance option in conjunction with reform is the way to best provide expanded and quality coverage, while preserving choice.

Feinstein wants to stop insurance industry abuses? Then she'll have to help pass a law that mandates these things, because the insurance industry will never voluntarily accept these concessions, as their testimony before Congress made abundantly clear.

And Feinstein wants to save Medicare and Medicaid? Well, the only way to do that is to aggressively control costs, as Budget Director Peter Orszag points out, is to reform health care in a real way.

In short, if Senator Feinstein wants to achieve any of the goals she says she wants to achieve, she's going to need to support robust health reform, including the choice of a public health insurance option.

And that fact makes her two statements on the issue all the more puzzling. Why, in the face of huge momentum for health reform, did Feinstein go on national television and say some particularly unhelpful things like, "I don’t know that [President Obama] has the votes right now," a comment designed to give comfort to the enemies of health reform? And why did she then turn around and say she's for all kinds of goals that can only be accomplished with reform?

It doesn't make sense, it's contradictory, and it still leaves Feinstein in the naysayer camp. So keep calling her office at (202) 224-3841 and sign the petition and ask her to just come out and say it, "I'm with the President and commit to using all my muscle to pass real health care reform this year, including a choice of a public health insurance option, to achieve the goals I've laid out for our health care system."

I'll say it once again: Senator Feinstein can either make history, or stand in the way.

In the last few days, there has been a significant shift in the political winds in Washington towards real health care reform, with a robust public health insurance option at its heart. The last thing we need is someone nay-saying that reform won't pass. Let's take a look at the landscape.

First, two polls from respected news organizations were released almost simultaneously, both showing strong support for a public health insurance option. The Wall Street Journal/NBC poll showed 76% in favor of the choice of public health insurance, and the New York Times/CBS poll showed 72% favor that same choice. As Nate Silver, polling guru and most accurate forecaster of the 2008 elections, put it, "Overall, polling points toward the public option being at least mildly popular and indeed perhaps quite popular."

Second, proposals in Congress are moving in the direction of offering Americans this choice that they clearly want. On Friday, the three committees in the House with jurisdiction over health care, endorsed by the House leadership, came out with a great bill, with everything we wanted in it.

Third, the Senate is moving in the right direction, however slowly. Kent Conrad, the author of the co-op proposal, is working with Chuck Schumer to figure out how a co-op could become a public health insurance option that meets our principles:

Schumer and other backers of a public option insist that any plan must be national in scope, have substantial funding at the beginning from the federal government, and include national purchasing power in order to negotiate lower prices.

Conrad ticked off the areas of agreement that were reached Monday.

"National structure: I believe to be effective there has to a national entity with state affiliates and those affiliates have to have the ability to regionalize. I think his concern there can be addressed," said Conrad. "Second, he believes there needs to be national purchasing power. I think that's a good point that the national entity would be able to do purchasing on behalf of the state and regional affiliates and on behalf of the national entity itself."

The HELP Committee is currently marking up a bill as well, moving the process along.

And finally, President Obama, the President with a 63% approval rating, is campaign hard for a public health insurance option. He went up against a somewhat hostile crowd at the AMA's annual meeting to promote his helath care plan, and he's going on national television for two hours tomorrow night to answer questions on it.

So why, in the face of all this momentum for a public health insurance option from the House, the Senate, the White House, and the American people, is Senator Dianne Feinstein going on TV and saying something like this?

President Barack Obama may not have enough votes in the U.S. Senate to pass his effort to overhaul the nation’s health-care system, California Democrat Dianne Feinstein said.

“I don’t know that he has the votes right now,” Feinstein said today on CNN’s “State of the Union” program. “I think there’s a lot of concern in the Democratic caucus.” Controlling costs of the new system is a “difficult subject.”

Where's the concern in the Democratic caucus? The people want reform, the House wants reform, the Senate is moving in the right direction, and the President is out promoting his plan. What concern?

The statement about having the votes is curious, too, because as it looks to me, we don't have the votes in the House for anything less than real reform, or so says Speaker Pelosi.

Why, then, is Feinstein insisting on being a nay-sayer on health reform? Honestly, the only people saying health care may not pass are hard-core conservatives and Feinstein. Even the insurance industry says it wants health care to pass!

Health Care for America Now is working to get to the bottom of this question. Our field partners in California are making sure she's hearing from her constituents on this issue, including office visits and hundreds of calls every day. They've got thousands of signatures on a petition asking Feinstein to support a public health insurance option. And they're going door to door to tell voters in California about health reform and Feinstein's positions. Given the pressure her constituents are putting on her, who is Feinstein representing here?

There's no reason for Senator Feinstein to be a nay-sayer on health care, especially given the political climate in Washington right now. So why is she? If you want to know the answer to this question yourself, give her a call at (202) 224-3841. I'd be very interested to hear her explanation.

Feinstein needs to stop nay-saying on health care. Real reform will pass this year, because we can't afford to wait any longer. Senator Feinstein should help make history, instead of standing in the way.

Jim Cooper uses "bipartisanship" to cloak his flip flop on the public option (via press release):

On the day after three former Senate majority leaders released their bipartisan health care reform proposal, Reps. Jim Cooper (D-TN), Mike Castle (R-DE), Parker Griffith (D-AL) and Jo Ann Emerson (R-MO) called for similar bipartisanship in the House and Senate.

“Health care reform should be our top priority, period,” said Rep. Jim Cooper (D-TN). “But the Senate’s restrictive reconciliation process will make real reform impossible. That’s why Democrats and Republicans must work together to pass a bill that meets President Obama’s goals, lowering cost, raising quality and covering all Americans. Yesterday Tom Daschle, Bob Dole and Howard Baker showed it can be done. Today a bipartisan group of members of Congress said we’re ready and willing to make it happen.”

Health Care for America Now pushed back, reminding Rep. Cooper that he has prior commitments where the public option is concerned (also via press release):

Richard Kirsch, National Campaign Manager, Health Care for America Now:

"We now know Jim Cooper talks out of both sides of his mouth on health care. On June 6, 2009, he stood before Organizing for America in Tennessee (video) and praised President Obama, his leadership, and his call for a public health insurance option. Now Cooper is trying to slow down reform and sacrifice what’s best for the voters for the sake of bipartisanship.  In his quote today, Cooper said he was with the President but then specifically took out one of the President’s key goals – choice of plans, including the choice of a public health insurance option.

"Rep. Cooper is infamous as the Democrat who led the charge against President Clinton’s health care plan. Clearly, he thinks he is going to make a name for himself again by trying to thwart the Obama plan. One thing is clear. No one on either side of the aisle can trust Jim Cooper.

"It may be easiest for some in Congress to get along by going along and pleasing their big campaign contributors from the health care industry, but doing so just for the sake of bipartisanship doesn’t help the American people who are looking for real solutions to the health care crisis."

As Richard explains, with moves toward cheap bipartisanship Rep. Cooper is placing himself profoundly out of synch with mainstream Americans:

"President Obama’s health care plan - and especially the choice of a new public health insurance option - is backed by majority of voters of every political lean. Two just-released polls place support for the public health insurance option at 76% and 83%. It could not be clearer what the public wants when it comes to getting quality, affordable health care for all this year. Only Republicans in Congress are out of sync.”

Members of Congress should know that the American people are listening closely to what they say on health care and specifically on the public option. Health Care for America Now and many other groups will be pressuring congressmen to honor their commitments to their constituents and their country.