Senate Finance Committee Post-Mortem

The Senate Finance Committee actually finished with their markup of the health care bill late last night. They will wait until the CBO submits a revised score based on the amendments, and then there will be a final vote next week. So, how did we do?

Well, we know that there will be no public option in the bill. Maria Cantwell's amendment for state-based purchasing pools between 133-200% of the poverty level passed. Most of the right-wing amendments, other than adding money for abstinence-only education (which I'm guessing will get stripped down the line), went nowhere. The Committee even voted down all the amendments attacking undocumented immigrants, including rolling back one that would have prevented legal immigrants from buying into the exchanges for five years, which would have been utterly senseless.

On the other hand... the bill did delay and reduce financial penalties for those Americans who choose not to buy insurance, softening the stringency of the individual mandate (there are also lots of hardship exemptions). That's good politically in a sense, but does blunt the impact of the mandate, which will probably lead to higher costs with a smaller risk pool. I agree, however, that nobody should be forced to buy a plan they can't afford. Overall, this will help with the politics of the bill.

The real disappointment was the rejecting of Ron Wyden's Free Choice Act on a technicality.

About one in the morning, Wyden's Free Choice Act came before the committee. But it never came up for a vote.

Instead, Max Baucus effectively ruled it out of order. The reason? It didn't have a full CBO score. This came as a surprise to Wyden and his team, who'd gotten the amendment scored by the CBO, and had been in endless negotiations with Baucus, the White House, employers, and labor over the past week. If the score was in fact partial, as Baucus and Conrad claimed, you'd think someone might have mentioned it. No one did [...]

To understand the Free Choice Act, you need to understand that the exchanges are currently closed to businesses over 100 employees. In many states, they'll be closed to businesses over 50 employees (the Finance Committee's bill lets states choose their threshold, either 50 or 100). And in all states, they're closed to individuals who are offered "affordable" coverage by their employer. If I don't like the insurance The Washington Post is offering, or I feel I can get a better deal on the exchange, I am simply not allowed to go use the new network and take my pick from the many plans offered.

That's a real shame, that we continue to prop up a broken and inefficient delivery system of employer-based health care because nobody, neither business nor labor, wanted to risk messing with the status quo. As a result, the insured get less choices, businesses continue to bear a large health care burden, and nobody but insurers really win. It makes little sense for businesses to want to stay in the health care business and for labor to assume that they would keep their gold-plated health benefits at the expense of a broken system forever - which didn't hold in the case of the automakers. Jon Cohn has more.

Overall, the bill was improved by the markup, but remains flawed, particularly by the absence of a real public option, but also through the affordability questions, which were only slightly improved. There's still a long way to go to make this tolerable.