As featured on p. 218 of "Bloggers on the Bus," under the name "a MyDD blogger."

Wednesday, July 29, 2009

Energy And Commerce To Mark Up - HC Out Of All Committees By The Recess

After reports overnight of no deal with House Blue Dogs, now there are reports of a compromise being reached and a markup session in the Energy and Commerce Committee scheduled for just a couple hours from now.

Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) has cut a deal to reconvene his committee and vote on the Democrats' sweeping health care bill, with a goal of completing work by the time lawmakers leave town for the summer on Friday.

There won’t be a vote before the full House before the August recess, but the committee breakthrough – after tense negotiations with Blue Dog Democrats – is a significant step for the Democrats.

"After two weeks of very long and intense negotiations, I'm proud to report that we've reached an agreement that will allow health care reform to move forward," said Arkansas Rep. Mike Ross, a top negotiator for Blue Dog Democrats on the Energy and Commerce Committee.

After all this, the Blue Dogs will only allow four of their members to vote on this package in committee.

And here's what they got for their troubles:

The Blue Dogs also succeeded in cutting $100 billion from the overall cost of the bill, bringing the total price tag under $1 trillion. The legislation will now exempt small businesses with a payroll less than $500,000 from paying for any government-sponsored health coverage - double the $250,000 in the initial draft. Doctors and other health care providers would also be allowed to negotiate their payment rates with the government-sponsored health care arm.

The new version of the bill also has a breakthrough on the concept of health care “co-ops,” seen by some as an alternative to a public plan. States would be allowed to create co-ops for residents to buy private insurance. But the Waxman-Ross deal will also keeps the "public option" of government-sponsored health care.

That first paragraph has internal contradictions all over it. The Blue Dogs "succeeded" in cutting costs from the bill - but the two subjects mentioned ADD to the bill's costs. Exempting more small businesses from the employer mandate means less money from small businesses that do not provide insurance for their employees. And allowing providers to negotiate payment rates with the public option, as well as opt out of the network, means higher costs and less choice for individuals who purchase their plans. It's not really fiscally responsible. It also doesn't explain where those cuts came from. I'm hearing that this comes through "enhanced delivery system reforms" and cutting the expansion of Medicaid as well as the "affordability credits" for those who lack insurance. I'm guessing that they lowered the subsidy level to 300% of the federal poverty line. Matt Yglesias argues that not many people in between 300-400% FPL lack insurance, but it would still provide an additional burden on their bank accounts.

Where would this compromise leave health care reform? All three committees in the House will have passed their bills, but members would go home for recess while those bills get merged by the leadership. That puts the House trajectory on line with the Senate, where the Finance Committee is making progress toward a goal of passing their bill out before the recess. So in that intervening month, while progressives and conservatives do hand-to-hand combat in town hall meetings and on the airwaves, Nancy Pelosi and Harry Reid have to figure out what to keep in and out of the various bills, for floor votes in September.

Meanwhile, the White House has released eight guarantees that would emerge from any health care bill, which all sound like insurance reform, the line they've been using recently, and which don't include anything to really transform the system.

* No Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.

* No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.

* No Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.

* No Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

* No Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.

* No Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.

* Extended Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.

* Guaranteed Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.

OK. These are all solid reforms that would help a lot of people. But they are incremental reforms at the edge of the policy. I understand the thinking - these are the consumer-based reforms people will actually see. But they'd see a public option in competition with an industry that currently denies coverage and does everything they can to get out of paying for treatment. I fear that nothing more fundamental is being attempted out of a fetishistic need for bipartisanship that trumps common sense and the actual prevailing political reality.

Over at Senate Finance, judging by the reports coming of the committee, a solonic gang of six -- three Democrats, including chairman Max Baucus of Montana, and three Republicans, including ranking member Charles Grassley of Iowa -- are turning out a bill whose resemblance to anything the president has championed is accidental and incidental. To secure Republican support, they oppose a public plan. To secure Republican support, they oppose employer mandates, even on the largest corporations. (And many of America's biggest employers are retailers with a proven record of not providing coverage to their workers: Wal-Mart, our largest, employs 1.4 million Americans, most of whom it does not cover.) The solonic six may end up requiring employers to fund subsidies for employees who need them, but that could create the bureaucratic nightmare to end all bureaucratic nightmares -- 700,000 Wal-Mart employees, say, bringing their tax returns to work so management can investigate ("You sure you reported all your income?") and stall ("Doesn't your spouse work at Home Depot? Why don't they pay the subsidy?") and investigate and stall.

Sounds like a plan to secure universal coverage by the middle of the next century [...]

Problem is, bipartisanship ain't what it used to be, and for one fundamental reason: Republicans ain't what they used to be. It's true that there was considerable Republican congressional support, back in the day, for Social Security and Medicare. But in the '30s, there were progressive Republicans who stood to the left of the Democrats. Nebraska Republican George Norris, who for decades called for establishing public power companies to compete with price-gouging private companies, was the father of the Tennessee Valley Authority. In the '60s, Rockefeller Republicans supported civil rights legislation and Medicare.

Today, no such Republicans exist. In New England and New York, historically the home of GOP moderates, Republicans occupy just two of 51 House seats. Nationally, the party is dominated by Southern neo-Dixiecrats. In their book "Off Center," political scientists Jacob Hacker and Paul Pierson compared congressional Republicans of different eras and concluded that a Republican House member in 2003 with a voting record that placed him at the median of his party was 73 percent more conservative than the median GOP member of the early '70s.

Max Baucus, then, isn't negotiating universal coverage with the party of Everett Dirksen, in which many members supported Medicare. He's negotiating it with the party of Barry Goldwater, who was dead set against Medicare. It's a fool's errand that is creating a plan that's a marvel of ineffectuality and self-negation -- a latter-day Missouri Compromise that reconciles opposites at the cost of good policy. Obama should thank the solonic six for their work, and, as much as is politically practicable, ignore it.

Exactly. You don't negotiate with crazy.

There's still a fight to be had on the public option, the design of the insurance exchanges in which a public option sits, and several other features. Ultimately the Blue Dogs appear more nervous than obstructionist, so August will be consequential. I hope OFA is ready.

...Really, negotiate with this?

This unidentified man decided he was doing the Tea Party-anti-reform effort a real solid by hanging freshman Maryland Democratic Rep. Frank Kratovil in effigy [note the creepily expert knotted noose] with a placard "Congress Traitors The American [and a word that looks like "idol"].

The event — a rally in Salisbury, Md. on the Eastern Shore — was attended by members of the business-funded Americans for Prosperity, a group that includes James Miller, a Federal Trade Commission chairman and budget director during the Reagan administration.

...More info on the Waxman-Blue Dog deal. They lowered the rate of the subsidy between 300-400% FPL, rather than eliminating it. And as stated above, the public option remains, albeit weakened because it can't use Medicare bargaining rates at all, but rates negotiated by the Health and Human Services Secretary.

Labels: , , , , , , , , , ,