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Public Option Support Surging In Senate

UPDATE: Thursday, 12:23 PM -- The Las Vegas Sun reports that while Nevada voters are opposed to the previous health care bill, they support moving it through by using reconciliation.

See the poll by Research 200 at http://act.boldprogressives.org/cms/sign/nv_poll_20100210/?action_id=3
081972&akid=.516684.ZjdoMV.

UPDATE: Thursday, 11:43 AM -- Adrianne Marsh, a spokesperson for Sen. Michael Bennett (D-Colo.), who is leading the effort, says that there are now 16 signatures on the letter calling for the public option to be moved through the Senate under reconciliation. The most recent to sign, said Marsh, is Sen. Frank Lautenberg (D-N.J.).

UPDATE: Thursday, 11:21 AM -- "Senator Mikulski has signed on to that letter," says Rachel MacKnight, a spokeswoman to Sen. Barbara Mikulski (D-Md.), up for reelection in 2010. Mikulski is a veteran lawmaker and chairwoman of a HELP subcommittee.

UPDATE: Thursday, 10:05 AM -- Organizers of the effort say that Sens. Jack Reed (D-R.I.) and Tom Udall (D-N.M.) have now signed on, bringing the number to 13.

UPDATE: Wednesday, 9:39 PM -- Sens. Amy Klobuchar (D-Minn.) and Ben Cardin (D-Md.) are the latest to indicate support for the use of reconciliation to pass health care reform legislation that includes a public option.

The Minnesota Independent published part of a prepared statement from Klobuchar:

I would want to make sure that the bill contains the Medicare care cost reform measures included in the existing bill. I am also supportive of the President's efforts to forge a bipartisan agreement. We must reduce health care costs for the people of this country.

Susan Sullam, a spokeswoman for Sen. Cardin said Wednesday that "Senator Cardin has always been for a strong public option. He also has long thought reconciliation was a viable option for passing strong health care reform."

Neither Klobuchar nor Cardin appear ready to sign a letter penned by by four other senators endorsing both the public option and the use of reconciliation. Eleven senators have signed the the letter.

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Sen. Dianne Feinstein (D-Calif.) became the 11th Senator to sign on to a new effort by Democrats to press Majority Leader Harry Reid (D-Nev.) to pass a public option for insurance coverage using reconciliation, her office confirmed to the Huffington Post on Wednesday.

The California Democrat joins a list of mostly progressive members to offer her late-stage support for the government run plan. In a letter to Reid on Tuesday a quartet of Democrats penned urged Reid to pass the proposal through parliamentary procedures that allow a simple up-or-down vote.

The senators outlined their rationale for supporting the public option in their letter:

Susan Sullam, a spokeswoman for Sen. Cardin said Wednesday that "Senator Cardin has always been for a strong public option. He also has long thought reconciliation was a viable option for passing strong health care reform."

Neither Klobuchar nor Cardin appear ready to sign a letter penned by by four other senators endorsing both the public option and the use of reconciliation. Eleven senators have signed the the letter.

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Sen. Dianne Feinstein (D-Calif.) became the 11th Senator to sign on to a new effort by Democrats to press Majority Leader Harry Reid (D-Nev.) to pass a public option for insurance coverage using reconciliation, her office confirmed to the Huffington Post on Wednesday.

The California Democrat joins a list of mostly progressive members to offer her late-stage support for the government run plan. In a letter to Reid on Tuesday a quartet of Democrats penned urged Reid to pass the proposal through parliamentary procedures that allow a simple up-or-down vote.

The senators outlined their rationale for supporting the public option in their letter:

Susan Sullam, a spokeswoman for Sen. Cardin said Wednesday that "Senator Cardin has always been for a strong public option. He also has long thought reconciliation was a viable option for passing strong health care reform."

Neither Klobuchar nor Cardin appear ready to sign a letter penned by by four other senators endorsing both the public option and the use of reconciliation. Eleven senators have signed the the letter.

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The senators outlined their rationale for supporting the public option in their letter:

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We respectfully ask that you bring for a vote before the full Senate a public health insurance option under budget reconciliation rules.

There are four fundamental reasons why we support this approach - its potential for billions of dollars in cost savings; the growing need to increase competition and lower costs for the consumer; the history of using reconciliation for significant pieces of health care legislation; and the continued public support for a public option.

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In putting her name among the signatories Feinstein expands the pool of senators pushing for a public plan beyond the progressive wing and those lawmakers facing primary challenges in the 2010 midterm elections. The California Democrat has been a supporter of the proposal from the start, though not a particularly vocal one. The recent news that the largest insurer in her home state, Anthem Blue Cross, was raising premiums on its customers by as much as 39 percent played a role in her decision.

"I can think of no better example of why we need health insurance reform," she said of the rate-hike news, "and this kind of behavior is a stark reminder of why any reform plan should establish a rate authority to keep insurance rates affordable."

The list of Senators currently signing the letter includes Jeff Merkley (D-Ore.), Sherrod Brown (D-Ohio), Michael Bennet (D-Col.), Kirsten Gillibrand (D-N.Y.), Bernie Sanders (I-VT), Al Franken (D-Minn.), Pat Leahy (D-VT), Roland Burris (D-Ill.), John Kerry (D-Mass.), and Sheldon Whitehouse (D-RI).

Senator Tom Harkin (D-Iowa), chairman of the Senate health committee, isn't yet signing on to the effort, but said through a spokeswoman that he "has always strongly supported the public option and will continue to fight for comprehensive health care reform."

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The White House signaled Thursday that an aggressive, all-Democratic strategy for overhauling the nation's health care system remains a serious option, even as President Barack Obama invites Republicans to next week's televised summit to seek possible compromises.

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(1) "Let families and businesses buy health insurance across state lines." This is a long-running debate between liberals and conservatives. Currently, states regulate insurers. Liberals feel that's too weak and allows for too much variation, and they want federal regulation of insurers. Conservatives feel that states over-regulate insurers, and they want insurers to be able to cluster in the state with the least regulation and offer policies nationwide, much as credit card companies do today.

To the surprise and dismay of many liberals, the Senate health-care bill included a compromise with the conservative vision for insurance regulation. The relevant policy is in Section 1333, which allows the formation of interstate compacts. Under this provision, Wyoming, Colorado, Arizona, Utah, and Idaho (for instance) could agree to allow insurers based in any of those states to sell plans in all of them. This prevents a race to the bottom, as Idaho has to be comfortable with Arizona's regulations, and the policies have to have a minimum level of benefits (something that even Rep. Paul Ryan believes), but it's a lot closer to the conservative ideal.

(2) "Allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do." This is the very purpose of the exchanges, as defined in Section 1312. Insurers are required to pool the risk of all the small businesses and individuals in the new markets rather than treating them as small, single units. That gives the newly pooled consumers bargaining power akin to that of a massive corporation or labor union, just as conservatives want. It also gives insurers reason to compete aggressively for their business, which is key to the conservative vision. Finally, empowering the exchanges to use prudential purchasing maximizes the power and leverage that consumers will now enjoy.

(3) "Give states the tools to create their own innovative reforms that lower health care costs." Section 1302 of the Senate bill does this directly. The provision is entitled "the Waiver for State Innovation," and it gives states the power to junk the whole of the health-care plan -- that means the individual mandate, the Medicaid expansion, all of it -- if they can do it better and cheaper.

(4) "End junk lawsuits." It's not entirely clear what this means, as most malpractice lawsuits actually aren't junk lawsuits. The evidence on this is pretty clear: The malpractice problem is on operating tables, not in court rooms. Which isn't to deny that our current system is broken for patients and doctors alike. The Senate bill proposes to deal with this in Section 6801, which encourages states to develop new malpractice systems and suggests that Congress fund the most promising experiments. This compromise makes a lot of sense given the GOP's already-expressed preference for letting states "create their own innovative reforms that lower health care costs," but since what the Republicans actually want is a national system capping damages, I can see how this compromise wouldn't be to their liking.

(5) To stop there, however, does the conservative vision a disservice. The solutions the GOP has on its Web site are not solutions at all, because Republicans don't want to be in the position of offering an alternative bill. But when Republicans are feeling bolder -- as they were in Bush's 2007 State of the Union, or John McCain's plan -- they generally take aim at one of the worst distortions in the health-care market: The tax break for employer-sponsored insurance. Bush capped it. McCain repealed it altogether. Democrats usually reject, and attack, both approaches.

Not this year, though. Senate Democrats initially attempted to cap the exclusion, which is what Bush proposed in 2007. There was no Republican support for the move, and Democrats backed off from the proposal. They quickly replaced it, however, with the excise tax, which does virtually the same thing. The excise tax only applies to employer-sponsored insurance above a certain price point, and it essentially erases the preferential tax treatment for every dollar above its threshold.

(6) And finally, we shouldn't forget the compromises that have been the most painful for Democrats, and the most substantive. This is a private-market plan. Not only is single-payer off the table, but at this point, so too is the public option. The thing that liberals want most in the world has been compromised away.

On Sunday, John Boehner and Mitch McConnell responded to Barack Obama's summit invitation by demanding Obama scrap the health-care reform bill entirely. This is the context for that demand. What they want isn't a bill that incorporates their ideas. They've already got that. What they want is no bill at all. And that's a hard position for the White House to compromise with. Whether done behind closed doors or not, the fact is that the GOP's "Solutions for America" homepage (found at http://www.gop.gov/solutions/healthcare), which lays out its health-care plan in some detail. It has four planks. All of them are incorporated in the Dem's bill.

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On the eve of next week's televised healthcare summit, President Obama and Democrats have no choice except to press ahead on reform, said Democratic pollster Stanley Greenberg Wednesday at a Monitor breakfast.

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A lot is being made of "portability" by those on the right, and I know what they're getting at. They SAY they want you to be able to carry your coverage across state lines if you move for a better job, or whatever (which seems a laudable goal); what they MEAN, though, is that this portability would mean that insurance would only have to be as good as that in the states with the WORST insurance plans, and that you (as another state) couldn't require MORE than that, because it would be unfair. That's why conservatives keep bringing up portability, and what they mean when they talk about it.

So address portability, by all means. But let's step around the issue of that idea that insurance in all states must match that of the LEAST states. Hell, we can write it so that it must match that of the BEST states, if we wanted to. Hawaiian-style insurance reform, anyone? :)

And "tort reform"... The amount of money that's eaten up by tort lawsuits is on the order of 2 to 3 percent of their profits. So when the conservatives start saying that the solution to healthcare reform is tort reform, just remember their reaction to Obama telling us all to save gas by checking our tires. If you thought his suggestion was ridiculous, you should think theirs is, too.

Would Iike to see SOME kind of tort reform? Sure; wouldn't everybody? But they keep talking numbers like $100,000 lifetime payout for extreme malpractice events like taking off the wrong leg (and then having to take the other one, too, because it had to come off to begin with). And they want this tort reform to apply to EVERYTHING, across the board, it seems. That means Ford's Pinto debacle would have had a maximum payout of $100,000 for killing people with a design they KNEW to be faulty and dangerous. Hell, no wonder greed-heads want that kind of reform. It would leave them all but immune to ever having to pay for their fuck-ups.

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As it turns out, Senate Democrats may not be able to force healthcare legislation through the chamber on a simple majority vote.

Republicans say they have found a loophole in the budget reconciliation process that could allow them to offer an indefinite number of amendments.

Though it has never been done, Sen. Jim DeMint (R-S.C.) says he’s prepared to test the Senate’s stamina to block the Democrats from using the process to expedite changes to the healthcare bill.

Experts on Senate procedural rules, from both parties, note that such a filibuster is possible. While reconciliation rules limit debate to 20 hours, senators lack similiarconstraints on amendments and could conceivably continue offering them until 60 members agree to cut the process off.

Another option for Democrats would be to seek a ruling by the parliamentarian that Republicans are simply filing amendments to stall the process. But such a ruling could taint the final healthcare vote and backfire for Democrats in November.

Or Senate Majority Leader Harry Reid (D-Nev.) could use a tactic similar to the so-called nuclear option to quash the GOP tactics.

If those options failed, and Reid couldn’t convince a single Republican to vote with his 59-member conference, Democrats might be forced to consider withdrawing the healthcare bill.

A Democratic leadership aide confirmed to The Hill that the options outlined in this articlee are correct.

House Democrats have said they would not pass the Senate healthcare bill unless changes are made through reconciliation, which is necessary because Republicans control 41 Senate seats, enough to block legislation through the regular process.

But Republicans may end up having that power even under reconciliation.

“You could keep offering amendments until you don’t have any more to offer,” said a congressional aide, who said he did not know how long senators would be willing to stay in the chamber to move the reconciliation package. “What the body’s tolerance would be is unknown.”

A former Senate Republican leadership aide said: “The limit is on debate, not on consideration of amendments.”

DeMint said he’s ready to try anything.

“You’ll see Republicans do everything they can to delay and stop this process,” DeMint said. “They need to get the message the track they’re on is the wrong track.”

Reid spent significant time last year in close study of the Senate rules for fast-tracking healthcare legislation under special budget rules.

Reid stayed away from the special process of passing healthcare reform with only 51 votes because he knew it would be messy.

But since Republicans won a Senate seat in Massachusetts, thereby stripping Democrats of a filibuster-proof majority, it appears Democrats will need to invoke those rules to make crucial changes to healthcare legislation.

DeMint said that using reconciliation rules to pass the House-requested changes to the Senate healthcare bill with only 51 votes is “tyrannical.”

“I think you’ll see us offering amendments to get us into November, if we can,” said DeMint.

Sen. Judd Gregg (N.H.), the ranking Republican on the Budget Committee, said: “You could continue to offer amendments, I suspect.

“You can offer an unlimited number of amendments on the budget after time is elapsed so it’s logical that you could also do it on reconciliation,” Gregg said.

Democrats could try to persuade Republican colleagues to back down and withdraw their amendments after several hours or days of voting. With a unified Democratic conference, Reid would need just one GOP senator to cut off the process.

The most likely candidate would be Sen. Olympia Snowe (R-Maine), who voted with Democrats to advance the Senate Finance Committee bill but has since opposed the healthcare measure on the Senate floor.

Reid or another Democrat could make a point of order that using amendments to stall a reconciliation bill violates the spirit of the Budget Act of 1974, which sets up for expedited consideration of budget-related bills.

Reid or another Democrat could argue that offering unlimited amendments violates the spirit of limiting debate.

The parliamentarian has ruled that the limit on debate does not allow senators to filibuster the motion to proceed to a reconciliation bill. The parliamentarian could rule that the same concept applies to amendments.

No one really knows, because a lawmaker has never tried to use amendments to filibuster a reconciliation package.

“We haven’t ever tried it before,” said a congressional aide.

Parliamentarian Alan Frumin could rule Republican amendments after a certain number out of order. But he could also allow the GOP amendments, since they are not expressly barred.

If Frumin ruled with Republicans, Reid would be in a difficult position. He could either pull the bill off the floor or he could appeal the ruling of the parliamentarian.

With a simple majority of 51 votes, Reid could overturn the ruling of the chair and set a Senate precedent that amendments must be limited to within reason. This tactic would be similar to the so-called nuclear option Senate Republicans considered using in 2005 to overrule Democratic filibusters of judicial nominees.

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if you can make them laugh, you can make them listen

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(Will restore thread title tomorrow.)

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