July came late this year.
In all the euphoria over the news that the Senate Finance Committee has approved its version of health care legislation, some context was missing. With a 60-vote majority in the Senate and a 79-vote advantage in the House of Representatives, it was all but assured that some sort of health care bill would clear the Democrat-dominated committees. It just wasn't supposed to take this long.
Back in June, the Washington Post published an internal memo that was written by Senate Democrats plotting out the Finance Committee's timeline for passing health care legislation. Originally, the vote to report the bill out of the committee -- which took place Tuesday -- was supposed to occur in mid-July, and by October 1st, President Obama was supposed to sign a final bill.
Thus, while the Finance Committee's vote will obviously provide forward momentum for President Obama's health care push, the reality is that the easy part took much longer than expected, and now Democrats are left to deal with all of the thorny issues that they've deferred over the past several months.
With health care legislation now having cleared the relevant committees, Senate Majority leader Harry Reid, along with Finance Committee Chairman Max Baucus and Sen. Chris Dodd, will begin merging the Finance Committee bill with the more liberal bill approved by the Senate Health, Education, Labor and Pensions (HELP) Committee. This is easier said than done.
The Finance and HELP committee bills have many similarities, including a requirement that insurers offer coverage to those with pre-existing conditions at an affordable rate; a mandate that forces individuals to purchase insurance or pay a tax; a significant expansion of Medicaid; subsidies for individuals to purchase insurance; and new government-run insurance exchanges. But there are also significant differences between the two bills.
The most crucial difference is that the HELP bill includes the creation of a new government insurance plan, which is opposed by at least 6 and by as many as 8 Democratic Senators, but seen as an essential part of reform by liberals. While Sen. Jay Rockefeller voted the bill out of the Finance Committee, in his remarks, he pressed the case for integrating the government plan into the final package, lamenting that in its current form the bill represented "too sweet a deal" for the insurance industry.
Beyond the issue of the government plan, the HELP bill offers more generous subsidies and expands Medicaid eligibility more widely than the competing Finance Committee bill. In addition, the HELP bill includes a mandate requiring employers to offer insurance to all workers, whereas the Finance proposal has a weaker measure to tax employers who don't offer insurance to workers who qualify for government subsidies.
Liberal activists have already made it clear that they don't view the Finance Committee bill as genuine reform.
"The end of the Senate Finance Committee’s process marks the beginning of the next phase -- crafting a strong bill that goes to the Senate floor," declared Richard Kirsch, National Campaign Manager of Health Care for America Now, a coalition of liberal groups. "The HELP Committee bill offers a better path forward in the Senate than the Finance Committee bill." He added that "The Senate Finance Committee bill falls short on making insurance affordable to America’s families, gives employers a 'free ride,' and does not create meaningful competition in the insurance market with a strong national public health insurance option."
Meanwhile, before the vote in the Finance Committee was even final, 30 unions revealed plans to take out ads in national newspapers on Wednesday opposing the bill. Labor leaders are particularly dismayed at the proposal to finance the bill by taxing high-end health plans, which will affect many union workers.
"The Senate Finance Committee bill remains deeply flawed," said Gerald W. McEntee, president of the American Federation of State, County and Municipal Employees, noting the tax on health plans, lower subsidies, and the lack of a government plan or employer mandate. He warned, "Senate leaders must make major improvements in the bill before it moves to the floor of the U.S. Senate."
The problem is that addressing such concerns by liberals would mean a far costlier bill that is likely to add to the federal deficit, and thus violate a key pledge of President Obama. Moving the bill to the left will also undermine months of delicate negotiations that enabled Baucus to attract support of moderate Democrats as well as a lone Republican, Sen. Olympia Snowe.
In explaining her decision to vote for the bill in committee, Snowe cautioned that it shouldn't be used to predict whether she would support the final merged bill. "My vote today is my vote today," she said. "It doesn't forecast what my vote will be tomorrow."
Liberal writer Noam Scheiber worried that "if you alienate her during the forthcoming negotiations, her defection from the final bill would be disastrous. Just imagine the atmospherics of Olympia Snowe getting up on the Senate floor and saying she was so serious about passing health care reform she voted for it in committee, but that she can no longer support the bill because it's moved too far to the left. It would be absolutely devastating."
In a potentially more worrisome development for Democrats, Sen. Joe Lieberman revealed on Tuesday that he couldn't even support the Finance Committee legislation as it was, because he was "afraid that in the end, the Baucus bill is actually going to raise the price of insurance for most of the people in the country."
And none of this even takes into account the fact that even if Reid can come up with a formula to attract the support of 60 Senators needed to block any filibuster, any bill still has to secure passage in the House.
By creating a bill that passed muster with the Congressional Budget Office and attracted the support of a Republican, the Finance Committee emboldens Blue Dog Democrats in the House to oppose a more costly bill that includes a government plan. Meanwhile, House liberals still maintain that they will not support a bill that does not include a government plan modeled after Medicare.
"While I applaud the Finance Committee for completing its work on the bill, I remain concerned that it does not include a robust public option," Rep. Raúl M. Grijalva, co-chairman of the 80-member House Progessive Caucus, said in a statement via email. "I remain committed to getting the best bill in the House that we can get so that we have a strong negotiating position in conference. Today's Senate action does not reflect the country's high approval ratings for a public option, and I believe that any meaningful health care reform must include that vital element to increase access and bring down costs."
While on Tuesday the media was eager to declare the Finance Committee vote a momentum shift in the health care debate, the sense of victory may prove short-lived.
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