Snapler

February 18, 2010

Public Option, Medicare Buy-In Could See Senate Floor Fights

Real health care reform is threatening to emerge from the ashes of the Massachusetts special election that exploded the effort in January. A growing movement in the Senate to urge Majority Leader Harry Reid (D-Nev.) to reinsert the public option into a health care reform package that would move through the chamber under majority-only rules depends on just how many votes backers can muster.

"Senator Reid remains a strong supporter of the public option, but it's always a question of where the votes are," Reid spokesman Jim Manley told HuffPost.

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December 16, 2009

Tom Coburn Demands 12-Hour Reading Of Single-Payer Amendment On Senate Floor

The GOP mantra, repeated at Tea Parties all summer, was that lawmakers and voters ought to "read the bill" in order to truly understand the many ills of health care reform.

Sen. Tom Coburn (R-Okla.), on Wednesday, did his part to help out those who can't read legislation themselves, and asked the Senate clerk to read a single-payer amendment from Sen. Bernie Sanders out loud on the Senate floor. The reading of the 767-page amendment is expected to take about 12 hours. [UPDATE: Several hours into the reading, Sanders took the Senate floor and withdrew his amendment.]

Sanders, an independent from Vermont, first filed his amendment on December 2, so the GOP has indeed had two weeks to read it.

By jamming up Senate business, Coburn's move prevents a vote on a funding bill for the Department of Defense. The current funding provision expires at midnight on Friday.

Coburn said he was doing Americans a favor. "I admire Senator Sanders for his willingness to fight for publically [sic] what many advocate only privately -- a single payer health care system funded and controlled by bureaucrats and politicians in Washington. Every American should listen to the reading of this amendment and pay careful attention to its vote tally," Coburn said in a statement.

"The American people deserve to understand the competing approaches to reform in the U.S. Senate. It's unfortunate that Senator Reid waited until the last minute to introduce his bill and now wants to rush it through the Senate. This reading will provide a dose of transparency that has been lacking in this debate."

The group, "Senate Doctors," a Republican coalition of lawmakers with medical backgrounds, re-tweeted that Coburn was "a rockstar."

Senate Democrats are powerless to prevent the full reading of the amendment due to parliamentary rules. And they don't appreciate the favor. "The only thing that Sen. Coburn's stunt achieves is to stop us from moving to the DoD appropriations bill that funds our troops -- not exactly the kind of Christmas gift that our troops were expecting from Dr. No," said Jim Manley, senior communications adviser to Senate Majority Leader Harry Reid (D-Nev.).

Coburn has a long and unapologetic career of standing in the way of Senate business.

Sanders provided a summary of his amendment to colleagues: "This amendment would establish a single payer health insurance system that would cover every person legally residing in the United States. The single payer system would be regulated and funded by the federal government through a payroll tax and an income tax, but it would be administered by the states. It would replace the coverage and revenue titles of the current bill, but it would leave in place most of the provisions in the quality, prevention, and workforce titles of the bill. This amendment starts from the premise that health care is a human right, and that every citizen, rich or poor, should have access to health care, just as every citizen has access to the fire department, the police, or public schools."


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December 11, 2009

Senate Bill Provision Creates Private Industry Rationing: Reform Advocate

A major health care reform group is criticizing a provision in the Senate health care reform bill that would cap the cost of medical care that consumers could have on a yearly basis.

In a conversation with the Huffington Post, Richard Kirsch, national campaign manager for the pro-reform group Health Care for America Now, said that imposing limits would essentially institutionalize the rationing of care within the private health insurance industry.

"This is one more example of a way the insurance industry want to ration people's care to protect their profits," Kirsch said. "It is a total gift to the insurance industry."

The annual cap has actually been in the text of the health care legislation since the Senate Finance Committee introduced its final product. But it was given scant attention until the Associated Press reported on it on Friday. Under the language, the administration would set limits on the dollar value of medical care an insurance company could provide to a consumer; though there would no lifetime limit on dollars spent.

Negotiators on the Hill viewed this as the most reasonable compromise to a tricky debate; one that will ensure that a single costly consumer doesn't raise premiums for others. Congress could have conceivably taken three approaches: eliminate all limits, allow the status quo to persist -- in which private insurers essentially set their own limits -- or allow the government to enforce a limit that was not "unreasonable."

"One of the goals of our bill is to reduce costs to American families who are being crushed by skyrocketing health care costs," Jim Manley, a spokesman for Senate Majority Leader Harry Reid (D-Nev.) said of the decision. "We are concerned that banning all annual limits, regardless of whether services are voluntary, could lead to higher premiums. We continue to work with experts on how best to accomplish our goals of preventing insurance companies from imposing arbitrary coverage limits while providing the premium relief American families need and deserve."

Efforts to balance the need for cost-effectiveness with moral fairness have proven tough for Senate negotiators. An earlier form of health care legislation, crafted by the Senate health committee, eliminated all caps (both annual and lifetime) -- a reform that Kirsch and others support.

"The whole purpose of insurance is to spread risk among everybody," he said. "By their same logic, you shouldn't have health insurance at all. Because someone is going to cost a lot and everyone will have to pay for it."

As an example of where he thinks such a policy fails, Kirsch pointed to the hypothetical case of a patient with a costly and recurring disease. Under the Senate's plan, such a patient would be fine, provided that his or her medical care comes under a certain dollar amount each and every year. But if expensive surgery were required one year (even if little medical care was required in other years) the patient would have to make out-of-pocket payments for the coverage that exceeded the limit.

Aides on the Hill say that they included other provisions in the legislation to ensure that such developments occur irregularly, if at all. The current legislation will have subsidies to help individuals who have serious, life-threatening illnesses, as well as subsidies for those who have trouble affording coverage on their own. A push for increased investment in wellness and prevention, meanwhile, is designed to preempt costly illnesses from occurring in the first place.

One Democratic source with knowledge of the legislative compromise noted that many large employees, as well as some union-negotiated plans and state high-risk insurance pools have implemented caps already as a means to keep premiums down across the board. The source also pointed out that the Secretary of the Treasury -- which will set the limits -- would be far more generous in setting the caps than private insurers themselves.

"The language in the Senate bill leaves a lot of discretion to the Secretary of the Treasury to determine what is reasonable and unreasonable with respect to a cap," said the source. "Premiums would go through the roof if we eliminated annual limits."

December 7, 2009

Health Care Reform Could Skip Final Step, Roll Right Through House

The health care reform bill that passes the Senate might be the one that ends up on President Obama's desk, bypassing the usual House-Senate conference committee and avoiding another 60-vote threshold to end a filibuster.

There is increased chatter on Capitol Hill about a possible "ping-ponging" of the Senate health care bill: that chamber would pass its health care bill, send it to the House and the House would be asked to pass it with no changes and send it directly to the president.

That limits the options of congressional critics -- under the usual procedure, lawmakers dissatisfied with the bill pushed through their chamber can win changes through adroit political maneuvering in conference committee negotiations.

"It's the only scenario by which we could actually get this whole thing done before the New Year. The House has indicated they'd consider it, depending on what the final bill looks like over here after we finish with the sausage-making," said a senate Democratic aide involved in the health care fight.

Senate Majority Leader Harry Reid (D-Nev.) is currently negotiating what's known as a "manager's amendment." That amendment includes large and small concerns that senators want worked out before voting to end a filibuster. If Democrats decide to ping-pong the bill, the manager's amendment becomes, in effect, the only place to work out differences.

"I've started hearing about it in the last week or so," said Jim Kessler, head of the group Third Way. Kessler, a former senior aide to Sen. Chuck Schumer (D-N.Y.), is working closely on health care negotiations and said he's heard talk of the ping-pong plan coming from the Hill.

"You would need pre-conference negotiations. That pre-conference negotiation would be what ends up in the manager's amendment," he said. "Essentially, the manager's amendment becomes the new conference."

Kessler said that if it can be done, it should be done. "You've got to keep your eyes on the prize, and the prize is health care reform," he said. "I think it's a great idea if it means health care reform gets passed... Eventually, they're going to have a bill that passes both houses. If you can do it without the long, arduous process, why not?"

Spokespersons for both Senate Majority Leader Harry Reid (D-Nev.) and House Speaker Nancy Pelosi (D-Calif.) declined to comment.

Reid and President Obama, of course, do not run the House. They would need the sign-off of Pelosi, who would need the approval of her caucus. To get such approval, the manager's amendment would need to sufficiently address House concerns. Pre-conference negotiations -- or, in this case, pre-manager's amendment -- are not currently ongoing at the staff level, said Jim Manley, senior communications adviser to Reid.

The plan risks infuriating the party's progressive base, which is much happier with the House bill than the Senate effort.

"As it stands, the House bill makes health care much more affordable for people than the Senate's bill. And right now, there is a real possibility that the House will be expected to swallow the Senate's bill without making these improvements. There are two legislative bodies and both have a say in what reform looks like -- this shouldn't be news to members of the Senate," said Lori Lodes, a spokeswoman for the Service Employees International Union, which is heavily involved in health care negotiations.

The differences between the House and Senate approaches are legion and House sources say the lower chamber is very unlikely to rubber stamp a bill agreed to by the White House and Senate. The House relies, to a significant extent, on a tax increase on the wealthy to fund reform; the Senate instead taxes some health insurance plans. The House allows the government to negotiate for lower drug prices and otherwise requires a greater commitment from drug makers than the Senate bill does. The House plan covers more people and includes a public option; the fate of a government plan on the Senate side is uncertain. Major parts of the House plan kick in a year earlier -- in 2013 -- than in the Senate bill. And then there's abortion.

Those difference, among others, will need to be bridged at some point, whether it's in conference or earlier. If they're not -- and if House progressives think they've been rolled -- then they might bail. The House bill only passed with a margin of five votes.

"The whole point is we tolerated negotiated rates and tolerated having to watch the Senate work its machinations, with the whole hope that in conference the House will go in strong," said Rep. Raul Grijalva (D-Ariz.), co-chair of the Congressional Progressive Caucus. "For a lot of progressives that have relied on conference as the vehicle to save the public option, it becomes a very, very difficult vote."

Grijalva told HuffPost that the strategy would require progressives to back down so that the president could get a symbolic win. "Progressives will be jammed into a corner and once again asked, 'You've got to do this for the president so he can give a State of the Union address,'" he said. "As much as the State of the Union becomes critical, this is not something we can get beaten up on to vote for."

Grijalva noted other significant differences in the way that the bills treat the pharmaceutical industry and that the Senate bill lacks a revocation of the insurance industries' anti-trust exemption. "It becomes a conscious call," he said. "That would be a vote that I could not take."

Regardless of when those differences are hashed out, said Kessler, they have to be addressed at some point. Better sooner than later, he said. "You'd have to do it with the concurrence of the House. This has to be a two-step process," said Kessler. "If you can do it now, why not do it now?"

If the House refuses to play along, it could either amend the bill and send it back for an up-or-down vote in the Senate, or go to a conference committee. "If the House doesn't like it, they'll send it back with changes. Then it truly is ping pong," said Kessler.


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December 2, 2009

GOP Senator Pens Obstruction Manual For Health Care

Sen. Judd Gregg, (R-NH) has penned the equivalent of an obstruction manual -- a how-to for holding up health care reform -- and has distributed the document to his Republican colleagues.

Insisting that it is "critical that Republican senators have a solid understanding of the minority's rights in the Senate," Gregg makes note of all the procedural tools the GOP can use before measures are considered, when they come to the floor and even after passage.

He highlights the use of hard quorum calls for any motion to proceed, as opposed to a far quicker unanimous consent provision. He reminds his colleagues that, absent unanimous consent, they can force the Majority Leader to read any "full-text substitute amendment." And when it comes to offering amendments to the health care bill, the New Hampshire Republican argues that it is the personification of "full, complete, and informed debate," to "offer an unlimited number of amendments -- germane or non-germane -- on any subject."

The details of Gregg's outline are a clear reflection of the extent to which Republicans are turning to the Byzantine processes of the Senate chamber as a means of holding up reform. And doing so with eagerness. Take for instance, the section on offering a "point of order."

"A Senator may make a point of order at any point he or she believes that a Senate procedure is being violated, with or without cause," he writes. "After the presiding officer rules, any Senator who disagrees with such ruling may appeal the ruling of the chair--that appeal is fully debatable. Some points of order, such as those raised on Constitutional grounds, are not ruled on by the presiding officer and the question is put to the Senate, then the point of order itself is fully debatable. The Senate may dispose of a point of order or an appeal by tabling it; however, delay is created by the two roll call votes in connection with each tabling motion (motion to table and motion to reconsider that vote)."

Senate Majority Leader Harry Reid's office pounced on such a vivid example of Republican instransigence. "Just in time for the holidays, here it is in black and white, the Republicans' manual for stall, stop and delay," said Jim Manley, Reid's spokesman. "And what do the American people get? -- higher costs and less coverage. What kind of present is that?"

Even if health care is passed out of the Senate, Gregg has outlined ways in which Republicans can slow its passage.

"The Senate must pass 3 separate motions to go to conference: (1) a motion to insist on its amendments or disagree with the House amendments; (2) a motion to request/agree to a conference; and (3) a motion to authorize the Chair to appoint conferees. The Senate routinely does this by UC [unanimous consent], but if a Senator objects the Senate must debate each step and all 3 motions may be filibustered (requiring a cloture vote to end debate)."

Considering the already lethargic pace of health care reform, this is an illuminating reminder of how Republican's are putting their energy into dragging out the process rather than affecting the legislation.

HERE IS THE FULL LETTER:

Larger size.


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November 25, 2009

Battle Between David Broder And Harry Reid Heats Up: Broder Comments ‘Mind-Boggling’

David Broder simply doesn't understand the way that today's Senate operates, Jim Manley concluded on Wednesday. Manley, the senior communications adviser for Majority Leader Harry Reid, said that the longtime Washington Post columnist's charge that Reid pales in comparison to former Senate leaders misunderstands the way the contemporary Senate works.

"It's all fine and dandy to pine for the golden days of yesteryear, when politics was practiced differently, but that's not the reality we're dealing with," Manley told HuffPost. "What David fails to understand is that Republican leadership in both the House and the Senate are being pulled along by the so-called birthers, the Tea Party movement and other far right fringe groups that are completely at odds with the views David claims to hold."

Manley said that Broder's failure to see the GOP for what it is today is common among Washington-based pundits.

"David might be one of the worst examples, but he highlights a myopic, inside-the-belt phenomenon that is at odds with the views of many Americans," said Manley. There's even a term for such thinking: Broderism.

The Broder-Reid spat broke into the open on Saturday night when Reid dismissed him as "a man who has been retired for many years and writes a column once in a while." (Broder has taken a buy-out from the Post but continues to write two columns a week on a contract basis.) Reid was peeved at a column Broder had written accusing the Senate bill of not cutting costs adequately.

It may seem petty, but the Reid-Broder battle is a proxy fight between two competing approaches to politics. Reid, by attacking Broder, puts himself on the side of those attacking the Washington politico-media establishment.

"Maybe I have an idealized view of what a Senate leader ought to be," Broder told Politico Wednesday for a story headlined: "David Broder: Harry Reid's no Mike Mansfield." "But I've seen the Senate when a leader could lift it to those heights...I wish it had that kind of leadership now."

That's not possible, said Manley, because Mansfield and Lyndon Johnson, revered Senate leaders, had a Republican Party willing to work across the aisle.

"LBJ had Robert Taft [R-Ohio], William Knowland [R-Calif.] and Everett Dirksen [R-Ill.]. Mike Mansfield had Dirksen and Hugh Scott [R-Pa.]. What David fails to acknowledge is that the current Repub leadership is betting on the president to fail," said Manley.

"Why he can't understand that is mind-boggling."

"That's an interesting argument and certainly there are differences between the people now and the people then and the environment that was there," Broder told HuffPost. "But if that's their effort to explain why Senator Reid has chosen the tactics that he's chosen, that doesn't strike me as an adequate explanation."

Broder disputed Manley's contention that the GOP blocks everything. "It is not a fact that the Republicans have refused everything. At least we don't have much evidence of that so far. If he's talking about a specific reaction to the pieces of the Obama agenda that have come up so far, then he's in effect saying Obama is so frustrated that he's about to abandon everything. I don't suspect it's the case. When the first measure relating to Afghanistan comes to the floor that generalization will collapse."

Broder is probably right that the GOP will back Obama in his effort to expand the war in Afghanistan, but Manley was arguing more on the domestic policy front.

He references the fight to pass an unemployment insurance extension, which the GOP eventually supported but slowed down for several weeks.

"How David can make this kind of comment after UI bill is beyond me. It took more than four weeks to pass a bill in the senate that it took the House an hour to pass on the suspension calendar," said Manley.

Broder acknowledged the unemployment point. "It's a good argument as it implies to the unemployment extension. There have been many occasions where I have been very critical of the Republican stance."

"It is a different Senate now and if I were writing on that topic -- Mansfield, Baker, LBJ and so on -- we might very well agree. But that was not the subject of that column and in my mind, that is not a particularly powerful or relevant rebuttal to the subject I was talking about, which is whether or not the potential savings everybody knows are needed are there in the bill Senator Reid brought to the Senate floor."

Manley had specific gripes about Broder's health care column, in which he cited deficit hawks to make the case that the Democratic Senate bill might not reduce costs.

Manley said that Broder's column was discussed by "puzzled" Democrats in the Senate cloakroom. "No one could understand it," said Manley. "We had the self-described gold standard of analysis - the CBO - highlighting that the bill reduces the deficit. And David utterly failed to acknowledge that was the case."

Broder often refers to the Congressional Budget Office with the highest praise, but relied mostly in his column on "experts" who proclaim themselves "bipartisan" but whose goals are to dismantle Social Security, Medicare and other vestiges of the New Deal.

Broder's argument was dismissed by his colleague at the Post, Ezra Klein. Broder, however, said he didn't have to look far to find people who agreed with him - which is, in fact, one of the biggest problems the blogosphere has with his type of writing and thinking. "It was hardly a unique viewpoint," Broder said accurately.

If Broder thinks that the GOP is genuinely willing to work with Democrats, the only centrist position between he and Reid might be in agreeing to disagree. "We have a Republic leadership betting on the president to fail," said Manley. "David's problem is he thinks this is all on the up and up."