22 February 2010

Back from the dead

zombies

No, not a horde of shambling zombies murmuring "Braaaiinnnsss..." although that does make for a lovely mental image.  It's the President's health care reform effort which has been most improbably resuscitated (again).

In case you missed it, there is a health care summit occurring at the White House this thursday, and everybody's invited (except me, as usual).  President Obama set the stage today with the release of his health care bill.  Except it's not really a bill.  It's a set of minor (or not so minor) adjustments to the bill which the Senate has already passed.  It's designed to make the bill, which is substantially more conservative than the now-dead House bill, tolerable if not acceptable to House liberals, and to remove some political distractions.

You can read the 11-page summary here [PDF], or just click through to Igor Volsky's excellent summary.  Or if you're too lazy even for that, here's the executive-executive summary:
  • Affordability - more generous subsidies to lower and mid-income families
  • Excise tax on high-cost insurance - still present but weakened and deferred till 2018
  • Payroll tax on high-income earners, no income tax surcharge (as in House bill), also taxes certain investment income
  • Individual mandate - weakened a bit but still present
  • Employer mandate - none, but with free rider provision for large employers strengthened
  • Insurance exchanges - state based, begin in 2014
  • Insurance regulations - no recission, pre-existing condition exclusions, no lifetime limits, preventative services must be covered.
  • Medicare donut hole - completely closed
  • Public option - absent
  • Anti-trust exemption for insurers - not repealed
  • Nebraska Medicaid deal - removed
  • Total cost -- increased by $75 billion (not sure what the revenue changes are or whether it is still deficit-reducing, since the CBO has not yet scored it).
  • Medicare Advantage - not ended, but will slowly phase in payment reductions to insurers administering it to bring back to medicare baseline
There's actually a lot more -- community health center investments, increased measures to restrict medicare waste and abuse, encouring generic drug availability and more.  I am not entirely sure whether these are new or are elements tossed in from the House bill.

Politically, this is going to be highly entertaining.  The GOP's response so far is incoherent at best; they called on Obama to post his proposal online at least 3 days before the conference so it could be reviewed, and then criticized him for doing so, complaining that it precluded any negotiation.  The White House counters that this is merely their "opening bid" in discussions, but the GOP seems fairly set in refusing to discuss any reform efforts that do not include a complete scrapping of the whole measure.  The White House is also trying to emphasize that this is a highly moderate bill, even setting up a special web site to trumpet the Republican ideas and amendments already included in the reform bill.

Most tellingly, if the GOP remains steadfast in its refusal to engage in any meaningful compromise, the White House is signaling that they are prepared to move through reconciliation and pass the bill without any republican support.  Clearly they have made the political calculation that it would be better to pass the bill and run in November on a record of accomplishment, even with a bill that is less than they would have liked and tarnished in the public eye than it would be to run having failed in their signature effort.  (Note, though, that much of the public opposition to the health bill is from the left, on the basis that it does not go far enough.)  If the GOP does not play ball (as it certainly appears they will not), then they are quite likely to get completely steamrolled, if the democrats avoid shooting themselves in their own feet (again).

It's also important to note that the process here does not require a whole new bill -- the Senate bill is already passed through the 60-vote filibuster, and the House can simply pass it as it is.  The reconciliation process is a majority-rules vote with only 50 votes needed.  So long as the House can hold its skittish caucus together, the legislative door is wide open for the Democrats to walk right through.

Jonathan Chait over at TNR makes a wonderful point about the freakout that we are going to witness from the GOP if the Democrats are ultimately successful in getting across the finish line:
Ever since Scott Brown beat Martha Coakley, conservatives, with very few exceptions, have been convinced that health care reform is dead. ... All the Democrats needed to do was have the House pass the Senate bill. If they insisted on changes, most of those could easily be made through reconciliation, which only requires a majority vote in the Senate. Most conservatives paid no attention to this basic reality, though they did indulge in some gloating mockery of those of us who pointed it out. ... You can imagine how this feels to conservatives. They've already run off the field, sprayed themselves with champagne and taunted the losing team's fans. And now the other team is saying the game is still on and they have a good chance to win. There may be nothing wrong at all with the process, but it's certainly going to feel like some kind of crime to the right-wing. The Democrats may not win, but I'm pretty sure they're going to try. The conservative freakout is going to be something to behold.
Given the freak-out we've already seen over this bill (I can't remember whether Obama is supposed to be Hitler or Mao any more) I can only imagine.


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