SBA Email Alert

SPBA Email Alert: – March 3, 2010

Health Reform Insights & Talking Points
Personal observations from SPBA President Fred Hunt

You are probably multi-tasking right now; reading this and listening to the President at the same time.  This is a reality check and to put into context what you are hearing.  All the pieces in the earlier e-mails still apply. This just describes some new twists that are taking place and the timetable.

Whether the President will actually say it or not, the Democrats now have a time schedule to pass health reform.  So, I’ll give you the dates and the reality-check factors of each.

By March 19th:  Target for House to vote to pass the mega Senate bill and send it  directly to the President, and it gets signed into law in 24 hours.

Reality check:   Many House Democrats strongly dislike portions of the Senate bill, so this is a giant leap of faith to go on record voting for things you hate, and especially since some divisive provisions, such as abortion & immigration almost certainly can not be rationalized as “budgetary” and thus put into a Reconciliation bill (though VP Biden, as President of the Senate, is ultimate  decision power of what can be in the Reconciliation bill).

So, Speaker Pelosi has said that the House won’t go out on this limb unless they have a letter signed by at least 50 Senators committing to pass a mutually-agreeable “tweaks”…meaning the same Reconciliation as the House passes + perhaps  another bill for changes that can’t be done via Reconciliation, although Pelosi has quietly indicated that abortion & immigration (issues with strong opinions in both chambers) might be dropped.  It is hard to imagine 50 Democrat Senators blindly saying they’ll vote for something not yet drafted.

By March 21st:  The House drafts a reconciliation bill to “clean up” (change things they don’t like) in the just-passed Senate version.  The wording of the Reconciliation is a delicate mine field. The changes the House would want are significant (such as public option), but what the Senate is apt to accept is minimal.  So, we are right back where we were last August as far as unsolvable disagreements.

Legislative Counsel says that the President’s health reform proposal (fleshed-out version of the outline at the Summit ) can not be introduced until the Senate mega version is passed by the House, so the Obama version is planned to be in the Reconciliation bill.

By March 23rd:  The Senate begins debate on the (House-drafted) Reconciliation bill.  Debate is limited to 30 hours, but unlimited amendments may be proposed, so this stage could drag out for weeks.

March 26th (the start of the Congressional Spring Recess) is the target to vote on Reconciliation.  The Democratic leaders’ goal is to get something voted (so Congressmen can’t later back down) before Congressmen go home and face voters during the Spring recess.

This is based on LOTS of wishful thinking, such as:

(1).  Will both liberal & conservative House Democrats who have strong problems with the mega Senate bill (but would demand opposing changes) be willing to make a flying leap of faith to, in effect, vote the mega Senate-passed health reform directly into law??  If Reconciliation or other attempts to make changes later stall, the House members would feel like chumps.   House members are already nervous sticking their necks out and making votes first on this explosive issue in an election year, leading into a home recess with voters, and knowing that the slower Senate process can drag out for weeks or months.

(2).  Will 50 Senators sign a document blindly promising to pass whatever Reconciliation bill the House comes up with?  That’s highly doubtful, even if this was not full of issues divisive among Democrats.

(3).  Will House & Senate be able to agree on word-for-word twin Reconciliation bills?

(4).  Will having the Obama version inserted into the process (and bitterness from many Democrats that Obama seems ready to accept 4 suggestions from Republicans while dumping key items of Democrats, such as public option and cost controls) smooth or muddy the Reconciliation and general legislative process on this?

(5).  Since the House & Senate barely had enough votes to pass their versions of the mega bills, is there any sign that some Democrats who voted “no” last time might be willing to now vote “yes” for the strategy described above?  The answer is yes.  For example, in the House, the following 9 Democrats who voted no before are rumored to be reconsidering and may vote “yes”.  So, Pelosi’s challenge to get enough votes to pull this off is much closer now than a couple of weeks ago.  Baird-WA + Boucher-VA + Gordon-TN + Kosmas-FL + Kravotil-MD + McMahon-NY + Murphy-NY + Tanner-TN

Other tidbits of news:

>>When advisors to a President start protecting their own reputations at the expense of the President (so as not to look like a loser) it is an indication that the bloom is off the rose of the Presidency and people who want to protect their reputations as political wizards want to distance themselves from what they think may be going down the tubes.  A series of articles praising Rahm Emmanual and leaving an unflattering view of Obama and his White House team is being interpreted as a giant sign.  Also, Tom Daschle, who was one of the key architects of the Obama health reform effort, is now bemoaning that it lacks cost controls.

>>Some ardent supporters of health reform, such as Health Care for American Now (HCAN) are shifting to guerilla warfare against AHIP, insurance companies, and even individual insurance execs.  The goal is to create the political correctness view that AHIP and its members are evil and “illegitimate”.  So, HCAN will try to disrupt the AHIP convention, picket insurance companies and even the homes of some insurance executives.

>>Bill Clinton’s stents recently got great praise from the press as a wonderful quick procedure when the former President had a heart scare.  However, whether stents are cost-effective is strongly debated.  If a health reform effectiveness panel were created to determine what would and would not be covered, stents (and/or other current popular procedures) might well end up dropped.  So, this is an interesting case example.  We know this worked for Mr. Clinton, but what if, next time, stents are not an approved option?

>>Democrats love to talk about Republicans in health care.  The story lines are that Republicans are the big obstacle to everything.  President Obama announces today that he is “exploring” 4 Republican ideas into his proposal (HSAs + medical malpractice + Medicare fraud & waste + addressing disparities among states in payments to providers by Medicaid).

However, as readers of these e-mails know, month after month the fierce battles are Democrat versus Democrat.  I just mention this as a reality check that when all sides are trying to hype their version of history, remember the truth.  It was not evil Republicans masterminding defeat for this health reform.  It was deep (and usually sincere) divisions within the Democrats.


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