What's next for health care reform?

J. Lester Feder of The Nation has a good summary of the next steps for health reform.

The Senate passed its version of the bill on Christmas Eve. Now, congressional leaders will combine the House and Senate versions of the bill to create a hybrid bill known as a conference report, which must pass both the House and the Senate before the president can sign it into law.

On the whole, the House bill is more progressive than the Senate version. For example, the House bill includes a public option, but the Senate bill doesn't, thanks to Joe Lieberman. The House bill would pay for reform by taxing the wealthy, the Senate version would tax high-cost health care plans.

Chances are, the final bill will look more like the Senate version. Amanda thinks that many observers are underestimating Speaker Nancy Pelosi:

I’ve been a little cowardly and not posting too much on the actual Senate bill because I don’t want to deal with the “kill the bill” crowd---or worse, people starting to talk third parties and other such nonsense---but I have been tweeting in support of getting through this process with our wits about ourselves, including reminding people that, contrary to mainstream media insinuations to the contrary, the House does matter.  The continued dismissal of Nancy Pelosi’s power has left me really uneasy, because I detect more than a whiff of unintentional sexism to it, though part of the reason that people overlook Pelosi is that she’s a publicly unassuming person.

Sadly, thanks to the institutional filibuster, the House really doesn't matter as much as the Senate. As Nate Silver explains at 538, Pelosi has way more flexibility than Reid when it comes to passing health care. Nate estimates that Pelosi has between 240 and 245 potential "yes" votes for final passage, of which she only needs 218. So, she can afford to lose some of the progressives who voted for the bill the first time if she makes up that support from more conservative Dems who voted "no" the first time. Reid absolutely needs 60 votes or the whole thing goes down in flames.

This flexibility is a drawback when it comes to negotiating in conference. Pelosi and Reid both want the final bill to pass. Reid knows that if the bill deviates from Ben Nelson's strictures on abortion, or Joe Lieberman's prohibition on the public option, the bill will die. In all probability, Pelosi can pass a bill without a public option. There's no way Reid can pass a bill that includes one. So, Pelosi has a lot less leverage in conference.

Comments

[Eric Jaffa]

My take on Nancy Pelosi in Conference is based on what she's said:

Nancy Pelosi, world's worst negotiator: "We want to defend our position" but "we have to yield on things."

Nancy Pelosi, world's worst negotiator: "The emphasis was not on 'public,' the emphasis was on 'option.'"

Nancy Pelosi, world's worst negotiator: "Whatever we have, it will be great."

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/12/17/MNGS1B5810.DTL&type=politics

[Brien Jackson]

For the life of me I don't understand why protecting the tax exemption on health benefits has become a "progressive" cause. It's not good for workers, it's really nothing but a tax giveaway to employers for converting wages into payments to insurance companies, and it's a big part of the reason wages aren't growing. Ending it ought to be a major progressive cause.

[Lindsay Beyerstein]

It's progressive because a lot of union workers traded wage increases for health benefits on the assumption that they would continue to be tax-free. I'd be okay with taxing expensive plans if they grandfathered in everyone who already has one and agreed to tax them from this point forward.

[Eric Jaffa]

It is good for workers to have a health-plan with low out-of-pocket costs, even if there are high-premiums paid by the employer.

Regarding "a tax giveaway to employers," it's the insurance company which has to pay the tax in the Senate bill (unless the employer self-insures.)

[Brien Jackson]

"It's progressive because a lot of union workers traded wage increases for health benefits on the assumption that they would continue to be tax-free. "

Well see, I'd argue that's exactly why it's very un-progressive; we're to the point where the real world effect of the exemption is that it's incentivizing workers to take a bad deal. The grandfather idea is interesting though.

[Wellescent Health Blog]

I can´t see anything other than the senate version of the bill coming into existence given the restrictions in the senate for the Democrats. That said, at least having the bill made into law will mean ongoing government interest in amending the bill and without the public eye on such activities, there is the possibility of different imaginative efforts at improvement.

[Ranjit Suresh]

"Sadly, thanks to the institutional filibuster, the House really doesn't matter as much as the Senate."

This perhaps, will be seen in the long run to be as substantial an issue as health care reform itself. The extraordinary metastasis of the filibuster over the last generation is propelling us towards a constitutional crisis.

The empty wastes of territories like Montana and North Dakota are the American equivalent of the unpopulated "rotten boroughs" that plagued Britain's Parliament until the Great Reform Act of 1832.

[LTACPartners]

The Senate seems to be holding all the cards when it comes to passing the health care reform bill. It would be surprising if the House did not lose significantly in the committee process.

www.ltacpartners.com/ltacnews

[Eric Jaffa]

Bob Herbert writes in the NY Times that the projected revenue from the "Cadillac Plans" tax is just a scam.

The projection of the "Joint Committee on Taxation" says that high-premium health insurance plans would be widely discontinued, and so the tax wouldn't directly raise much revenue.

But their projection assumes companies would give out so many raises after switching to cheaper health insurance plans that income tax revenue would skyrocket.

www.nytimes.com/2009/12/29/opinion/29herbert.html?_r=1

"A survey of business executives by Mercer, a human resources consulting firm, found that only 16 percent of respondents said they would convert the savings from a reduction in health benefits into higher wages for employees. Yet proponents of the tax are holding steadfast to the belief that nearly all would do so."

[Brien Jackson]

So Bob Herbert is the latest lefty to channel his inner Krauthammer. Whoopie

[Eric Jaffa]

Brien Jackson -

Charles Krauthammer is against both the House and Senate health-care bills.

The tax on so-called Cadillac Plans which Bob Herbert critizes is only in the Senate bill.

[minstrel hussain boy]

re: mandated insurance

i predict that the result will be exactly the same as when having car insurance was mandated by law. fewer companies will offer more expensive plans which cover less.

in california the abuses and excesses of the car insurors were so corrupt and blatant that an entire new branch of government was created to ride herd on them. the insurors simply shrugged their shoulders and bought them off. our first "commish" left office in disgrace when it was exposed that he had been bought off by the insurance companies in exchange for gobs and gobs of campaign cash. sic transit quakenbush.

as usual, with these types of things, the fix and the dodge will be in place long before the mechanism of check or balance is up and running.

the part that infuriates me is that when they are talking about health care reform, they are talking about insurance.

how about talking about doctors? huh? do they fit into this whole fucking mess anywhere?

(i have one of those soon to be taxable plans through my union. as lindsey reported, that health care was something that was offered in lieu of pay raises. of course, being half native american i am very used to hearing promises of things for "as long as the grass grows" and i tend to take them with a grain of salt and make sure that i have a fall back plan)

[Thomas]

Why not let the Republicans filibuster? Bring the legislative process to a halt and then get the whole Democratic party get on the same page saying "the Republicans are the roadblock... yadda, yadda, it's all their fault" exactly the same way that the republicans would if the positions were reversed

[Brien Jackson]

"Why not let the Republicans filibuster?"

We're a bit past that point.

[Sean]

"or worse, people starting to talk third parties and other such nonsense"

Yeah, what nonsense. Just keep on supporting the Dems expecting something different than what you've been getting for the last 40 years. That'll work.

Don't forget to support healthcare "reform," because the Dem's plan will magically transform into single payer right before our eyes.

[Alon Levy]

Lindsay, what you say about unions trading wages for health benefits is historically inaccurate. The big manufacturing and public sector unions traded fighting for universal health care for health benefits for their workers, in the 1940s and 50s; they also had high wages, but the health insurance and pension benefits were an agreement to deny the same benefits to poorer people, not an agreement to raise workers' living standards.

It's weird that liberals would sympathize with people making $55 an hour in wages and benefits whose activism has historically been about denial of benefits to people making far less, and is now having the government subsidize their privilege.

Also, I'm not sure where Amanda got the idea that people are attacking Pelosi only. The attacks I've seen linked on 538 are on Reid more than on Pelosi. It's true that both liberals and conservatives underrate Pelosi's back room competence, but I think Reid has always caught a lot more flak for failing to act on the liberal agenda.

[Lindsay Beyerstein]

Yes, the big manufacturing unions gave up on universal health care--to their everlasting shame and detriment. I'm not talking about a strategic blunder that happened before we were born. I'm talking about what happens every day at bargaining tables all around the country: Workers accept extra benefits in the form of insurance instead of cash raises because the tax implications are favorable.

[Alon Levy]

I don't think workers really get a choice there. Employers have to provide coverage to all employees, to avoid adverse selection; that's one of the conditions of tax exemption.

Even for unions, it's not really a choice. The alternative to employer-provided coverage up until now has been no coverage, or the volatile individual market. It's likely that in an environment where there are more generous subsidies for the working class to purchase insurance, and where discrimination based on preexisting conditions is illegal, those workers and the service unions would have chosen to go for higher wages instead. (Ideally, we'd ask SEIU for its opinion - I believe it's positive about the overall package. On the other hand, SEIU's activism nowadays seems to center around raiding member unions at random.)

[Lindsay Beyerstein]

Workers get their choice when they vote on their contract. The details of the contract get hashed out at the bargaining table between union negotiators and management. What demands the negotiators make, and what they're prepared to give up in return depend on the relative value of the different options.

[Yourtime]

I agree with this. The life of me I don't understand why protecting the tax exemption on health benefits has become a "progressive" cause. It's not good for workers, it's really nothing but a tax giveaway to employers for converting wages into payments to insurance companies, and it's a big part of the reason wages aren't growing.

[TMH]

Let me see if one working mom can answer that question.

Without the tax exemption on health benefits, it is likely that most employers will drop coverage all together. Without a public option, people will be forced into the private market. Families like mine, with several pre-existing conditions? Good luck finding an affordable plan that will give us nearly the coverage we get from my job. Meanwhile, as noted above, employers will funnel the savings not to their workers, but to shareholders and CEOs.

Until there is a robust public option, I'll keep my employer-based insurance, thank you very much.

[smchris]

Guess it depends on how much Little Miss "Impeachment is off the Table" depends on insurance company contributions. I certainly am no longer naive enough to believe she has courage or principles.

[Weaseldog]

You folks are not giving Nancy Pelosi enough credit.

She has worked very hard to be a good negotiator. During the Bush administration, she negotiated with her party (cracked the whip) and got them to cave on every fantasy, wish and wet dream that Bush and friends proposed.

She understands that negotiation is the art of avoiding confrontation, by caving on every request. and she cracks the whip to make sure that her party falls in line. Which it does.

As a Republic Concubine, I'm that she'll work hard to make sure that Lieberman gets everything he desires.