National Health Care Reform Not a Done Deal

Although the U.S. Senate appears ready to pass its version of health care reform by the arbitrary Christmas deadline, there's still a long journey ahead. The Heritage Foundation's Foundry blog highlights the six key issues the House must cave on before the bill becomes law. Including differences in tax provisions, employer/individual mandates, Medicaid expansion, and abortion, the issues are not trivial. Nonetheless, Heritage notes:

For each option, choosing one version over the other will have huge consequences for the American people. But since Sens. Joe Lieberman (I-CT) and Ben Nelson (D-NE) have threatened to veto the bill if any significant changes are made by the House in conference, it is most likely the Senate will prevail on every issue. Speaker Nancy Pelosi (D-CA) might even just save herself and the leftist majority in the House the embarrassment and pass the Senate bill as is.

The New York Times also considers the differences, letting Sen. Joe Lieberman explain the power imbalance between the chambers in striking a balance.

Senator Joseph I. Lieberman, independent of Connecticut, said, “There is a natural tendency to split the difference between the Senate and the House.” But on major issues in the health bill, Mr. Lieberman said, “splitting the difference means you won’t have 60 votes in the Senate.”

The public continues to reject the reform, with the latest Quinnipiac Poll registering 53 percent disapproval. As Ted Van Dyk points out in a long year-end piece considering politics in 2010, 

The history of major domestic reforms is that they cannot be sustained unless passed on a bipartisan basis. The pending health-care package was a Democrats-only exercise that got the necessary 60 Senate votes only at the cost of outrageous payoffs extended to favored states and industries by Majority Leader Harry Reid.

Not only unpopular and partisan, the measure may also be - at least in part - unconstitutional. Stateline.org reports that seven Republican attorneys general. including Washington AG Rob McKenna, are investigating the Cornhusker provision - the deal Nebraska Sen. Ben Nelson secured for his crucial vote.

“The Nebraska compromise, which permanently exempts Nebraska from paying Medicaid costs that Texas and all other 49 states must pay, may violate the United States Constitution -- as well as other provisions of federal law,” Texas Attorney General Greg Abbott (R) said, according to The Dallas Morning News.

And in today's Wall Street Journal, constitutional scholar Richard Epstein argues that the regulatory structures established by the reform turn insurance into a public utility.

Taken together, these restrictions are likely to drive [insurance companies]  out of business and run afoul of the constitutional guarantee that all regulated industries have to a reasonable, risk-adjusted, rate of return on their invested capital.

The Heritage Foundation raises additional questions about the measure's constitutionality.

Although it is always difficult for the Supreme Court to thwart what is perceived to be the popular will, polling consistently shows that this legislation faces strong popular opposition. If that remains true after enactment, the majority of the Justices who are inclined to preserve the enumerated powers scheme and adhere to the original meaning of the text will have little inclination or incentive to stretch the Constitution to reach so decidedly unpopular and far-reaching a law as this one.

A pair of Tennessee lawmakers - likely to be joined by others across the country - contend that the reform's Medicaid expansion violates state sovereignty. 

And in our state, we have a mirroring of the come-apart between progressives and, what, pragmatic Democrats on the bill. Rep. Brendan Williams tears into the legislation, calling it a reform that does little more than force more Americans into a broken system.  State Democratic Chairman Dwight Pelz, on the other hand, labels the bill an historic victory for working families. 

The Seattle Times gets it right.

To us — and to the American people, if polls tell the true story — the top issue is the economy. We wish Congress would focus on that and, for the moment, set this expensive health-care package aside.

Yep.