WashACE Blog

Passing Obamacare without a Vote?

The Washington Post this morning reports that House Speaker Nancy Pelosi has grown fond a a particularly ingenious (devious?) plan for passing national health care.

Instead, Pelosi, D-Calif., would rely on a procedural sleight of hand: The House would vote on a more popular package of fixes to the Senate bill; under the House rule for that vote, passage would signify that lawmakers "deem" the health-care bill to be passed.

At Olympia Business Watch, Jocelyn McCabe takes note.

They're delusional if they think "deem and pass" gets them off the hook. It's a technicality. They're still voting. After the president promised that health reform negotiations would be broadcast on C-SPAN for all to see, Congress crafted the bill behind closed doors and cut back-room deals (e.g. the Louisiana Purchase, Cornhusker Kickback). And now, after demanding an "up or down" vote on health reform, they're hurtling toward passage with a parliamentary trick that avoids a public vote. Accountability?

In National Review Online, Andy McCarthy explains the procedure, how it has been used in the past, and why the precedents do not justify its use now. He concludes:

When there's a real dispute, they have to pass the bill the regular, constitutionally mandated way: Both houses on the exact same text, with every legislator accountable for his vote.

If, instead, the legislative process becomes a farce that departs from the constitutional procedures we are entitled to enforce, then it no longer represents the consent of the governed. It is the first American principle that government derives its just powers only from the consent of the governed, and when it takes on a form that becomes destructive of the fundamental rights of the governed, it is no longer legitimate.

This Wall Street Journal/NBC Poll demonstrates why the Speaker would like to avoid a vote.

WashACE Friday Phone Conference Podcast is Up

Listen to it here

And thanks to the members and supporters who joined us this morning. I'm looking forward to next week's conversation.

Baby Stepping to a Budget Solution

Budget writing generally happens outside the public view, so it might not be a matter of much ocncern that what's visible is not too exciting. Brad Shannon of the Olympian writes that the House is poised to vote tomorrow on an "early cuts" package. Estimated savings: $47 million.

The Associated Press reports on a package of bills under consideration to trim spending that digs a bit deeper.

Washington’s Legislature got a head start on its cost-cutting chores Tuesday, discussing bills that would close state offices once a month, extend a wage freeze for nonunion workers and trim about 175 full-time government jobs.

The measures are part of the Legislature’s plan for a quick response to the state’s budget deficit, pegged at about $2.6 billion through June 2011. Lawmakers hope to pass the bills soon and send them to Gov. Chris Gregoire for final approval.

A fourth bill, suspending cash bonuses for state workers, rounds out the Legislature’s proposed early savings plan. The overall savings of the package isn’t yet clear, but early estimates put the value at about $150 million.

The plan for once-a-month office shutdowns could save about $90 million, according to a preliminary estimate from legislative staff.

A couple of observations: It's hard to see any of this as a "head start" when the problem has been clear for months. And the numbers being discussed fall woefully short of what's required to solve the problem.

Flipping to the tax side of the budget, there's also not much definition. Shannon's story gives House Speaker Frank Chopp's thoughts. End a tax break for owners of private airplanes, search for loopholes, maybe something to do with the sales tax, maybe bottled water.

If past is prologue, we'll not get a clear picture for several weeks, maybe not until the last days of the session.

Although several of us have speculated that Scott Brown's victory in Massachusetts will hold up or, possibly, eliminate additional federal aid (see Kim Bradford's post at The News Tribune blog), Chopp minimized the impact.

...Chopp brushed off suggestions that the election of Scott Brown as U.S. senator from Massachusetts, filling the late Democratic lion Ted Kennedy's seat, won't affect the state’s efforts on health care. If health reform stalls, extra Medicaid money the state has angled for would be in peril, but Chopp said he doesn't think children's health funding would be jeopardized.

Still, $700 million or so must count for something. The Spokesman-Review has Sen. Majority Leader Lisa Brown's take:

State Senate Majority Leader Lisa Brown of Spokane said a complete health care reform package may not pass before the Legislature adjourns on March 11, but a separate bill that adjusts federal Medicare funding may pass because it has support from governors of both parties. [I think the reference should be to Medicaid funding.]

“We haven’t counted on it yet. Regardless of what happens, we’re going to try to avoid any cuts to the basic health plan,” Brown said.

Baby steps.

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.

Budget and Health Care - Joined at the Hip

And sooner or later, the grind may force us to consider hip replacement surgery, which may or not be covered, depending on our age, health status, or choice of a public option plan.

As the Senate takes up Harry Reid's health care legislation, the old nagging questions persist. Without apparent irony, the Washington Post carries this headline: In health care reform, no deficit cure. Not exactly, in vino, veritas, besides, I expect there's more vino than veritas in Senate chambers. Really, no deficit cure? From the WaPo:

"The hope that health-care reform would take care of our budget problem has evaporated," said Isabel Sawhill, a fiscal expert at the Brookings Institution.

Many budget experts also worry that lawmakers may not have the stomach to keep the new taxes and spending cuts intended to pay for the package. Republicans are already planning to offer an amendment to strike more than $400 billion in proposed Medicare cuts from the package, a move that would blow a huge hole in financing for the bill.

In merging bills drafted in committee, meanwhile, Reid significantly watered down two of the most important cost-containment provisions: a tax on high-cost health insurance policies that was opposed by labor unions and an independent commission that had been designed to automatically and methodically restrain Medicare spending. Senior White House officials have called those provisions critical, but House leaders are adamantly opposed to both.

Did anyone really believe that this thing would not only pay for itself but also cut the deficit? I doubt it.

While the Senate fusses with the bill, state governments are reckoning the costs and effects on their unbalanced budgets. Here's Tennessee Gov. Phil Bredeson, saying what most governors must be thinking.

A couple of polls show most of the public would prefer lawmakers move on to economic recovery and jettison the health care debate. Gallup reports 49 percent want their member of Congress to oppose the legislation, while 44 percent lean toward it. 

That's closer than I would have thought. Still, it's hard to see the numbers improving for the reformers.

Former and would-be Oregon Gov. John Kitzhaber thinks Congress has made a mistake by emphasizing access over costs. Here's the NPR coverage. 

"I don't believe that what's going to come out of Congress is going to have any impact on the medical cost inflation, which is what's really crushing individuals and businesses, and really putting the country at economic risk," he says.

There's much to dislike in Kitzhaber's plan - rationing, for example - but he's right to focus on costs.

The Massachusetts model, still touted in policy circles, tends not to be so highly regarded in the Bay State, where Rasmussen Reports that more voters consider it a failure than a success

In 2006, Massachusetts implemented its own statewide version of health care reform and 32% of the state’s voters consider that reform a success. The latest Rasmussen Reports telephone survey of the Bay State finds that 36% consider the plan a failure and another 32% are not sure. 

Smart, incremental reforms still make a great deal more sense than big government takeovers.

Gallup Links Health Care Reform to President's Declining Approval Ratings

Yesterday, the Gallup Poll reported that President Obama's average approval ratings in the third quarter dropped to 53 percent; down from 62 percent in Q2 and 63 percent in Q1.

...the 9-point drop in the most recent quarter is the largest Gallup has ever measured for an elected president between the second and third quarters of his term, dating back to 1953. One president who was not elected to his first term -- Harry Truman -- had a 13-point drop between his second and third quarters in office in 1945 and 1946.

Why?

The dominant political focus for Obama in the third quarter was the push for healthcare reform, including his nationally televised address to Congress in early September. Obama hoped that Congress would vote on healthcare legislation before its August recess, but that goal was missed, and some members of Congress faced angry constituents at town hall meetings to discuss healthcare reform. Meanwhile, unemployment continued to climb near 10%.

As mentioned in the previous post, there's not likely to be much relief in the unemployment area. And health care reform efforts aren't looking much better. Yesterday's defeat of the so-called "doc fix" is seen as a stunning rebuke to Senate leadership. Here's Heritage's take on it.

As we reported on Monday and Tuesday, yesterday’s “doc fix” vote was part of a White House Chief of Staff Rahm Emanuel strategy to smooth passage of President Barack Obama’s $1 trillion-plus health care overhaul by transferring a quarter of its cost into a separate, and completely unpaid for, bill.

And ...

Instead of the massive overhaul being pursued by the White House, a solid majority of Americans tell Gallup they want to see Congress move in the opposite direction. By 58% to 38%, Americans would generally prefer to see Congress deal with health care reform “on a gradual basis over several years” rather than “try to pass a comprehensive health care reform plan this year.”

Makes more sense that attacking insurance companies. When all else fails, do the right thing.

Politics, Polling and Promises of Health Care Reform

So far, health care reform continues to plague Congressional leaders and appears to be creating an electoral backlash for aspirant Democrats. Let's look at a couple of recent analyses.

In this morning's Wall Street Journal, John Fund blames national issues, especially health care, for leading to Democratic losses in special elections in Oklahoma and Tennessee.

Also in the WSJ, Peggy Noonan thinks she knows why Americans have soured on further expansion of government's reach: We know how it turns out. While the New Deal and Great Society represented new ventures, "virgin territory," things are different today.

Now the national terrain is thick with federal programs, and with state, county, city and town entities and programs, from coast to coast. It's not virgin territory anymore, it's crowded. We are a nation fully settled by government. We are well into the age of the welfare state, the age of government. We know its weight, heft and demands, know its costs both in terms of money and autonomy, even as we know it has made many of our lives more secure, and helped many to feel encouragement.

But we know the price now.

And it's one we're reluctant to pay. even if polling shows we don't know the details. (Then again, neither do a lot of the folks voting on the legislation.)

For example, as the Washington State Labor Council reports, labor unions have absolutely no interest in seeing new taxes on their health plans, as required under the Baucus bill.

These union-negotiated benefits are not "Cadillac Plans" offering excessive benefits. The benefits in these plans are roughly comparable to other plans, but provide for more limited cost-sharing.

That's a pretty big difference. Here's their justification.

Many union members have chosen to forego wage increases at the bargaining table in order to preserve their health care plans over the years. Now, the Senate is considering punishing these working-class families for that choice by targeting them with a new excise tax in order to avoid taxing wealthy families that can really afford it. That's why this new health-care excise tax is a deal-breaker for organized labor.

The "tax the rich" meme never grows old for some folks.

Centrist Democrat Al From has some good advice for Congressional leaders: Forget about the public option, concentrate on cost control, and deliver a bipartisan solution. I like his summary.

I'd personally like to see health-care reform include fees (as the president proposed) on Cadillac health-care plans, incentives to replace fee-for-service payments with more cost-effective models (the best way to bring down health-care costs over the long haul), and measures to limit abuses in malpractice suits (which Republicans have long called for).

Very sensible. Maybe when they tire of threatening insurance companies, they'll get around to it.

Massachusetts Denying Health Care Choice: A Preview of Federal Reform

This Boston Globe story offers a glimpse of what federal health care reform might look like. It's not pretty.

... a growing number of hospital officials and physician leaders warn that the new payment system proposed by a state commission would not work without restrictions on where patients receive care - an issue some providers say the commission and the Patrick administration have glossed over.

“You can’t reap these savings without limiting patients’ choices in some way,’’ said Paul Levy, chief executive of Beth Israel Deaconess Medical Center.

The Massachusetts health care model has been widely cited as a successful precursor to federal reform efforts. It's been plagued by high costs. Now, inevitably, bureaucrats are stepping in to control use.

And Congressional liberals continue the pressure for a public option.

The most robust public plan, favored by liberals and included in two of the House bills, would tie reimbursement rates for health care providers to those paid by Medicare, reducing the nation’s overall health care bill by $110 billion over 10 years, according to estimates the nonpartisan Congressional Budget Office has provided to lawmakers. The third bill contains an idea being pushed by centrist Democrats to negotiate reimbursement rates with providers, saving roughly $25 billion over 10 years, the budget office estimates say.

As House Democratic leaders try to meld those approaches, liberals like Representative Jan Schakowsky, Democrat of Illinois, said they saw support building for the stronger public option because it saves more money. “It’s the best cost-containment measure we can get,” she said.

Cost-containment ultimately means saying no to patients. No wonder proponents prefer attacking insurers to defending their alternatives.

So much for choice and competition.

U.S. Senate Finance Committee Passes Health Reform Bill; Insurance Companies in the Crosshairs

Yesterday, Maine Sen. Olympia Snowe joined the Democrats on the Senate Finance Committee to give a bipartisan gloss to the Baucus health care reform bill. The New York Times plays it as high drama, with Snowe herself saying hers was a vote of historic consequence.

“Is this bill all that I would want?” Ms. Snowe said. “Far from it. Is it all that it can be? No. But when history calls, history calls. And I happen to think that the consequences of inaction dictate the urgency of Congress to take every opportunity to demonstrate its capacity to solve the monumental issues of our time.”

According to the Times, folks noticed:

Ms. Snowe’s remarks silenced the packed committee room, riveted colleagues and thrilled the White House.

The Finance Committee action, while important, is far from the end of the game. And, as the Washington Post writes, the reformers' strategy is now clear: Demonize the insurance companies.

"The insurance industry has decided to lead the charge against health reform, and everyone recognizes their motives: profits," said White House deputy communications director Dan Pfeiffer. "We are going to make sure they can't sink this effort at the last minute."

Pfeiffer castigated the industry for releasing a report Monday that concluded that the finance panel's bill would increase costs for consumers. "They made themselves a very good foil," he said.

The industry's sin: Pointing out that the reform plan will cost families a bundle. Here's how PowerLine presents it, complete with graph:

Today's big news story is the release of a report by PriceWaterhouseCoopers on the impact the Senate Finance Committee's health care "reform" bill will have on health insurance premiums. PWC concluded that the cost of health insurance for the average family will rise by $4,000 by 2019, as compared with doing nothing:

The PWC analysis covered four features of the Baucus bill; the report acknowledges that other provisions of the bill could reduce costs slightly, but those reductions are very small compared to the effects discussed in the report.

The Washington Post reports that the messenger, PWC, comes under attack.

"Those guys specialize in tax shelters," said Nancy-Ann DeParle, director of the White House Office of Health Reform. "Clearly this is not their area of expertise."

Really? Assessing costs and benefits would seem to be right down the middle for PwC.

Former Clinton adviser Robert Reich hews the line.

Now's the time for Senate Finance Committee and the White House to say to the insurance industry: You want to play hardball? Okay. We'll play it, too.

Somewhere in all that hardball, the best interests of the American taxpayer has gotten lost. Most of us continue to be more concerned with getting the economy back on track than with the false urgency driving the health care debate. Be nice to see Congress join us.

More Confirmation of Voter Resistance to Proposed Health Care Reform

A new survey confirms what we posted on yesterday: Voters just aren't buying the health care reform the president and Congressional leaders are selling.

The Zogby International/O'Leary Report survey of more than 4,200 likely voters found that a large majority oppose key provisions of Obama and the Democrats' healthcare reform proposals, including plans to extend health insurance to as many as 50 million uninsured Americans and to incorporate a form of healthcare rationing in the reforms.

Jennifer Rubin at Commentary considers the findings.

The numbers are dramatically worse for ObamaCare in this poll than in other polls. Part of the explanation lies in the sample—likely voters seem to hate ObamaCare a lot more than do Americans generally (who may not even be registered to vote). Moreover, getting voters to think about specific aspects of the plan rather than the broad question of whether they like the “House Democrats’ plan” or “the president’s plan” (neither of which yet exist in fixed form) reveals just how averse to a government takeover of health care are those who will head to the polls in 2010.

Rasmussen Reports adds to the pile of negative polling numbers, finding things have reverted where they were before the president's speech to Congress and the rest of us.

Forty-five percent (45%) of all voters nationwide now favor the plan while 52% are opposed. A week ago, 44% supported the proposal and 53% were opposed.

Rubin also notes that the Zogby survey found that 78.5 percent of respondents believed tort reform is needed to reduce the cost of medical malpractice insurance.

That's the theme of AWB president Don Brunell's column in the Columbian.

Medical malpractice should be a central tenet of this massive health-care overhaul. Brushing the problem aside only inflates the $900 billion needed to pay for the reforms over the next decade.

George Will, in a scathing Newsweek column, addresses the issue this way.

[The president] says the nation's economic health depends on controlling health-care costs. Yet so important is the trial bar in financing the Democratic Party, he says not a syllable in significant and specific support of tort reforms that could save hundreds of billions of dollars by reducing "defensive medicine" intended to protect not patients from illnesses but doctors from lawyers.

The more voters see the inconsistencies, the less credible will be the efforts of the reformers.