The HealthCare Follies Continue

If I could make sense of the health care mess.... well, maybe I can, but let's start with the storyline.

First, over the weekend, the Democrats announced that they were pretty much giving up on getting everyone in Bart Stupak's coalition to come back into the fold...

Stupak notes that his negotiations with House Democratic leaders in recent days have been revealing. “I really believe that the Democratic leadership is simply unwilling to change its stance,” he says. “Their position says that women, especially those without means available, should have their abortions covered.” The arguments they have made to him in recent deliberations, he adds, “are a pretty sad commentary on the state of the Democratic party.”

They may get some of stupak's coalition, but not all.  Stupak's more electrifying charge (that Democrats actually argued that the amendment created more costs due to more babies being born) is apparently an argument he's heard from individual Democrats, but not the House leadership. It's still pretty appalling, and sure as hell sounds like a death panel, as Allahpundit noted. The U.S. Conference of Catholic Bishops, who previously backed the House bill, have now jumped ship. Perhaps they don't believe the Senate simply made a typo in another provision that could lead to publicly-funded abortions...

Liberals wanted to expand the reach of community health centers, which have provided low-cost health care to people in underserved areas since the 1960s. And they wanted the health care bill to commit $7 billion for these health centers. The moderates agreed, and new language was hurriedly added to the Senate bill.


"This is all stuff that was inserted late at night and they were trying to reach a final agreement" on the bill, says Timothy Jost, a professor and health law expert at the Washington and Lee University School of Law. Unfortunately, no one remembered to write in an explicit provision explaining that this $7 billion in spending for the health care centers would be subject to all the usual restrictions on how federal money is spent. One of those restrictions, the so-called Hyde Amendment, prohibits most federal funding for abortions.


..."It seems that this is something that slipped by," Jost says, "because elsewhere in the bill they made [funding] subject to [the Hyde amendment]."


And that's how a silly slip-up allowed the anti-abortion forces to issue the dubious claim that this bill will unleash a flood of federally-funded abortions. But though the Democrats' omission makes it easier for anti-abortion rights groups to claim the community health care ceneters funding could pay for abortions, it doesn't make it true.


Community health centers don't perform abortions. They never have—not even in the 1960s and 1970s before the Hyde Amendment was introduced. And they don't plan to in the future. In a statement issued last week, the clinics' umbrella organization, the National Association of Community Health Centers (NACHC), said that "health centers do not plan to, nor are they seeking to, become providers of abortion." And Secretary of Health and Human Services Kathleen Sebelius has pledged that none of the money from the health care bill will be used to fund abortions at community health centers.

The problem is that leaving a loophole like that is an invitation for someone to abuse in the future.  None of the points mentioned above prevent someone from using the loophole to fund abortions in the future. Even if you agree that it's a typo, then it brings to mind the question of why we should trust Congress enough to believe there aren't additional "typos" that will come to light later, when they're rushing to try and pass a bill before the President heads overseas (and before their members go home for an Easter recess that might not be so restful). Maybe they can use Nancy Pelosi's latest stupid argument in favor of the bill -- unemployed artists will no longer have to find jobs to finance their health care, since the government will subsidize it, allowing them to not work and pursue their life's dream!  Hey, I can finally puruse my dream of being an "artist" who watches TV all day!  But that's all backdrop for the real remaining issue -- the vote count.

The White House is confident it will have passage of the week -- so confident that two major advisors essentially guaranteed it on the Sunday talk shows.  Of course, the House Majority Whip (you know, the guy who actually has to count the votes for the Democrats) says they don't have the votes yet.  Which means the White House is still looking for votes, which might be why they're suddenly backtracking on the President's pledge not to have any more special deals in the legislation...

Still seeking votes for his proposed health care overhaul, President Barack Obama appears ready to reverse his position and allow unpopular deal-sweetening measures in the hopes of finding Democratic support for legislation whose future will be decided in coming days.


...Clinching support, though, might require Obama to back away from his insistence that senators purge the legislation of a number of lawmakers' special deals.


Taking a new position, Axelrod said the White House only objects to state-specific arrangements, such as an increase in Medicaid funding for Nebraska, ridiculed as the "Cornhusker Kickback." That's being cut, but provisions that could affect more than one state are OK, Axelrod said.


That means deals sought by senators from Montana and Connecticut would be fine — even though Gibbs last week singled them out as items Obama wanted removed. There was resistance, however, from two committee chairman, Democratic Sens. Max Baucus of Montana and Chris Dodd of Connecticut, and the White House has apparently backed down.


Axelrod said the principles the White House wants to apply include "Are these applicable to all states? Even if they do not qualify now, would they qualify under certain sets of circumstances?"

Somewhere, Jim Geraghty is updating his line that all of Barack Obama's promises have an expiration date. However, the real issue is why Gibbs and Axelrod would issue such blanket guarantees.  I think there's a combination of two things going on here.  First, they have some degree of confidence (hopeful confidence? desperate confidence?) that Nancy Pelosi will get the votes somehow, despite the loss of at least a few Stupak bloc voters.  The second issue is that they're trying to create a sense of inevitability and momentum for the bill -- it can't be stopped, so people (or at least, wavering House Democrats) should get on board.  I think it's a mix of both, really, but the question House Democrats have to be asking is whether they can really trust this Administration to get the pulse of America right.

Axelrod seems to saying that he wants the GOP to make the fall elections about the health care bill.  I think what House members realize is that the GOP does not have to do it -- the Tea Parties, the independants, and the core GOP base are already making it about the bill, without much in the way of urging from the GOP leadership.  The rebellion against the health care reform bills and process wasn't coordinated from above, much as the Obama Administration fervently wishes it were.  The fact that it comes from the grass roots means that the arguments Axelrod is making will be arguments that Democratic candidates will be having with constituents as much as with opponents.  And when you're arguing with people, it's tough to get their vote.

And this is before we get to the optics of the situation -- and here's new Senator Scott Brown,who is the walking, talking symbol of what this debate has cost Democrats, delivering Saturday's GOP response to the President's weekly radio address...

Maybe you remember what President Obama promised in his State of the Union address. He said he was going to finally focus on jobs and the economy for the remainder of this year. I applauded him for that. Well, here it is, it’s almost spring. And what is he out there talking about again? That same 2,700-page, multi-trillion dollar healthcare legislation.


So, an entire year has gone to waste. Millions of Americans have lost their jobs, and many more jobs are in danger. Even now, the president still hasn’t gotten the message.


Somehow, the greater the public opposition to the healthcare bill, the more determined they seem to force it on us anyway. Their attitude shows Washington at its very worst – the presumption that they know best, and they’re going to get their way whether the American people like it or not.


And, when politicians start thinking like that, they don’t let anything get in their way – not public opinion, not the rules of fair play, not even their own promises.


They pledged transparency. Instead, we have a healthcare bill tainted by secrecy, concealed cost, and full of backroom deals – and that’s just not right. They should do better. The American people expect more.

Let the vote-counting continue. Firedoglake's estimate is here. Jay Cost is here. The Hill is here. I have no count, but a prediction that the bill with either pass by a small majority, or go down in flames as moderate Dems bail and are followed by liberals seeking to make a statement on the bill not going far enough.

At the end of the day, I doubt the bill dies, even if it doesn't pass this week. The Obama Administration needs a win, no matter how many votes this costs them in the fall. I think the longer this carries on, the worse things get for them, and I don't just mean this fall. The chicanery being used to push this bill through... well, let's just say a declaration of Shenanigans is coming.



Get your brooms.

The Health Care Follies Continue

Interesting nugget from a Time article that talks about Chuckles Schumer and Dick Durbin fighting over Harry Reid's position as Senate Majority Leader, even before Reid possibly loses his election this fall...

The first time leadership aides noticed something was amiss was during the health care debate last November, when Schumer made some notable overtures to the progressive wing of the party. He'd previously taken flack from progressives for his championing of Kirsten Gillibrand, a moderate Dem from upstate New York who was appointed to Hillary Clinton's seat. Just after Senate Finance Committee chairman Max Baucus passed a bipartisan health reform bill out of his committee, Schumer demanded that the public option — a liberal provision that provided government competition to private insurers — be put back in. Reid initially bowed to Schumer's pressure but weeks later had to drop the provision in order to secure all 60 Democratic votes to overcome a Republican filibuster threat. That delay would come back to haunt the Democrats after the New Year, when Scott Brown's surprise victory in the Massachusetts Senate race cost them their critical 60th vote.

I'm thinking that if health care reform fails, the Tea Party movement should send thank you notes to Schumer for being an ambitious jerk. On more substantive matters, The Hill has another Whip count, with the expected number of no votes on health care from Dems to be 25 as of now; if my math is correct, Pelosi can't afford to lose more than 12-15 more Dems or the game is over. In other words, Bart Stupak's coalition will probably decide it. Unless, of course, more Democrats follow the lead of the Congressional Hispanic Caucus, which is now threatening to torpedo the bill unless their concerns over illegal immigrants get addressed as part of the package...

Since last fall, Congressional Hispanic Caucus (CHC) members have kept quiet, at least publicly, about their objections to the immigration provisions in the Senate bill.


The Senate language would prohibit illegal immigrants’ buying healthcare coverage from the proposed health exchanges. The House-passed bill isn’t as restrictive, but it does — like the Senate bill — bar illegal immigrants from receiving federal subsidies to buy health insurance.


Hispanic Democrats say they haven’t moved from their stance that they will not vote for a healthcare bill containing the Senate’s prohibitions.


...On Wednesday, members of the CHC privately acknowledged they’ve told their leaders that anyone who is assuming they’ve backed away from their position is in for a rude awakening.


“The [Hispanic] Caucus didn’t want to raise it as an issue too early,” one Hispanic Democrat said Wednesday. “But it’s real. It’s a problem.”


Those alarm bells have apparently been heard. CHC Chairwoman Nydia Velázquez (D-N.Y.) said she and others have, on behalf of two dozen Hispanic Democrats, been in discussions with Speaker Nancy Pelosi (D-Calif.) and other leaders about how to resolve the matter.


“And we will continue having discussions,” Velazquez said.


However, it is unlikely that the Senate will be able to change the immigration provisions under reconciliation rules. And even if it is deemed possible, there may not be enough support in either chamber of Congress to do it.


Not every member of the CHC would stand in the way of healthcare over the immigration issue. As a House leader, it would be unlikely for Becerra to vote against the president’s signature domestic policy priority. And centrist Rep. Henry Cuellar (D-Texas) said the Senate language is “not a deal-killer” for him.

Somewhere, Congressman Joe Wilson is laughing.  That last statement by Cuellar probably gives away the game -- as noted by Ed Morrissey, the Caucus members probably just want an assurance from President Obama that he will indeed take up immigration reform this year, as he promised last year. But if the bill starts to look unlikely to pass, the votes against it could snowball based on people suddenly discovering "principled" reasons for opposition.

Meanwhile, perhaps we're getting closer to the final bill, or to a real end to it, as Speaker Pelosi and House Majority Leader Hoyer have now canceled all Committee hearings and gone behind closed doors with the party leadership, providing us with more of the transparent, open government promised by the President. Jake Tapper says a compromise bill is close to being complete.

Maybe they have the votes and are doing a little champagne toast in Ted Kennedy's honor or something, but I tend to think that if they had the votes, a vote would be scheduled before another Democratic congressman melts down in an ethics scandal (or worse, disclosed more details about what goes on in the House gym showers).

So do they have the votes?  My thought is that if they did, we wouldn't see ideas like this get floated...

House Rules Chairwoman Louise Slaughter is prepping to help usher the healthcare overhaul through the House and potentially avoid a direct vote on the Senate overhaul bill, the chairwoman said Tuesday. Slaughter is weighing preparing a rule that would consider the Senate bill passed once the House approves a corrections bill that would make changes to the Senate version.


Slaughter has not taken the plan to Speaker Pelosi as Democrats await CBO scores on the corrections bill. "Once the CBO gives us the score we'll spring right on it, " she said.

And I thought reconciliation was a bad idea politically. By contrast, this is toxic. The Heritage Foundation refers to this nicely as "procedural fraud." Forget the optics of the issue -- this is one sure way to guarantee that we'll be debating the legitimacy of the bill as law forever. In their fervor to pass the bill, Democrats are undermining Congress and the legitimacy of the legislative process. What's really bad is that I don't think I'm exaggerating, if they pursue this latest procedural flimflam. Deeming the bill passed -- I'm sure the Democrats will be chagrined when this gets used against them some day in the future.

As to whether they have the votes, Pelosi has already indicated the White House's March 18th deadline may not be workable.  Michael Barone says the votes don't look like they are there yet. We'll see if that changes, or if the Dems merely change the rules again -- maybe the Democrats will find a way to claim that a minority is a majority.

The Health Care Follies Continue

Instapundit points out how Drudge is having fun with the so-called health care endgame.  I do think the most telling part of the continuing mess that is health care reform comes from this quote from Nancy Pelosi...

You’ve heard about the controversies within the bill, the process about the bill, one or the other. But I don’t know if you have heard that it is legislation for the future, not just about health care for America, but about a healthier America, where preventive care is not something that you have to pay a deductible for or out of pocket. Prevention, prevention, prevention—it’s about diet, not diabetes. It’s going to be very, very exciting.


But we have to pass the bill so that you can find out what is in it, away from the fog of the controversy.

(hat tip: Peter Suderman) It says a lot about the bill and/or the Democrats' communication abilities that they can spend a year or so discussing the concept, several months discussing the actual bills, and think that the key is to stop talking about it so people will understand it.

As to the actual endgame... there's multiple folks trying to figure out the voting breakdown.  Jay Cost at RCP has been running numbers, FireDogLake has a running whip count, and National Journal is keeping track as well.  I think two things are indisputable -- the fate of the bill lies with approximately 40-45 House Democrats (including Bart Stupak's crew), and Nancy Pelosi doesn't have the votes yet.  The fact that she's pushing back on the latest White House deadline says a lot...

The WH is anxious to get health care passed by Easter recess, just like they were anxious to get it finished by Aug. recess, then by Thanksgiving, then by Chirstmas. And Pelosi has had enough: She told WH CoS Rahm Emanuel to stop pressuring the House to pass the Senate bill by March 18, before Pres. Obama leaves for an overseas trip, according to Rep. Henry Waxman (D-CA), who sat in on the leadership meeting at the WH yesterday.


And House Maj. Leader Steny Hoyer echoed the sentiment, pushing back on a March 18 vote. House Dems have yet to schedule any votes, lending credence to the notion that they don't have the votes yet.

The problem for Pelosi and the House Dems who might be reluctant to vote on the bill boils down to three points.  First, they don't yet know what the Senate will do, even though they're getting assurances that the Senate will pass a reconciliation bill with a bare majority, but they don't know if they can trust that this will happen, especially sicne no one has seen a new reconciliation bill yet.  Second, the Stupak abortion language issue remains in flux -- one day Stupak is saying they can get a deal, another day he's saying that he won't agree to deals to fix the bill in the future, which seems to be the only way to do it (my personal belief is that Stupak and his unknown posse of approximately 12 really want to vote for the bill and may do so ultimately, but I'm sensing that this is more than just posturing on their part -- if the public opinion doesn't move toward passing this bill, they may decided that they'll vote against it on principle just to be part of the majority).

But the third issue is the one that will ultimately decide the contest -- public opinion.  Public opinion is decidedly against the the reconciliation process the Senate may use, but seemingly split on everything else...

A new Associated Press-GfK Poll finds a widespread hunger for improvements to the health care system, which suggests President Barack Obama and his Democratic allies have a political opening to push their plan. Half of all Americans say health care should be changed a lot or "a great deal," and only 4 percent say it shouldn't be changed at all.


But they don't like the way the debate is playing out in Washington, where GOP lawmakers unanimously oppose the Obama-backed legislation and Democrats are struggling to pass it by themselves with narrow House and Senate majorities.


More than four in five Americans say it's important that any health care plan have support from both parties. And 68 percent say the president and congressional Democrats should keep trying to cut a deal with Republicans rather than pass a bill with no GOP support.


Leaders of both parties in Congress say that's not how it's going to work out. After a year of off-and-on negotiations, Republicans adamantly oppose Obama's plans. The White House and Democratic leaders say it's now-or-never for a health care overhaul, which would cover an additional 30 million Americans, require almost everyone to buy health insurance and impose new restrictions on insurance companies.


The Democrats' plan relies on parliamentary rules that bar Senate filibusters. That would enable Senate Democrats to pass a companion health care bill — which House Democrats are demanding — with a simple majority. Democrats control 59 of the Senate's 100 votes, one shy of the number needed to stop GOP filibusters.


The new poll underscores Obama's struggles to wrest control of the health care debate from Republicans, who couch his efforts as a government takeover and costly intrusion into private lives.


Many of his allies are baffled, because Americans clearly want change, and some of the individual components of the Democrats' health care agenda seem popular. Moreover, the public has not embraced the Republicans' overall approach to legislating, giving lower approval ratings to GOP lawmakers than to Democrats, although both parties fare badly.


In the AP-GfK Poll, 43 percent of those surveyed said Obama and Congress should keep working to pass health care this year, while 41 percent said they should start from scratch. On Capitol Hill, the Republicans favor that new-start approach; Democrats say that's just a way to stall the effort to death.


Sandy Stemm of Springfield, Ore., would seem the ideal target for Obama's appeal. She's a Democrat and former bakery manager who recently lost her job and health insurance.


But Stemm, 47, doesn't like the idea of congressional Democrats going it alone on health care.


"I think it's important to come to an agreement," she said in a telephone interview. "We're all in this together, whether we're Democrat or Republican."


John DeHority, a Democrat from Rochester, N.Y., supports Obama's effort and thinks Republicans have "made a travesty of the process." But he suggested the GOP is winning the political battle.


"I think passing the bill in its current form would be political suicide for Democrats," said DeHority, 56, a researcher in health care imaging. He said he thinks the proposed changes would fail because they would not control costs, and "Democrats will take the fall for that."

See, that last bit is what Democrats need to worry about, unless they've now decided to accept that their political annihilation will be be okay because the bill has passed -- the downside being that unlike other entitlements, the lack of broad support for this bill might mean effects to repeal it actually gain steam.  One of the biggest problems with this bill is that the best selling point Democrats have for liberals (and it's one that some liberals, like Dennis Kucinich, aren't buying) is that it gets their foot in the door toward eventually nationalizing health care.  But passing an unpopular program that ends up being more costly rather than less costly that may be coupled with cuts and changes to people's access to health care isn't likely to drive people to want more government intervention -- it's likely to make them want less. 

And the idea that the public will forget about the crazy process used to pass the bill -- pass one bill, then use reconciliation to fix the bill -- is incredibly obtuse, even for Washington.  Part of what drives anti-incumbent and anti-Washington sentiment is the idea that politicians change the rules whenever they can't get what they want,  In this case, they'd be changing the rules to push through something that has less popularity than Tiger Woods -- even the people who like the bill aren't rushing out to passionately defend it.  Keith Hennessey summarizes my thoughts nicely...

I am struck by the enormous gap between the two parties on the strategic calculation being made by the President and Democratic Congressional leaders. If you set aside your policy views, do you think the current path makes strategic sense for the majority? Almost every Republican insider I meet shakes his or head in befuddlement and says no, I just don’t get why they’re doing this.


Dan Meyer was Speaker Gingrich’s Chief of Staff in the mid-90’s, and later served as the head of Legislative Affairs for President Bush (43). He and I survived the 95-96 government shutdown conflict between Congressional Republicans and President Clinton. I worked for Senate Budget Committee Chairman Pete Domenici at the time. Dan made a comparison the other day. Imagine, he said, right after the government had reopened in January of 1996, after Republicans had been getting hammered every day for a month, if I had run up to you and said, “I’ve got a great idea! Let’s shut it down again!” You’d think I was crazy.


That’s what this feels like. The President and his allies could now quite easily enact a massive expansion of Medicaid and S-CHIP, paid for by a subset of the offsets in these bills. I would oppose such a bill, but it would be a legislative slam dunk with few political costs (for them) outside of a disappointed left wing. To my chagrin they might pick up a few Republican votes. And yet they press onward with a super-high risk strategy. This is a classic bird-in-the-hand tradeoff.


...The leaders may be narrowly self-interested and able to exert tremendous party discipline on those with different interests. Legislative failure could harm a rank-and-file Democrat from a purple district, but it would be devastating to the President and the Speaker, who are judged on their ability to lead others. We know that some Congressional Democrats don’t like this bill as a policy matter. We know that some are afraid of the political consequences of voting aye. Yet many in both groups appear willing to vote aye.

I also like William Jacobson's claim that this bill is now Obama's Stalingrad, not his Waterloo, although I guess that would make the GOP the USSR. I would say something about what that makes Obama, but I don't want to trigger Godwin's Law.

Bottom line? There are less than 240 days until the November election. That much is certain. Everything else is a guess.