Making Sense Of The Health Care Reform Summit
President Obama called for the summit and my strong impression is that it served his purposes very well.
He managed to orchestrate a public event that presented the Democratic bill in more understandable and appealing a fashion that heretofore; underscored the many Republican ideas that are already included in the bill; and rejected the demand to start over and move step-by-step but indicated a willingness to consider further Republican proposals in return for their buy-in to the underlying bill.
I don’t believe there is any market among congressional Republicans for the latter and this will become apparent in the hours and days that follow.
While the audience for this summit was too small to have any measurable impact on public opinion, clips and stories will bounce around the media and Internet in a way that strengthens the Democrats’ resolve to finish the job.
I expect they will pass health reform within a month or so, with the House approving the Senate-passed bill and both chambers passing a small bill under reconciliation that makes the changes proposed by the president this past Monday.
Then, as the president said at the end of the summit, the public can have its say. That’s what elections are about.
Making sense of the health summit and its aftermath means appreciating three key points:
The first is that, despite complaints by Republicans that Democrats have not been bipartisan, Republicans have shown no real interest in compromise. Unless that changes, Democrats have no option but to try to agree on procedures to enact some close cousin of the two bills already approved by both houses of Congress.
Second, the major coverage provisions of the House and Senate bills are inseparable.
Those components are:
1. The requirement that each person have health insurance
2. Subsidies to make that requirement affordable
3. The rule that all but small employers either provide coverage for their workers or pay a penalty
4. The prohibition barring insurance companies from cutting off coverage or jacking up premiums for the sick
5. The creation of insurance market exchanges to cut insurance sales costs
6. New taxes or spending cuts to pay for subsidies
These are inextricably linked. Cut back subsidies, for example, and the individual mandate becomes unacceptable. The inseparability means that those opposed to the Democrats’ approach can ask for the inclusion of additional elements, but they cannot expect much receptivity unless they are prepared to accept the basic outline.
Third, given the lack of wiggle room, Republican intransigence and the Democrats’ inability to cut off a Republican filibuster, the only way forward is for House Democrats to pass the Senate bill. Mobilizing enough House Democrats will require prior agreement over key changes in the not-yet-passed Senate bill. But House Democrats are unwilling to vote on the Senate bill unless and until a set of changes has been enacted.
Those must be passed under reconciliation procedures that require only a simple majority in both houses. But enacting changes in a bill not yet passed is subject to restrictions that will preclude key changes in the Senate bill that some House Democrats may regard as essential.
The rules for reconciliation get into the weeds. But you cannot understand the obstacles to mobilizing majority support in the House for the Senate bill without appreciating the technical difficulties created by the rules governing reconciliation legislation that first have to be enacted.
Topics: 2010, affordable health care, America, Associated Press, better coverage, bipartisan healthcare meeting, bipartisan meeting, Blair House Meeting, business, Congress, Democrats, Governance, government, health care, health care reform, health care summit, health care system, Health Insurance Reform, health insurance reform bills, House Republican bill, insurance, Insurance Companies, insurance market exchange, insurance sales costs, middle class, monitor, news, Obama Administration, politics, President Obama, Republican plan, Republicans, Senate, subsidies, talking points, U.S., United States, White House
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