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A Roadmap To The Health Care Fight Ahead

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All the news coverage these last few days has focused on the developments in the Senate Finance Committee. And for good reason! That's where all the news is. But that may obscure the fact that there's another health care bill that's been voted out of the Senate Health, Education, Labor, and Pensions Committee, and a final package emerging in the House of Representatives, and each of these will help shape the bill President Obama hopes to sign.

Before August recess, each of the three House committees with jurisdiction over health care reform approved different versions of the same so-called "tri-committee bill". Over the break, the chairmen of those committees, working with leadership and the Democratic caucus, made progress on stitching those bills together into a package that will be voted on by the entire chamber. That work continues, and yesterday, Speaker Nancy Pelosi said the House will pass a bill "when we're ready," but that she's not waiting for the Senate to move ahead first.

Things haven't matured quite that much in the Senate. The Finance Committee will hold hearings on its bill next week, and the current thinking is that the legislation will likely pass with only Democrats (or Democrats plus Republican Olympia Snowe of Maine). When that's done, Senate Majority Leader Harry Reid--working with Finance Chair Max Baucus, HELP Comittee leaders, and the White House--will take the lead merging the two bills into a final product that he thinks can overcome a filibuster, and then pass with at least 51 votes. This will mostly happen behind closed doors.

Assuming success in the Senate (still a pretty big assumption) that bill will have to be merged with the House bill. This is where the fight over the public option is likeliest to boil over. House progressives have insisted that health care legislation include a public option, while Senate centrists seem prepared to kill just such a bill. One of those two factions will likely have to agree to settle. That will be a political decision, and it will be ugly no matter who wins.

Of course, this wouldn't be Congressional politics if there weren't a couple significant caveats to all this: First, the Massachusetts legislature is expected to pass a law allowing Gov. Deval Patrick to appoint a temporary replacement for Ted Kennedy, who died of brain cancer last month. Assuming all goes smoothly and Patrick follows through, Democrats will once again have 60 votes in the Senate. That would significantly change the dynamics of the health care negotiations. In at least a technical sense, Snowe would no longer be necessary to pass a bill: Democrats would be able to do it all on their own, as long as they stayed united against a Republican filibuster. The onus, in other words, would be shifted to conservative Senate Democrats--not Snowe. But they'd still maintain significant leverage.

Secondly, if at some point in this long, involved process, it becomes clear that Democrats don't have 60 votes to overcome a filibuster, then their energies will turn to the filibuster-proof budget reconciliation process. And that would touch off a very different legislative fight.

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29 comments

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September 18, 2009 2:15 PM   

Nice summary. I'm more optimistic than I've been in months about a public option in the final bill. Maybe Obama and the Dems can pull this off, after all. Here's hoping.

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September 18, 2009 2:22 PM   

So, we're looking at, what, about a week for this all to shake out?

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September 18, 2009 2:38 PM    in reply to LarsThorwald

Ha ha. Surely you jest.

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September 18, 2009 2:49 PM    in reply to jerryfatheart

I am jesting. And don't call me Shirley.

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September 18, 2009 2:31 PM   

test

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September 18, 2009 2:36 PM    in reply to AnswerFrog

PERMISSION DENIED!

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September 18, 2009 2:37 PM   

Oh lordy. I wish I could sleep from now until the end of the year ...

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September 18, 2009 2:40 PM   

This has been one heck of a roller coaster and it will continue for several more weeks (months)

But it is clear that some bill will pass ,that will be somewhere between the house bills and the Baucus bill. How good this bill is will depend on the details hammered out from now until Obama signs it.

Teh real test will be how well this system performs in the real world and if it can solve our huge HC problems. I suspect that we will have to strengthen it down the road with further legislation. (say, to tack on a public option to the Exchange if one isn't included this year)

What is also clear is that the GOP has doubled down on opposing this, a real all out effort to kill it. So when it is signed into law, and 99% of the GOP has voted against it, it will be a major defeat for the rightwing. I suspect we'll also see confidence and favorability of the Dems will go up. People like success.

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September 19, 2009 1:41 PM    in reply to AnswerFrog

Assuming all goes smoothly and [Mass. Gov. Deval] Patrick follows through, Democrats will once again have 60 votes in the Senate.

Joe LieberSchmuck (Likud-Aetna&Cigna) will never vote for a bill that endangers insurance company profits.

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September 20, 2009 7:09 PM    in reply to AnswerFrog

So since we don't need reform. Rmember everyone who has a denied application or claim...send your bills to your Congreemen to pay. They say there is NO PROBLEM.. (with their campaign chests).

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September 18, 2009 2:40 PM   

Caption for the photo:

"Clowns on the left of me,
Jokers on the right, here I am:
stuck in the middle with you."

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September 18, 2009 2:50 PM    in reply to agio

I had this lyric running through my mind:

You have to wash with the crocodile in the river
You have to swim with the sharks in the sea
You have to live with the crooked politician
Trush those things that you can never see

It's a cruel crazy beautiful world

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September 18, 2009 5:55 PM    in reply to Schmed

Amen. And that's America for you, folks.

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September 18, 2009 2:40 PM   

Now Cantwell is joining Rockefeller in saying she won't vote it out of committee without a public option. Sounds like the Baucus bill doesn't have the votes unless it's given an abrupt, mind-altering change.
Have I missed something?
Thank you, Maria, my senator.
http://mcjoan.dailykos.com/

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September 18, 2009 3:00 PM    in reply to julimac

Here is what Shumer is saying. He's on the Finance Committee as well:

"There is a view on the part of the chairman and on the part of just about everyone in there to try to come up with a consensus that every Democrat and perhaps Olympia Snowe could support," Schumer said. "And I would say just about everyone in the room thought it was doable."

Sounds like what a democrat like Cantwell would vote out of committee, but, may or may not support on the floor, could be two different things. As long as they are allowed to mark up the base bill and attach amendments, it could be doable for the dems to vote yes. Just to get the damn thing OUT!

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September 18, 2009 3:24 PM    in reply to julimac

Maria is also my Senator. When it's too corporate for Maria and she takes a position before the very last minute, then you know without any doubt, that the bill is rotten. We rarely get to say thanks to Maria, but this is one of the those times.

I knew that McCaskill was a conservative DEM, but I am still surprised at her support for Baucus. His Bill is such an obvious sellout, I can't imagine any DEM wanting to be tied to it in any way. If Lieberman likes it, you know it's bad.

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September 18, 2009 4:15 PM    in reply to julimac


I have had a bad feeling about this for the last few days. I think, what will happen, is that some or all of the Republicans on the committee, will vote FOR the Bill. Think about it. They know some kind of bill will pass in the long run. Their bestest friends, the Insurance Industrial Complex, loves the Baucus Plan, so if the insurance industry loves it, so do the Republicans. So, if SOMETHING has to pass, they would rather it be the Baucus Bill.

Also, it would really make things sticky for the Democrats and the White House , who have been trumpeting 'bi-partisanship' for the duration of this clusterf*ck. How could they, then, go against the bill changes that would be necessary, and how could they go for 'reconciliation'?

Tell me I'm wrong...please?


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September 18, 2009 4:19 PM    in reply to newpantaloons

wrong

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September 18, 2009 4:33 PM    in reply to newpantaloons

Ugh... maybe we just have to hope they're too stupid to do that? Not a pretty picture.

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September 18, 2009 9:22 PM    in reply to newpantaloons

Glad to oblige!

You're wrong. If you look at the list of 10 R's in Finance you will see that most of them don't do 'nuance' well. And not just because it is a French word. Cornyn's base in Texas and Crapo's base in Idaho don't get the concept of 'strategic voting'. On the other hand they understand the concept of not giving an inch to 'Socialized Medicine'. And even more 'Government mandate'.

We look at Baucus Care and see a huge gift to the private sector. The Right will look at it and see some government bureaucrat telling you what you have to do with your own money and charging you up to $3800 per family for non-compliance.

Conservatives on Finance will be better served by just voting no at every stage of the game. I mean if you had to list Senate seats on their target list for pickup Conrad, Baucus and Reid have to be at the top of their list. A scenario where the Senate deadlocks and let's those guys look like ineffectal doofuses can only be good for the Republicans longterm.

They are more likely to throw Max a boat anchor than a lifeline at this point.

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urr

user-pic

September 18, 2009 2:56 PM   

The Roadmap is explained (and outlined graphically in slides 17, 18) in this tutorial from kaiserEDU.org:
http://www.kaiseredu.org/tutorials/reformprocess/player.html

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September 18, 2009 3:01 PM   

Another informative post, Brian. What's come over you? Anyway, please keep up the good work giving us the big picture overview we need to maintain our sanity. To me, at least, it's been clear for nearly 6 weeks that we were headed to just such a crossroads, where the delicate balancing act of 60 and 51, with no Republican help, was the hard reality of the situation. In my optimistic opinion, the meaning of the Democratic maneuvers of the past month or so has been a tightly choreographed exercise that will enable the Blue Dogs to say they fought hard against the Public Option before reluctantly giving in. Boy do I hope I'm right!

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September 18, 2009 3:24 PM   

We (the people) need to make one principle absolutely clear to all in congress who will be voting in favor of health care reform:

"No requirement to buy health insurance without the right to buy it from a strong not-for-profit public insurer!"

That must be the contract with America. You force us to buy something, then you must sell us what we want (and need) to buy!

It should be remembered by all Congressional Democrats that this bill will be viewed as the "Democratic bill" in the future. Crippling the bill for bipartisanship-sake for a token Republican vote or two is profoundly stupid. Any defects will be viewed as solely the Democrat's fault.

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September 18, 2009 3:35 PM    in reply to CareyInLA

Agree 100%. I've been saying this for months. No individual mandates without a viable, strong public option.

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September 18, 2009 6:23 PM    in reply to CareyInLA

Here, here! Keep the public option!

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September 18, 2009 5:18 PM   

Roller Coaster is right - read this and weep:

New DNC Obama Ad: Get “Fired Up” and “Ready to Go”
for No Public Option
http://campaignsilo.firedoglake.com/2009/09/18/new-dnc-obama-ad-get-fired-up-and-ready-to-go-about-no-public-option/

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September 18, 2009 5:40 PM    in reply to aview999

I like Firedoglake. But on this they are a bit misleading.

Here is the bill outline the White House sent to Congress immediately before the joint session:

http://i.cdn.turner.com/cnn/2009/images/09/09/obama.plan.pdf

It DOES include a robust public option.

And on many occasions, President Obama has stated a robust public plan is his preference to provide competition and control costs.

But HE is not writing the Bills. Congress is doing that.

And what folks like firedoglake want is for President Obama to draw a line in the sand and say something like:

"I will not sign a bill that does not include a robust public option."

He still might do that. At some point.

But its not time to spend that kind of political capital yet. Its pointless. Until the Bills from the House and Senate go to conference.

Firedoglake is demanding President Obama take a stand and draw a line in the sand, right now. Like HE magically controls all.

He doesn't.

This is going to be a long, long campaign to get what we know is right (or as close to it as we can). And its going to take ALL OF US to see it clear.

The people to be beating up right now for a robust public option is Congress. Not President Obama.

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September 18, 2009 6:57 PM    in reply to willia451

I agree.

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September 18, 2009 7:18 PM    in reply to willia451

I gurantee you Obama won't do it until he is positive it is about to pass. Or he is guranteed one with a PO will pass.

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