Yesterday's events have given health care new momentum, but advocates are a long way from popping champagne.
There remain unanswered questions about how the proposed Senate bill and public option opt-out will be structured, along with questions about its final cost and how the government will pay for it.
A Democratic aide told TPMDC today the House is aiming to have its bill on the floor in early November with a vote by Nov. 11, Veterans' Day.
The Senate has several stages ahead - a CBO score for the merged bill Senate Majority Leader Harry Reid introduced yesterday and then an agreement for what amendments will be allowed. It will be on the floor for debate in the next two weeks.
Once each bill passes its chamber, private negotiations will produce a conference report that will get another House and Senate vote.
Translation: there may be snow on the ground in D.C. before anything finally heads to President Obama's desk.
Most of the conservative Democrats Reid is trying to win over aren't saying yet if they will back the party in a procedural vote to cut off debate, a legislative term known as cloture that needs 60 votes. (Joe Lieberman (I-CT) just said he would be okay with a filibuster, while Sen. Blanche Lincoln (D-AR) isn't sure.)
Leadership expects Republican shenangians, and our GOP sources suggest that's an accurate hunch.
House Democrats have been telling TPMDC for weeks they are angling for a "robust" public option so that would give them a stronger negotiating point once both chambers have passed their versions of a bill.
They argue it will be easier to muscle the public option into the final conference report, which must get an up-or-down vote with no amendments possible on both floors. Several House aides have told me they view that stage as easier, since they think Reid can muster 51 votes for final passage.
But Republicans can still filibuster a conference report, and it's back to the question of the 60 votes Reid needs to break one.
He's talking one-on-one with centrists who either aren't comfortable with the public option or who are getting political pressure back home.
And that's where the advocacy groups we wrote about earlier come in.
If the unions and groups like MoveOn do what they are promising and rally for Lincoln and others, that could be the difference between winning and losing in 2010.
MoveOn announced today the results of a survey of its 3.2 million members, showing 93 percent do not think MoveOn should back senators that vote with Republicans to filibuster the health care bill.
"That means no donations, no volunteering, and no help getting out the vote," MoveOn told members, adding stats for the states of Nelson, Lincoln and Sen. Mary Landrieu (D-LA).
MoveOn members who have given previously to Nelson's campaign are sending him letters reading, "If Senator Nelson joins with Republicans to block an up-or-down vote on a health care reform bill, as a past supporter I will refuse to support Senator Nelson's re-election."
Lincoln will get the same treatment.
"Our member vote can provide a clear incentive to senators who are deciding where they stand on Senator Reid's bill," the group wrote in an email to members. "So MoveOn members are hitting the streets, and the phones, to get the word out. We've planned in-person events at the state offices of conservative Democrats starting today, we're developing a new round of ads, and we'll be flooding their offices with phone calls all week."
MoveOn also tells members that even though it's a promising compromise, the opt-out isn't the best type of public option and that they will keep fighting for a "robust" one in the final package.

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Indie Pro
October 27, 2009 2:14 PM
I can't wait to see what Reid is actually bringing to the table:
If the option is modeled on the provision in the HELP Committee’s bill, the plan would only save about $25 billion over 10 years, without significantly lowering health insurance premiums. It would likely lack Medicare’s market clout or leverage to significantly lower health care costs, but would still represent a not-for-profit alternative that can begin spearheading critical delivery system reforms.
Since both Senate bills establish state and regional based exchanges in lieu of a single national structure, it’s likely that the compromise in the merged Senate bill will establish 50 different options, all controlled by the Secretary of Health and Human Services. The public plan would have to attract a network of providers, charge premiums “in an amount sufficient to cover expected costs,” and meet all solvency and reserve fund requirements.
If Reid follows HELP’s template, then within each state or region the Secretary would negotiate reimbursement rates on behalf of the pubic option that would likely mirror the rates used by private insurers (the legislative language states that rates “shall not be higher, in aggregate, than the average reimbursement rates paid by health insurance issuers offering qualified health plans through the Gateway”). The HELP language also allows the public option to “develop or encourage the use of innovative payment policies that promote quality, efficiency and savings to consumers,” a critical provision that would allow the public option to invest in payment and delivery system reforms.
http://wonkroom.thinkprogress.org/2009/10/27/reid-help-public-option/
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Indie Pro
October 27, 2009 2:44 PM in reply to Indie Pro
that being said,
if any liberal or progressive organization is getting a sense of its membership without actually knowing what Reid is proposing, then they are failing their members.
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Tanjaoui
October 27, 2009 7:03 PM in reply to Indie Pro
Thank you for that, seriously. I tried posting a link to several PNHP articles by Kip Sullivan that basically made the same point. The Senate po might be little different from a coop in substance. And they might be contracted out to private insurance companies to manage...for a 'fee'. I'm glad you're bringing this up. What are we getting into? This is a far cry from what Jacob Hacker envisioned.
Also wondering why my TPM post never appeared. Too many links? There were 3. Wrote TPM asking what the deal was. No response as of this writing. Weird.
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JeffB
October 27, 2009 7:27 PM in reply to Indie Pro
Is this the end of Health Care Reform with a Public Option?
http://www.youpolls.com/details.asp?pid=6373
.
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matyra
October 27, 2009 2:17 PM
Don't forget this too: There's a lot of money in play.
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sisterkevin
October 27, 2009 5:40 PM
Let's blow the whole thing up. Thank God I finally have Medicare. Single payer or nothing. Because nothing is what you'll get. BTW, it won't be called "nothing", but at the end of the day the two bucks in your pocket you started out with will be the same two bucks you put on your night stand just before your head hits the pillow. Sometimes the truth is overwhelming. Me thinks this is one of those "moments in history". We're fucked.
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AnswerFrog
October 27, 2009 7:31 PM in reply to sisterkevin
Truly an all or nothing mentality. I guess the millions who die from lack of coverage in the meantime would just be "collateral damage"?
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KQuark
October 27, 2009 8:03 PM in reply to sisterkevin
Just another selfish senior. You have yours so blow up healthcare for the uninsured like me. If the Dems can't pass a public option opt out tell me how in we can get single payer. All the purists see things through ideological glasses while people continue to suffer.
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Indie Pro
October 27, 2009 10:50 PM in reply to KQuark
since those around 50 may be forced to pay 20% of their income for insurance, I'd say they are selfish and lucky.
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tonyneal
October 27, 2009 6:33 PM
Haven't we really had enough of this nonsense? First it's the Rethuglicans and now it's the "centrist" Dems. All because of a rule, the 60 vote rule, that can be changed simply by changing it to 56, 55, 50.... Yep, just a Senate rule which means a rule of the Senate, any rule, can be changed by a majority. Imagine what could be done with a 50 vote rule (and Biden for 51).
Yes we can!
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jet
October 27, 2009 7:30 PM in reply to tonyneal
Just wait... If the Dems actually gain a seat or two in 2010... I bet Harry Reid would jump at the chance to change the rule to a 65 vote threshold.
You can't have enough excuses why you can't get your party in line.
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CharlesBrown
October 27, 2009 7:44 PM in reply to tonyneal
Or why not just bi-pass this Republican/Blue-dogs filibuster altogether.
The question I am posing is should the Opt-Out Public Option be in the realm of a Federal legislation if individual States may choose to withdraw. I think that if the Opt-Out Public Option is a reasonable/popular compromise to most constituents and legislators, then HCR should be a legislation on the States level.
I propose that those States that are in favor of Public Option or Single-Payer should form their own Health Care Union and not bother with Senate and Obamacare.
Lets face it, the US is inhabited by two very different groups of people, and the dividing line seem to be the States borders. It would be an injustice to both groups if they are forced to live with legislation that neither can fully accept.
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calgarr
October 28, 2009 1:07 AM in reply to CharlesBrown
With all due respect, that's insane. If lawmakers at the federal level are inept, apathetic, and greedy, then at the state level they are practically vegetables. Anything that passed through state leg would be useless at best, and probably take ten years to go into effect.
Also, reducing this to a state matter would divide the debate into fifty mini-debates, and at each one would be a gang of certifiably-nutty teabaggers and gun-toting protesters with a fifth-grade understanding of the second amendment. How long do you think it would take for one of them to do something monumentally stupid? Not long.
Finally, saying that the dividing line between party influence conforms to state lines is...well, I can't think of a word to describe how obviously incorrect and self-serving that statement is. Oh, wait, I know a word that describes exactly that concept: republican.
What a very republican idea.
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CharlesBrown
October 28, 2009 1:48 AM in reply to calgarr
I said those States that are in favor of PO or Single-Payer should form their own Health Care UNION.
ie. Only those that want to join can join, and not all 50 States have to join in order to form a UNION. And like the name imply, the UNION would have its own governing assembly from all of the member States to deal with all matters of health care. So it would be an Opt-In arrangement that bi-passes the morons in the Senate and the White House. Of course, there would be no assembly if no State wants to join, but if there is one, it would only be filled with legislatures who want HCR. Why do I have to explain this. It should be obvious.
Did you think I expect all States would join? I would not expect a State like Texas to join for the reasons that you mentioned; its full of nutty tea-baggers with a legislature filled with vegetables. Nor would I want them to join. Fortunately, most States are not like Texas.
BTW, I'm not a republican. How would you like to be called a pathetic brain-dead servile Obamabot?
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calgarr
October 28, 2009 2:06 AM in reply to CharlesBrown
Well, I certainly didn't mean to imply that I think you are a republican, simply that the idea you propose is one I would expect to hear from them, along with the specific comment about state lines and party lines. Mostly, it was meant as a joke, I don't want to make any enemies here.
Having said that, I'd like to get more into this UNION idea of yours. So you think it's likely that these legislative bodies would only attract people with a genuine desire for real HCR? That seems like saying congress only draws people who want to improve the quality of life for all Americans. Sure, it should be that way, but it's not. And it wouldn't be in a union, either. We would have pseudo-democrats obeying their insurance company overlords weakening every measure from the inside and republicans doing everything they can to derail the whole process. You can't just say "Hey, only get involved if you want robust HCR", it won't work. THAT should be obvious.
Remember, it wouldn't be a state (or the people who live their) that decides to opt-in and join an assembly, it would be a bunch of politically minded, ambitious people, each with their own agenda...just like we have now. This union/opt-in/assembly system wouldn't work any better than federal legislation, because it doesn't circumvent the basic problem: morons are not limited to the senate or the white house. They're everywhere! How could you possibly ensure that this doesn't go wrong?
Hey, I could be wrong...and again, I'm sorry if I offended you, that is truly not my purpose. I'm still learning all this stuff, and I probably don't have the best grasp of commentary etiquette. Just getting into the conversation, you know?
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CharlesBrown
October 28, 2009 3:37 AM in reply to calgarr
The whole point of this thread is how to break the Republicans/ConservaDems filibuster in order to pass an Opt-Out Public Option (OOPO) that Harry Reid is bringing to the Senate floor. My proposal is that its not necessary to break the filibuster in order to have a HCR resembling the OOPO.
The advantage and the whole point of forming a Health Care Union of States is that you can exclude obstructionists like Texans/Republicans/Conservadems/whoever from filibustering your HCR, assuming that you want a HCR with an opt-out or opt-in provision. So basically, Union = No filibuster by definition. All you would need is a willingness to form a Union. I can't get any clearer than that and I'm not discussing morons.
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calgarr
October 28, 2009 11:10 AM in reply to CharlesBrown
Okay, I see. That is definitely a way around the filibuster, no doubt. I wonder how it would go down...it is a very interesting idea.
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theWalrus
October 27, 2009 7:21 PM
"End Game: So When Will Health Care Really Happen?"
Never.
Just wait. You'll see. The fun has just begun.
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mld678
October 27, 2009 7:36 PM
America needs to move forward – one group continuously stands in the way. It’s time for MoveOn to Move Over! The group turned 11 this year, and has repeatedly been the source that drives American politics into the gutter. Stop embarrassing our nation, and move on. http://www.friendsoftheuschamber.com/moveover/
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theWalrus
October 27, 2009 7:51 PM in reply to mld678
If it wasn't for "fanatical, liberal" groups like MoveOn this country would have President McCain right now, we'd be at war with Iran, in a great Depression and stripped of even more of our rights than we lost under Bush. Bush put us in the SEWER, so at this point even the gutter is an improvement.
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DestinyofAmelie
October 27, 2009 9:36 PM in reply to mld678
Seriously? Are you a reality based blogger?
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atticus1104
October 27, 2009 9:23 PM
While discussing healthcare with Neil Cavuto, John Boehner acts like a high school meathead and takes a personal shot at Harry Reid.
http://progressnotcongress.org/?p=3287
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xargaw
October 27, 2009 9:30 PM
If there is no public option that every American can access if they choose, I say kill the whole Bill. Obama has done little to direct and lead on this issue. Unless he takes the lead immedicately, it will likely be worthless, whether it passes of not. It will not deserve to pass if all we get from the WH is more of the same.
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xargaw
October 27, 2009 10:16 PM
All of the Republicans and some of the Democrats should be hanging their heads in SHAME. Healthcare in this country is a disaster with people not being able to see a doctor, a dentist, or have needed tests and treatment. People are doing without in life and death situations and some 40K+ are dying every year, not to mention financial ruin for many families. And what are these legislators that have great healthcare doing? They are politicing, taking bribes from industry and posturing for power and for the camera. I believe there will be a special place in hell for callous and uncaring lawmakers. The mercy they so casually deny others will be withheld from them someday. Having volunteered in hospital settings and long term care facilities, I have seen firsthand our legally criminal system. It is unjust and heartbreaking. In America, care is cruelly rationed by industry more than any government plan would ever allow.
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hoppycalif2
October 27, 2009 11:55 PM
Something called "health care reform" will become law around the first month of next year. It will slightly tighten the rules on insurance companies, and it will require that all of us pay tribute to those companies at whatever rates they chose to charge. Obama will take a bow for passing the bill. The Democrats will take a bow for passing the bill. The Republicans will take an oath to repeal that law at the first opportunity.
Then, we will move on to something called "Energy Efficiency".
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conversefive
October 28, 2009 12:51 AM
I'm all ready and waiting for this public option to take effect. Then I can drop my privately paid for health insurance (since I'm self-employed), pay the annual fine for not having health insurance and purchase the government option insurance when it is needed. Works for me!
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chitowner
October 28, 2009 2:29 AM
I predict Mr. Obama will sign something before Christmas and call it historic reform. And it will be, but nothing comparable to passage of Medicare in 1965. It will outlaw discriminatory practices like pre-existing condition exclusions, benefit caps and arbitrary cancellations, but it won't curtail the health care cost spiral or significantly reduce premiums; and it will not include any substantive or meaningful "public option" plan, other than some "trigger" - in an attempt to placate progressives - that will never be pulled. In the end Mr. Obama will have made some improvements to the system, mandated a lot of people to get coverage - and pleased a lot of health care lobbyists in the process. Real health care reform? Not much. I hope this prediction doesn't come true, but that's how I see it right now.
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Odel Roo
October 28, 2009 9:17 AM
What is the end state? I am paying nearly $700 per month for med and dental ins. What does anybody expect the cost reduction to be after a 2 trillion dollar investment over 10 years?
Will I see a savings of 10%, 20% or no change at all?
From what I see now only 10% of the population will qualify for the PO... that said... how will a PO be a competitor to bring down costs? Are they going to force practices to accept the new PO? more and more are not taking new medicare patients?
Really folks - we are being led down a primrose path. Are we so willing take on all this debt without a clear business plan?
The only guarantee in all this is the govt will be getting more money from the taxpayer. No guarantees or even a coherent business plan to benefit the end user - none!
This just seems to be a big scam - with the only benefit going to Uncle Sam.
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