Health Care Reform is in Serious Trouble

January 11, 2010

Sadly, I come home to find that Health Care Reform is one special election (ironically, it is that which would replace Senator Kennedy) from being derailed.  The story is all over the news, but here’s this from Talking Points Memo:

The new survey of Massachusetts by Public Policy Polling (D) sends a very alarming message to Democrats: Due to a fall in interest by Democratic voters, the race for the late Ted Kennedy’s Senate seat is a toss-up, and Republican Scott Brown even has a one-point edge over Democrat Martha Coakley.

The numbers: Brown 48%, Coakley 47%, with a ±3.6% margin of error. The election will be held on January 19. Independent candidate Joe Kennedy, a libertarian who is not related to the famous Kennedy family, was not included in the poll. If Brown were to pick up this seat in Democratic Massachusetts, it would surely spell the end of the health care bill — Brown has made it very clear that he would use his power as the 41st Republican Senator to stop the bill.

In addition, the New York Times did a recent profile on the pro-life democrat Bart Stupak in which he claims, including himself, to have 11-12 votes against Health Care Reform in the House unless it has his abortion-language.   And if the health bill doesn’t pass (given that it only passed by three votes in the first place, it is looking less and less likely given that several other pro-abortion rights dems have said they won’t vote for reform if it has such language), he said:

“It’s not the end of the world if it goes down,” he said over dinner. He did not sound downbeat about the prospect of being blamed for blocking the long-sought goal of President Obama and a chain of presidents and legislators before him. “Then you get the message,” he continued. “Fix the abortion language and bring the bill back.”

Alarmingly, it is looking more and more like health care reform failure is a real possibility.   Being unwilling to substantially (and magently) compromise with the opposing party (even on common sense things like tort reform and buying of private insurance across state lines)–or even one’s own pro-life democrats–has a real chance of killing the whole thing.

And if it does, the red/blue-state wars will have claimed another 30-some-million victims.


Health Care Reform on the Brink: Stupak Takes Off the Gloves

December 22, 2009

Well, we’ve been waiting to hear from him, and now he tells us in no uncertain terms:

Rep. Stupak: “So we’re getting a lot of pressure not to say anything, to try to compromise this principle or belief, and we’re just not – that’s just not us, I mean, we’re not going to do that. Members who voted for the Stupak language in the House – especially the Democrats, 64 Democrats that voted for it – feel very strongly about it. It’s been part of who we are, part of our make up. It’s the principle belief that we have. We are not just going to abandon it in the name of health care.” “So, to go back and ask you again, do you have the votes needed to stop the bill, if it comes to that?”

Rep. Stupak: “Well, if all the issues are resolved and we’re down to the pro-life view or, I should say, no public funding for abortion, there’s at least 10 to 12 members who have said repeatedly, unless this language is fixed and current law is maintained and no public funding for abortion, they’re not gonna’  vote for the bill. There’s 10 or 12 of us — they only passed the bill by 3 votes, so they’re going to be short 8 to 9, maybe 6 to 8 votes. So they do not have the votes to pass it in the House.”

He has now said it publicly.  He and several other pro-life democrats are prepared to kill health care reform in order to make sure no federally administered and subsidized insurance  exchange provides abortion coverage.  Is the party itself ready to kill health care reform–and essentially fall on its own political sword–to make NARAL and Planned Parenthood happy?  Who are the democrats and will they get on the side of a consistent ethic of life as public opinion shifts in that direction?

Given the push to get the bill passed by the President’s State of the Union speech in late January, the coming weeks will be interesting indeed!

Health Care: the Final Battle

December 22, 2009

So here we are…the final stage.  Positioning has already started for the conference committee to reconcile the House bill and the coming Senate bill.   At this point there appears to be three areas of concern–let’s deal with each in turn.

1.  Financing.  For how will the bill be paid?  The House bill increases taxes on persons in the upper tax brackets, while the Senate bill taxes those with very good health care plans.  The former makes conservatives upset while the latter makes some liberals upset–especially given that many unions have negotiated for precisely the kinds of plans that would be taxed.  However, this is not the kind of issue that will hold back the bill–and I wonder if the Senate actually did this to use as a bargaining chip on which to compromise in conference committee to get what they really want.

2.  The public option or expanded medicare buy-in.  The House bill has it, but the Senate bill does not.  Senators on both sides said they wouldn’t vote for it with/without one…but, one side flipped-floped on this issue and the other didn’t…so we clearly see for which side it means more.  In addition, Obama himself will be a negotiating member of the conference committee and for several months now his support for the public option has been lukewarm at best–just yesterday calling it ‘symbolic.’

3.  Abortion.  This is the big one.  Pro-life groups like National Right to Life and the more influential (because, unlike other pro-life organizations, they actually want to see the bill passed) US Catholic Bishops have pointed out that the Senate’s abortion language is unacceptable.  In addition to forcing the federal government to manage, and taxpayer money to subsidize, an insurance exchange which covers abortions, the Senate bill will require purchasers of such plans to pay a distinct fee or surcharge which is extracted solely to help pay for other people’s abortions. David Brody suggests that the Senate will be forced accept the House language on abortion because pro-life democrat Bart Stupak has enough determined fellow democratic pro-lifers who are willing to kill the bill over this, and the other side does not.

My prediction? I think the senate will compromise on how the bill is financed in order to remove the public option.  However, I think there will be blood on the floor over abortion language…but I hopefully predict that Stupak and company will steel their spines and force a bill that is comprehensively pro-life…something that will also signal the beginning of the end of the democratic party’s being beholden to the abortion-rights crowd.

Some wonder how a bill that is seemingly so unpopular could be passed.  Well, the honest answer is that so many democrats–including the President–are so convinced that covering the uninsured is a moral imperative that they are willing to sacrifice their futures to get it.  While this is something I very much admire, there is evidence that it might not be this dramatic.  For the reason the numbers keep falling is not because more people want less of this kind of reform, it is because they want it to go farther.  Good news for those of us who want to see those who cannot afford insurance and those who have preexisting conditions to get needed care.

“It Had All Come Down to Abortion”

December 20, 2009

Sadly, so many important and complex ethical issues today seem to be seen through the lens of the abortion wars (yet another reason it is so important to have discourse on this topic far, far differently than we currently do), and health care reform is another one of them.  It was not just a central issue, but THE issue down the stretch.  Indeed, as Politico reports, “It had all come down to abortion”:

After a break for lunch, Reid turned to abortion.  Nelson and Chief of Staff Tim Becker, who had flown in from Nebraska, set up shop in one room of Reid’s suite. Sen. Barbara Boxer (D-Calif.) and her aides settled into another wing with Sen. Patty Murray (D-Wash.), the two senators there to represent Democrats who favor abortion rights.  The opposing senators never spoke with each other or sat at the same table. They negotiated through Reid and Schumer.

Through the afternoon and early evening, they appeared deadlocked. Both sides, in consultation with advocacy groups, rejected various offers.  They couldn’t get beyond differences between the so-called Stupak amendment in the House bill, which would require women who receive federal subsidies for insurance to seek out a separate abortion rider, and a proposal by Sen. Bob Casey (D-Pa.) requiring policyholders to opt-out of abortion coverage. “I don’t know if we can do this,” Nelson said he told Reid at one point. “I’m running out of ideas.”

As he spent the day munching on almonds, peanuts and potato chips, Nelson said he eventually had what he described as a breakthrough. He turned over a piece of paper, and drew a line down the center.  “Why don’t we have two policies?” Nelson asked. “One with and one without.”  Nelson proposed that every state insurance exchange offer at least one plan that does not cover abortion, and policyholders could choose a plan with or without abortion coverage, unless states choose to ban it. Also, people who receive federal subsidies would need to write two separate checks as a way to ensure that none of the federal dollars went toward the abortion premium.

But this was not a new idea, and the pro-life groups who had supported Nelson (and had previously rejected similar ideas) were aghast.  As National Right to Life pointed out, “This seems to envision a system under which the OPM director would administer multi-state plans that cover elective abortions, and perhaps even possess authority to require such plans to cover elective abortions, as long as the director also ensured that there was one plan that did not cover abortions (except types of abortions also funded by the federal Medicaid program).”  The idea that the federal government would subsidize and manage (and perhaps require) health insurance companies that cover abortions is unprecedented, and Senator Nelson looks like a small time legislative sell out for this 11th hour move.

But with the senate vote likely to pass tonight, this sets up a huge and dramatic conference committee process between the House and Senate in the next couple weeks.  Pro-Life Democratic Representative Bark Stupak has already said that his pro-life democrat cohort will not support the Nelson compromise which means, if they are serious, the Senate bill cannot pass the House.  I know I’ve beat a dead horse on this blog already about this issue, but it is worth repeating again and again: the political winds have shifted; being liberal no longer means supporting abortion rights…and it certainly doesn’t mean supporting federal funding and managing of abortion.  Democrats now appear to have a huge choice to make: either pass a bill that will cover 30+ million of our most vulnerable citizens, end refusal of coverage based on preexisting conditions, and save billions of dollars in the long run–or reject the call of history and of their president and cave into the pro-abortion rights extremists of their party…leaving the bill to suffer a humiliating and unnecessary defeat.  If they choose the latter, they sacrifice not only those vulnerable uninsured counting on them to succeed, but also their political future and that of their president. If they choose the former, they get on the right side of history and score a huge victory for authentic reform.

Oh, and they go a long way to ending the horrifically destructive practice of viewing virtually every issue through the lens of the abortion wars.

Letter from the US Bishops on Health Care Reform

December 16, 2009

The US Catholic Bishops, major providers of health care in the United Sates, (and supporters of the ‘liberal’ bill proposals in Congress) have sent a letter to the Senate showing the hypocrisy of voting against amendments like Stupak/Nelson (sorry this is a bit long, but worth it):

The central argument against the Nelson amendment, voiced during floor debate by many
Senators, was that this amendment goes too far by barring federal subsidies to entire
health plans that include abortion coverage. The three-decades-long precedent of the
Hyde amendment and similar provisions governing all other federal health programs, it
was claimed, is this: Federal funds may not be used “directly” for an elective abortion,
but non-Federal funds such as private premium dollars may be used in the same health
plan for such abortions.1 The underlying health care reform bill was said to respect this
tradition by “segregating” funds with plans to allow “private” funding of abortion. It was
chiefly on the basis of this argument that the Nelson amendment was tabled

However, yesterday’s overwhelming vote to approve the Consolidated Appropriations
Act creates a new situation. In that vote, almost all Democrats, including almost
every Senator who claimed the Nelson amendment’s policy goes too far, voted in
favor of that exact policy. For these Senators voted to retain the actual current
language of the Hyde amendment, and of the parallel provision governing abortion in the
Federal Employees Health Benefits Program – and that language clearly requires a policy
in all other federal health programs that is identical to that of the Nelson amendment.
Here is the language of the Nelson amendment that Senators claimed was new and

1 No abortion provision at issue forbids funding abortions (or plans including abortion) when the mother’s life is endangered or in cases of rape or incest; these exceptions are not at issue and will not be included in quotes from the provisions. Abortions not covered by these exceptions are here called “elective” abortions.
2 No funds authorized or appropriated by this Act (or an amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion.

Here is the Hyde amendment, governing all current programs funded by the Labor/HHS
appropriations bill, which the Senate just voted to reaffirm:

None of the funds appropriated in this Act, and none of the funds in any trust
fund to which funds are appropriated in this Act, shall be expended for any
abortion…. None of the funds appropriated in this Act, and none of the funds in
any trust fund to which funds are appropriated in this Act, shall be expended for
health benefits coverage that includes coverage of abortion…. The term “health
benefits coverage” means the package of services covered by a managed care
provider or organization pursuant to a contract or other arrangement.
(H.R. 3288 as approved by the Senate on December 13, Division D, sec. 508;
emphasis added)

The Hyde amendment states further that it does not prevent use of state, local or private
funds for abortions, as long as these are separate from the state matching funds that
combine with federal funds to purchase a benefits package. In other words, not only
federal funds, but other funds used to purchase the same package, may not pay for
elective abortions.

Here is the parallel provision governing the Federal Employees Health Benefits Program,
which the Senate also approved yesterday:

No funds appropriated by this Act shall be available to pay for an abortion, or
the administrative expenses in connection with any health plan under the
Federal employees health benefits program which provides any benefits or
coverage for abortions.
(H.R. 3288 as approved by the Senate on December 13, Division C, sec. 613;
emphasis added)

Neither of these longstanding provisions says anything about “segregating” private and
federal funds within a health plan or benefits package. Attempts to achieve such
segregation are irrelevant to current policy, which bars federal funds from being used for
any part of a package that covers elective abortions.

Literally the only substantive difference between these noncontroversial and widely
supported provisions and the Nelson amendment is that the latter explains at length that
(a) it does not prevent purchasers who do not receive federal subsidies from buying a
health plan including elective abortions, even on the Exchange created by the health care
reform bill, and (b) it does not prevent purchasers receiving federal subsidies from buying
separate supplemental abortion coverage with their own funds.

What this means substantively is that the democratic opposition to Stupak/Nelson-like amendments is a disingenuous political ploy.  They really don’t have principled opposition, but rather this is the kind of public face they have to put forward to keep NARAL and Planned Parenthood happy.  While frustrating, the fact that they really ultimately don’t care about the principle might make a ‘manager’s amendment’ which brought back this kind of language that much more likely to get through.  Again, whether or not this happens–especially if Senators Nelson and Casey steel their spines and insist on it–will be a major turning point in the self-definition of the democratic party.

And it might be the basis of the only remaining problematic opposition to the bill as both the public option and medicare buy-in appear to be dead.  More drama to  come.

A Lack of Will from Senator Casey?

December 10, 2009

While it is true that (as mentioned below) there could be a manager’s amendment snuck in at the last minute with Stupak-like language, and this is the reason for their equivocation about pro-life language in the Senate Health Care Reform Bill, I begin to worry more and more that this is simply a lack of will on the part of Senators Nelson and especially Casey.  Consider this statement from Senator Casey:

Yet in the debate over health-care reform, Casey’s pro-life voice has been muted. He has done nothing more for the unborn than do as he did yesterday in voting for the Nelson anti-abortion amendment. He has not said he will hold up the legislation if it contains indirect funding of abortion. As he said recently, “I just think that there’s going to be enough momentum to get a bill passed that one issue – even a very important issue – will not prevent passage.”

Momentum?  Senator, if you have the will to filibuster this bill you (all by yourself) will force the dems to put in Stupak like language….much like Lieberman, all by himself, forced out the public option with a filibuster threat.   Letting health care reform fail for reasons  that will be painted in the midterm elections as selling out to pro-abortion rights extremism will be political suicide.  Especially for a country that now describes itself as pro-life (with the arrow continuing to point up) and that has the exploding magenta phenomenon of the ‘pro-life democrat’ (over a quarter of the Democratic caucus voted for Stupak).  Senators Casey and Nelson must act like their colleagues in the House; they must steel their spines in the confidence of this growing movement and the seize a moment to pass health care reform in a way that protects all  vulnerable members of the human family.  Those ‘liberals’ who default into a mantra of choice and privacy (which ignores and therefore sacrifices the vulnerable to the interests of the powerful) are losing ground and they are losing the public debate.  Now is no time for weak knees in the face of ‘momentum’.  Now is the time for confidence.  You hold all the cards.

Contact Senators Casey (PA) and Nelson (NE) and tell them to keep the pressure on.  And tell others (especially their constituents)  to do the same.