The Democratic Party seems to be settling around the reconciliation sidecar strategy as their only path forward. It would require the Senate to pass a set of fixes to the original Senate health care bill and then the House to pass the original bill and the reconciliation measure of “fixes” at the same time. Nancy Pelosi prefers this route and Harry Reid sounds up to it. The important question is: Can they actually sell this set of reconciliation fixes to the American people?
Pelosi indicated that she was not going to put the public option in the reconciliation measure, and she would deal with only issues talked about before Scott Brown won his election in Massachusetts. That is a very bad political decision. Democrats are going to need a simple, easy to explain justification for creating this reconciliation sidecar.
What are the Fixes?
It appears this sidecar will likely contain changes to the excise tax, some form of new tax on the wealthy to pay for the changes, more savings from Medicare, possibly increased affordability tax credits, maybe a move to eventually close the Medicare Part D donut hole, and, possibly, a national exchange.
None of these changes sound like good justification for another health care bill. Maybe you can try to rally people around the national exchange or the eventual closing of the donut hole by 2019, but I doubt it.
Explaining why you need to fix the excise tax just ends up pointing out how unpopular and poorly designed the tax was in the first place–and how all 60 members of the Senate Democratic caucus voted for this bad idea anyway. Not a move that will make selling health care reform easier.
The same goes for the national exchange. You end up needing to explain how stupid state-based exchanges are, and that begs the question of why the Senate Democrats put them in the original bill. Selling a bill of hard to understand but expensive technical fixes for all the terrible problems with a bill you have not yet passed sounds like a public relations nightmare.
Something Popular to Justify Reconciliation
The easiest way to sell the reconciliation measure is not to fix unpopular problems, but to add something new that is very popular. It will allow Democrats to say, “we need to do reconciliation to add X.” That X could be a public option or a Medicare buy-in, as both are very popular. If the label “public option” is too politically charged, they could just create a modified Medicare buy-in program which would basically be the same thing as a public option, but slightly easier to sell as “Medicare buy-in.” This is similar to an idea even Blue Dog Mike Ross once pushed for.
The new popular thing added could have something to do with lowering drug prices–possibly drug re-importation or direct Medicare drug price negotiations. Both are very popular and were top health care reforms promised by Democrats.
This popular new item used to sell the reconciliation measure could even be something that has not be talked about before. Maybe it could be a way to get around the individual mandate requiring people to buy a product from a private insurance company. This could be done with an option of not buying insurance, but having the tax credits you would have gotten automatically be put in a special health saving account with a super catastrophic plan from the government similar to Singapore’s system or the Dutch health care alternative for some Orthodox Calvinists.
This new idea could possibly be the national, semi-public co-op that Chuck Schumer once proposed. It would be set up by the federal government, and partly overseen by appointed officials. Possibly a super powerful council and government oversight agency to make the new co-ops feasible. Or maybe the popular new provision would be an even higher minimum medical loss ratio requirement for insurers, or a new special agency dedicate purely to making sure individuals insurance premiums are not being misspent.
The Take Away
The important thing is that Democrats need a way to sell this reconciliation measure. They need a big flashy new idea to get the base excited, and to soak up the bulk of the media attention about this reconciliation bill. Something like “Medicare buy-in” to show that this will really change the bill and that there is a justification for spending several more weeks on health care.
Currently, the leadership is too focused on getting the deals and counting the votes. Those votes will evaporate after several weeks of debate if the reconciliation measure can’t be easily sold and defended. A bill only full of hard-to-understand technical fixes that require Democrats to explain how badly the Senate Democrats ruined the first health care bill will not sell. Once Republicans start attacking, no one will want to vote for it. The bill needs a good, understandable reason Democrats can point to for why they created another health care bill.