White House Health Proposal – The Politics
So what to make of this new health care proposal from the White House? Well, certainly it’s an indication that they’ve built a plan to do two things – 1) move using the reconciliation sidecar approach and 2) force the Republicans into making bad choices.
Most everything in the White House summary would be germane to a reconciliation passage. White House communications director Dan Pfeiffer said today on a conference call that “the President believes the American people deserve an up-or-down vote on health reform… If opposition decides to take extraordinary step of filibustering, we designed this to pass” through alternative means, basically reconciliation.
But there are a couple pieces of the proposal that could not really pass through reconciliation. The new federal rate reviewer, for example. I see no way that has a budget number attached to it, meaning it would be subject to a Byrd rule challenge. But this may be just what the White House WANTS. When I asked Pfeiffer about it, he said that they took the limitations of reconciliation into account, and that ultimately, what passes muster is up to the Senate parliamentarian. But there could be a vote to waive the parliamentarian’s decision, one that would require 60 votes. At that point, Republicans would have to make the choice to vote down a federal regulator devoted to making sure customers across the country don’t get gouged on their health insurance premiums. That’s smart politics, and I could see why they’d welcome such a vote.
They didn’t do this for everything, just a few pieces that would force Republicans into bad votes. The other major area comes from the waste, fraud and abuse section, which are practically all proposals from old Republican bills.
Basically, this makes the proposal sound a bit more populist than it is. The rate reviewer portion is designed to elicit a certain Republican response. The raising of the threshold of the excise tax was pre-ordained by the indexed increase. To explain: the tax initially came into play in 2014; now it gets delayed to 2018 for all plans, not just union plans. The tax at 2018 was designed to rise annually by the CPI + 1%. That would mean that the 2018 level of the excise tax was always going to be around $27,500, which is the new threshold they’re calling an “increase.” It’s a bit of a “fun with math” game. Another example: the affordability additions that are .3% or adding 3% to the actuarial value. It looks OK on paper but amounts to a rounding error in practice.
The White House summit, like the summary, is designed to elicit a Republican response. Pfeiffer said on the call that the President would not agree to the demand to start over from scratch, believing a lot of good work has already been done. “But we are coming to this meeting with an open mind and we hope the GOP does the same. We hope they have a plan that they post online, and we’d be happy to host it at whitehouse.gov, or link to it,” he said. They want this summit to be a comparison of ideas, not a dart board for the Democratic plan. It’s a race to the high road, to hopefully spur Democrats into believing (if they don’t already) that Republicans are acting in bad faith and would never agree to any health care bill, so they must take it on independently.
This is a document designed to get a bill to pass. It’s basically the Senate bill with a series of changes. Politically, it’s designed to rock Republicans on their heels a bit, and considering that Democrats have owned the health care issue for 60 years, that it’s taken this long to get around to doing that is a bit shocking.
…the White House’s plan is posted at this website, where public comment will be allowed.
FWIW, here’s Nancy Pelosi’s statement on the release of this proposal:
The President today made available to all Americans the Administration’s health insurance reform proposal, which contains positive elements from the House and Senate-passed bills. I look forward to reviewing it with House Members and then joining the President and the Republican leadership at the Blair House meeting on Thursday. This discussion will continue a year-long historic level of transparency and open debate of this crucial reform effort.
Our nation is closer than ever to guaranteeing affordable health care to America’s middle class and small businesses, lowering costs and strengthening Medicare for seniors, holding insurance companies accountable, and reducing our deficit. The cost of inaction is too great for our nation and for every family facing the heartbreaking reality of skyrocketing health care costs and denied care or coverage.
We must pass comprehensive, affordable health insurance reform, and I am hopeful that Thursday’s meeting will help us achieve this goal.