Democrats agree to drop government run insurance option

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Post by racehorse » 12-19-2009 02:46 PM ... ain-wreck/

December 19, 2009

McConnell: Health care bill a 'legislative train wreck'

Posted: December 19th, 2009 12:19 PM ET

Washington (CNN) – Sen. Mitch McConnell, the Senate Republican leader, said the latest version of the Senate health care bill "is a legislative train wreck of historic proportions."

"If they were proud of this bill they wouldn't be doing it this way," McConnell said, referring to the reform bill fashioned in the Senate, where Democrats hold the majority. "They wouldn't be jamming it through in the middle of the night on the last weekend before Christmas."

Democratic senators on Saturday reached their goal of rounding up 60 votes supporting the health care legislation after U.S. Sen. Ben Nelson, who had been the lone Democratic holdout, reached an agreement that eased his concerns about abortion.

"Change is never easy, but change is what's necessary in America today. That's why I intend to vote for cloture and for health care reform," Nelson told reporters. Cloture means the Democrats needed the 60 votes to end debate on the health bill and send it to the Senate floor for a vote.

McConnell said the legislation "will have a profound impact on our nation. This is not renaming a post office. Make no mistake, this bill will reshape our nation and our lives."

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Post by racehorse » 12-19-2009 02:54 PM ... 97_pf.html

With Nelson on board, health-care bill could pass by Christmas

By Shailagh Murray and Lori Montgomery
Washington Post Staff Writer

Saturday, December 19, 2009; 1:30 PM

Sen. Ben Nelson (Neb.), the final Democratic holdout on health care, announced to his colleagues Saturday morning that he would support the Senate reform bill, clearing the way for final passage by Christmas of President Obama's top domestic policy priority.

Asked if he had secured the 60 votes needed to overcome a Republican filibuster, Senate Majority Leader Harry Reid (Nev.) told reporters, "It seems that way."

The Senate is expected to work its way through a series of procedural motions over the next few days, with a vote on the legislation scheduled the evening of Dec. 24th. A conference with the House to produce a final bill would likely extend into January, Senate aides said.

Congressional budget analysts said the revised package, unveiled Saturday morning by Reid, would spend $871 billion over the next decade to extend coverage to more than 30 million Americans by dramatically expanding Medicaid and offering federal subsidies to those who lack affordable coverage through employers.

Those costs would be more than covered by nearly $400 billion over the next decade in new taxes and nearly $500 billion spending reductions, primarily cuts to Medicare, the federal health program for people over 65. The remainder, about $132 billion over 10 years, would go to lowering the federal deficit.

But the Congressional Budget Office found that the package could reduce budget deficits by as much as $1.3 trillion in the second decade, starting in 2019, a significant improvement in long-run savings compared with both the House bill and the measure Reid had previously crafted. In his blog, CBO director Douglas Elmendorf attributes the change to lower targets for Medicare spending after 2019.

Democratic leaders worked for days to hammer out a deal with Nelson, and finally reached a tentative agreement late Friday night with him on abortion coverage provisions that had proven the major stumbling block to winning his support. Nelson also secured favors for his home state and to benefit different factions of the health-insurance industry.

Republicans strongly rejected the revised bill as laden with risky new policies and giveaways to win votes. GOP leaders invoked a Senate rule to require the package of changes in the legislation to be read aloud on the floor, a process expected to last about five hours.

"This bill is a monstrosity, a 2,100 page monstrosity full of special deals," said Senate Minority Leader Mitch McConnell (R-Ky.). "This is not renaming the post office. Make no mistake, this bill will reshape our nation and our lives."

But Republicans also were running out of options in their quest to derail the bill. Locking down Nelson's support meant Reid had cleared a path through the Senate's complex parliamentary minefield. A 60-vote super majority means the minority's primary source of power in the Senate, the filibuster, cannot be sustained.

Under the new abortion provisions, states can opt out of allowing plans to cover abortion in the new insurance exchanges the bill would set up, to serve individuals who lack coverage through their jobs. Plus, enrollees in plans that do cover abortion procedures would pay for the coverage with separate checks -- one for abortion, one for the rest of any health-care services.

Nelson secured full federal funding for his state to expand Medicaid coverage to all individuals below 133 percent of the federal poverty level. Other states must pay a small portion of the additional cost. He won concessions for qualifying nonprofit insurers and for Medigap providers from a new insurance tax, and was able to roll back cuts to health savings accounts.

"I know this is hard for some of my colleagues to accept and I appreciate their right to disagree," Nelson told reporters at the Capitol, of the many changes made at his behest. "But I would not have voted for this bill without these provisions."

The revised Senate bill closely tracks with the $848 billion measure Reid drafted earlier this month, before he entered into negotiations aimed at winning the needed 60 votes. Since then, Reid has made numerous concessions to moderate Democrats in addition to Nelson and others with abortion-related concerns. Reid also scrapped efforts for a government-run insurance plan, or public option.

Instead of a public option, the final bill would allow private firms for the first time to offer national insurance policies to all Americans across state lines. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress.

Starting immediately, insurers would be prohibited from denying children coverage due to pre-existing conditions. A complete ban on the practice would take effect in 2014, when the legislation seeks to create a network of state-based insurance exchanges, or marketplaces, where people who lack access to affordable coverage through an insurer could apply for federal subsidies to purchase policies.

Insurers competing in the exchanges would be required to justify rate increases, and those who jacked up prices unduly could be barred from the exchange. Lifetime limits on coverage would be banned and annual limits would be "tightly restricted," aides said, until 2014, when they, too, would be banned entirely.

Reid's package also would give patients the right of appeal to an independent state board if an insurer denies a medical claim. And all insurance companies would be required to spend at least 80 cents of every dollar they collect in premiums on delivering care to their customers.

Under the proposal, every American would be required to obtain coverage or face annual penalties. Employers, too, could be fined if they failed to offer affordable coverage and their workers sought subsidies in the exchanges. Reid's package would offer additional assistance to the smallest businesses, however, including six years of tax credits, starting in 2010 to help businesses with 25 or fewer workers and average wages of less than $50,000 to purchase policies. And workers who couldn't afford employer-offered insurance but earned too much to qualify for a federal subsidy would be permitted to keep their employer's contribution to their coverage and use the money to buy insurance on the exchanges.

Reid also strengthened cost-containment provisions, expanding the scope of an independent Medicare advisory board charged with reining in runaway Medicare costs. Under the final bill, the board also could make recommendations for Congress, the federal government and the private sector, a change demanded by seniors' groups. And the legislation would provide grants to state governments to test ways to eliminate medical malpractice lawsuits.

The package would rely on nearly $400 billion in new taxes, according to congressional tax analysts, including a new 10 percent tax on indoor tanning salons to be paid by the customer. With the addition of the tanning tax, Reid proposes to scrap an earlier provision that would have imposed a 5-percent levy on cosmetic surgery.

In addition to the tanning tax, the Reid amendment would increase certain levies in the original bill. For example, couples making more than $250,000 a year would pay an additional 0.9 percent in Medicare payroll taxes, instead of the 0.5 percent increase Reid originally proposed. And people who failed to obtain insurance for even one month would face monthly penalties that by 2016 could add up to as much as $750 a year or 2 percent of a person's income, whichever is greater.

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Post by HB3 » 12-19-2009 04:52 PM

Interesting thoughts here. I guess one could hypothesize that it doesn't matter how bad the bill is -- in fact, the worse it is the better, since gross inefficiency could conceivably just result in calls for greater and greater regulation to "fix" the problems in the first bill. What did David Icke call it? "Problem/reaction/solution...."

Readers question Dems' motives on health care
By: Byron York
Chief Political Correspondent
December 18, 2009

Earlier this week I asked why Democrats continue to push a national health care bill, even though dozens of polls show a solid majority of Americans don't want it. Are President Obama, House Speaker Nancy Pelosi, and Senate Majority Leader Harry Reid irrational? Politically tone deaf? What could possibly account for their rush to pass legislation that the public decisively rejects -- less than a year before the 2010 elections?

I outlined the theories of a Democratic strategist who asked to remain anonymous. He said that Pelosi is determined to fulfill the Democratic Party's destiny -- a national health care system -- and believes losing 20, or even 40 Democratic seats in the House would be an acceptable price for achieving a goal the party has pursued since Franklin Roosevelt. The president is looking for a crowning achievement and has the comfort of not running for re-election in 2010. And, the strategist said, Reid believes that whatever losses Senate Democrats sustain in 2010 will happen regardless of whether health care is passed.

So they all forge ahead.

After the column was published, I heard from many readers with their own ideas. The strategist wasn't telling me the whole story, they said; the Democrats' motivations go much deeper. So here are some other theories for the party's headlong rush into what looks like political disaster.

"The Democrats are playing for the long term," wrote one reader. "They know that, once they've planted a new entitlement, it will grow as fast as they can water it with taxpayer dollars."

"The only way to fully understand the motivation for pursuing this legislation is that it creates dependency," wrote another. "The unstated, but ever-present, goal of health care reform is to make as many Americans as possible as dependent on the federal government as possible for as much of their lives as possible." The reader theorized that the bill's mandates -- requirements for everyone to have health coverage -- are designed to create what Democrats "have dreamed of for generations: total dependency and a universal entitlement that can never be voted out of existence."

It's been done elsewhere, said another reader, who argued that the Democratic plan is designed "to make it so our conservatives will be like the conservatives in England, where the entire political paradigm has lurched leftward to the point where the only difference in the two parties is who will give you more."

Other readers pointed to pressures inside the Democratic coalition. "Leadership figures are worried about their position inside the caucus, and they need the support of unions and 'progressive' organizations to hold caucus majorities," one wrote. Added another: "The real answer may lie in the fact that both sides of the political fence have beloved factions that vote much more often than the national average. When energized, a near-100 percent turnout of a particular group of, say, 20 percent of the electorate means a much higher effective turnout." In other words, Democratic leaders are doing it for their noisy -- and loyally voting -- fringe.

Yet another reader's theory: "I think they're insane."

No readers took issue with the strategist's argument that Democrats display so much confidence because they believe they know what is best for the American people. And, as I predicted, conservative readers loved the strategist's comparison of Democratic leaders with robbers who, having decided to knock off a bank, conclude it's best to keep going no matter what. "They're in the bank, they've got their guns out," the strategist said. "They can run outside with no money, or they can stick it out, go through the gunfight, and get away with the money."

"Yes!" wrote one reader. "'Dog Day Afternoon' for Democrats!"

This week the president told the nation that we are "on the precipice" of passing historic health care legislation. He could not have chosen a better word, because that's what a majority of readers -- and the American public -- believe: that we're about to plunge into a health care system that is more expensive and offers lower-quality care than what we have now.

Finally, when I wrote, "Democrats are all in. They're going through with it. Even if it kills them," one reader said it really came down to a much more fundamental question: "But what if it kills us?"

Can't argue with that. ... 80202.html

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Post by Linnea » 12-19-2009 05:39 PM

Really beginning to enjoy all this. Haven't heard so much hyperbole since the run up to the War in Iraq. Politicians, talking heads, the Media heroes, the frantic bloggers...

US hypermania at its best.

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Post by badspell » 12-19-2009 08:27 PM

Linnea wrote: Really beginning to enjoy all this. Haven't heard so much hyperbole since the run up to the War in Iraq. Politicians, talking heads, the Media heroes, the frantic bloggers...

US hypermania at its best.


You say so much in so few words.
All hear few listen

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Post by racehorse » 12-19-2009 08:36 PM ... 1F3F5420D2

Stupak aims to sink 'unacceptable' abortion compromise

By: Ben Smith

December 19, 2009
01:26 PM EST

An aide to Rep. Bart Stupak (D-Mich.) coordinated opposition to the Senate health bill’s abortion compromise this morning with the Republican Senate leadership, according to a chain of frantic emails obtained this morning by POLITICO.

Stupak, in an interview with POLITICO, called the Senate bill’s abortion position "unacceptable" – but disavowed his staffer’s collaboration with Senate Minority Leader Mitch McConnell.

“I never talked to McConnell about the health care bill,” said Stupak, adding that “I did not authorize the email [which] “was sent without my knowledge.”

Stupak said that he has discussed the Senate’s abortion position with Democratic senators Ben Nelson (Neb.) and Robert Casey (Penn.), who both hold conservative views on abortion.

Stupak's continued opposition to the Senate plan, despite those conversations and intense pressure from the White House, suggests that reconciling it with the House bill may prove politically challenging.

The Senate language represented “a dramatic shift in federal policy,” said Stupak, adding that he remained hopeful that the differences could be resolved in conference. Nelson, though, said earlier Saturday that his support for the legislation was contingent on the abortion compromise remaining in it.

The emails suggest a previously unseen degree of coordination between the offices of Stupak and McConnell. Stupak is the leader of a group of pro-life Democrats who say they’ll oppose the sweeping legislation if it uses government money to pay for abortion, while McConnell is firmly committed to killing the legislation.

The fact that their offices have made common cause against the Senate's health care compromise will likely further infuriate Stupak’s Democratic colleagues in the House, and demonstrates his willingness to stop any bill that doesn’t pass his test.

“Guys - when will we see your letters of opposition to the managers amendment?? We need them ASAP!” wrote Erika Smith, the Stupak aide, at 9:23 this morning, less than an hour after the amendment had become available.

The email’s recipients included key staffers for the U.S. Conference of Catholic Bishops, National Right to Life, the Family Research Council, as well as Autumn Fredericks Christensen, aide to top pro-life Republican Chris Smith, and Lanier Swann, a McConnell aide.

A minute after Smith sent out her plea, Lanier reiterated it to the list.

“Nelson is telling people in the building he will vote yes. If there was any time to weigh in against this deal —- THIS IS IT,” Swann wrote at 9:24 a.m.

Response to the bill has been negative from groups on all sides of the abortion divide.

Douglas Johnson, an official at the National Right to Life Committee, a group whose staffers were looped on Smith’s email, released a statement Saturday afternoon calling the Senate compromise “light years” away from Stupak's amendment. The president of the Susan B. Anthony List, Marjorie Dannenfelser, said the bill “is not ‘compromise’ or ‘middle ground’ – it is a betrayal of conscience for millions of Americans.”

“The new abortion language solves none of the fundamental abortion-related problems with the Senate bill, and it actually creates some new abortion-related problems,” she said.

Cecile Richards, the head of Planned Parenthood, called it “a sad day when women’s health is traded away for one vote,” adding that “there is no policy reason for this action, it is simply a political maneuver.” And the National Organization of Women sent out a release calling the provision “every bit as bad as the infamous House-passed Stupak-Pitts Amendment.”

The manager’s amendment, which emerged after hours of negotiations between Nelson and Senate Majority Leader Harry Reid, stops short of the total ban on health insurance plans that participate in a new exchange system offering abortion coverage. Instead, it includes a provision that allows states to prohibit abortion coverage in the exchanges.

The amendment also requires that health plans that provide abortion services separate, for accounting purposes, private premiums and federal funds, and ensure that the federal funds don't pay for abortion services, a maneuver derided in the past by anti-abortion groups as a shell game.

The compromise paved the way for a Senate vote on President Obama's top priority, but the frantic emails this morning suggest reconciling the bill with the House’s may remain an obstacle.

Stupak said that he was in Northern Michigan, without internet access, when the emails were sent from his office to McConnell’s. Smith “should have let me make up my own mind,” said Stupak.

A spokesman for McConnell declined to comment about the staffers’ exchange.

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Post by racehorse » 12-19-2009 08:46 PM ... view=print

December 19, 2009

Jane Hamsher


Left/Right Populist Outrage Will Defeat Senate Health Care Bill

Glenn Greenwald and Ed Kilgore both have very good pieces up today on the impoverished left/right dialectic that dominates the media coverage of politics, and its inadequacy when it comes to discussing the dynamics of the health care debate. The sight of pundits yucking it up about the "Democratic circular firing squad" have become as tedious and threadbare as those counseling "don't let the perfect be the enemy of the good." Both of these admonitions have at their heart the notion that "liberals" are being irrational, unreasonable and rigid in refusing to accept the Senate health care bill.

But in the very next breath, they will then promote statistics that say the tea parties are more popular than either the Democratic or the Republican party, and wonder if it's an opportune time for a third party candidate. (From the "right," of course, because who would take the "left" seriously.) At no time do the synapses firing in their brains make the connection that both the "lazy progressive bloggers" and the tea party activists are saying almost the exact same thing about the Senate bill.

Ben Smith printed a letter from a "liberal blog denizen" (who curiously didn't want to use their name) that I think represents the White House/media thinking pretty well:

The trick is to put a package together that some visible element of "the left" is out there opposing, but that actually has the support of everyone who matters on the left. SEIU isn't opposing the bill. NAACP isn't opposing the bill. Important thought-leaders like Paul Krugman aren't opposing the bill. Surf over to and you'll see they're highlighting some "f*** you Joe Lieberman" stuff, but not seriously trying to push liberal Senators to vote "no" (indeed, during an earlier iteration of the argument they espoused the view that any filibustering Democrat deserve a primary challenge.). But members who want to feel like they're doing some meaningful triangulation get to point to Jane Hamsher on MSNBC denouncing the whole thing and feel like they're getting one over on the left.

This is probably the most useful role that the existence of a large and feisty activist blogosphere can play during a non-election time. Their existence and their passion shift the whole public conversation to the left. They make it possible for governing from the center to be *seen as governing from the center* rather than having a replay of the Clinton years when centrist governance came to define the left-most pole of the possible.

I read that letter and marveled that this is the thinking of the White House. And yet, I think it is. It's got the blueprint for holding the "veal pen" captive, and then triangulating against those (bloggers) whose financial structures make them much more responsive to populist sentiment -- and hence difficult to neuter. It's the only way that lashing out at Howard Dean and coddling Joe Lieberman -- something guaranteed to galvanize the netroots instantly -- makes any sense.

Because blogs/Dean have been needling the White House's health care shell game, they've turned their attention toward discrediting those messengers and trying to use it to their advantage. I understand the impulse -- when you go into a comment thread of a blog post, the person who disagrees with you is the one who is going to get the emotional rise out of you. But it's a huge mistake to overweight that, because you wind up doing what the White House is doing right now: standing with their backs to a tsunami rising over their heads, of which Howard Dean and the blogs are only a small symbol.

And the media, who are eagerly lapping up attacks on Dean and the crumbs being tossed out of the White House press office, only reinforce that blindness.

There is an enormous, rising tide of populism that crosses party lines in objection to the Senate bill. We opposed the bank bailouts, the AIG bonuses, the lack of transparency about the Federal Reserve, "bailout" Ben Bernanke, and the way the Democrats have used their power to sell the country's resources to secure their own personal advantage, just as the libertarians have. In fact, we've worked together with them to oppose these things. What we agree on: both parties are working against the interests of the public, the only difference is in the messaging.

Harry Reid and Dick Durbin put on a nice show for the credulous. As Durbin said when he was trying to build his email list, "The question is no longer if we will have some sort of public option in the final health care reform bill, but instead what form it will take." But the very same day, he was also warning about "60 votes" on MSNBC, and it was Durbin who whipped Lieberman's vote for PhRMA to kill Dorgan's drug reimportation bill (after Harry Reid kept it off the floor for 7 days until PhRMA could twist enough arms to defeat it).

The end is the same as it was when Medicare Part D passed. Remember how Democrats made a big show of passing negotiation for prescription drug prices when they knew George Bush would veto it? We saw how long that lasted. When it comes to true differences in the parties, only the set dressing on the road to capitulation seems to change.

With unemployment at 10%, the idea that you can pass a bill whose only merit is that "liberals hate it" just because the media will eat it up and print your talking points in the process is so cynical and short-sighted it's hard to comprehend anyone would pursue it. It reflects a total insensitivity to the rage that is brewing on the popular front, which is manifest in every single poll out there.

Yet time and again, we're told "Obama retains his popularity with liberals" and that "screeching liberal bloggers" aren't having an impact. Nobody seems to notice that the "screeching liberal bloggers" are reflecting the very same sentiments of the vast majority of the country, whether the very small segment of the population who self-identify as "extremely liberal" holds the President responsible or no.

Rahm Emanuel has convinced himself that Ron Brownstein is a "liberal" and dismisses all of this as "the progressive backlash against the progressive backlash." He's betting that any inadequacies will be forgotten come November 2010 if the Dems can claim a "w" by passing any crap bill and slapping "health care" on it. And that if Congress just spends the next year naming post offices, any objections that Americans might have to paying 8% of their incomes to private corporations who will use the IRS as their collection agency will just disappear.

It's scary to think that people this obscenely stupid are running the country. All the while, the painfully obvious left/right transpartisan consensus that is coalescing against DC insiders of both parties appears to be taking everyone by surprise.

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Post by racehorse » 12-19-2009 08:51 PM ... ic-mistake


Sen. Mitch McConnell: Approving health bill would be historic mistake

Sen. Mitch McConnell

When Senate Democrats huddled at the White House for a presidential pep talk on health care this week, most of the pundits focused in on a handful of intransigent Democrats. But the problem Democratic leaders are having in passing the Obama administration's signature domestic issue is with the American people, who overwhelmingly oppose the Democrat plan.

It's easy to see why. In early September, Obama came to Capitol Hill and made a dramatic plea for health care reform that would "slow the growth of health care costs for our families, our businesses, and our government." Three months later, Democrat leaders unveiled a $2.5 trillion 2,074-page bill that fails the president's own first principles of reform. Incredibly, they still want to pass it.

This would be a terrible mistake. Americans are outraged that lawmakers who promised to lighten the financial burden of rising health care costs are now poised to pass a bill that would make these burdens even greater. That's the primary reason why a recent CNN poll shows that 61 percent of Americans oppose this bill. People feel like they've been taken for a ride in this debate, and they're not happy.

There is simply no question at this point that the health care debate has gone off track. At some point along the way, Democratic leaders seem to have put a higher priority on satisfying various constituencies -- on finding votes -- than on meeting the president's promises. They took their eye off the ball. As a result, the bill they produced breaks nearly every pledge the president made about reform.

In July, the president pledged that the bill he signs "must ... slow the growth of health care costs in the long run." Yet a recent report by the administration's own budget scorekeeper at the Department of Health and Human Services says the Democrat plan would lead to hundreds of billions of dollars in more spending and higher health insurance premiums. This report, by the man the administration turns to for unbiased analysis, echoes a study by the nonpartisan Congressional Budget Office, which said federal health care spending would rise under the Democrat plan.

One of the administration's most insistent assurances all along is that under its plan those who like the care they have could keep it. But that can no longer be said for the nearly 11 million seniors enrolled in Medicare Advantage. According to the director of the Congressional Budget Office, enrollees in this program would see their benefits cut by about half under the Democrat health care plan.

The administration insisted its plan would not raise taxes on middle-class Americans. In September, the president said no family making less than $250,000 a year would see any form of increase: "Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes." Yet an analysis by staff on the Joint Committee on Taxation suggests that within a decade one fourth of all individuals and families filing tax returns under $200,000, would, on average, see their taxes go up.

In June, the president said he was committed to paying for his plan in a way that "protects our senior citizens." But this pledge is impossible to square with one of the core sources of funding for the Democratic bill: nearly $500 billion in cuts to Medicare, cuts that will lead to lower quality at hospitals that treat Medicare patients, hospices, home health care, and for enrollees of Medicare Advantage. Indeed, according to the CMS actuary, one fifth of all hospitals and nursing homes that treat Medicare patients would find it harder and harder to survive under the Democrat plan.

The president said during a campaign stop last summer that his plan would "bring down premiums by $2,500 for the typical American family," an appealing claim that simply would not be kept under the bill the president has shepherded through Congress. In fact, according to the CBO, most people will either see only minor changes from the status quo -- or will actually see their premiums go up.

Many Americans are just as frustrated with the process as they are with the substance of this debate. In January, the president outlined a path to reform that would involve "not negotiating behind closed doors, but bringing all parties together, and broadcasting those negotiations on C-SPAN ..." Yet that particular pledge seems almost quaint after weeks of closed-door negotiations and a flurry of back-room deals by Democrats aimed at pushing their bill through by Christmas.

Throughout this debate, Republicans have pushed for common sense reforms that would lower costs without raising taxes, premiums, or increasing the federal debt. After all, reform should alleviate existing problems, not spread them. That's the message Americans have been sending all year. Democrats either haven't been listening, or they didn't think people would notice if they took the debate in a different direction. Whatever the reason, a growing number of Americans are demanding that we stop this bill, start over, and get it right. The bill we have simply can't be fixed.

Faced with a bill that does none of the things they said it would, the White House is left with nothing but an empty call for senators to "make history." Americans have a different message for wavering Democrats: Passing this bill would be an historic mistake.
Sen. Mitch McConnell, R-Ky., is the U.S. Senate Republican leader.

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Post by racehorse » 12-19-2009 09:08 PM ... -care.html


Nelson Pledges Support For Health Care Bill, Making Passage Likely

by Nate Silver @ 12:08 PM

According to multiple reports, Nebraska Senator Ben Nelson has agreed to support the Democrats' health care legislation after a series of amendments introduced by Majority Leader Reid. This potentially gives the Democrats exactly 60 votes for passage. Maine's Olympia Snowe, the most moderate Republican, is not expected to lend her endorsement.

Needless to say, this dramatically increases the likelihood that Democrats will pass a bill, although it is not certain. How could the bill die? There are basically five ways:

1) There is a 'surprise' conservative vote against cloture. Technically, speaking, there are not 60 Democrats who have formally stated that they'd vote yes. Or, someone could renege on their promise to vote yes. With Snowe -- and presumably Collins -- apparently poised to vote against the measure, there is no margin for error.

Still, being good Bayesians about all this, it seems likely that we would have heard something if this were the case. After all, announcing one's potential opposition to the bill is a highly profitable enterprise: Ben Nelson, Joe Lieberman, and Mary Landrieu have at various points in the past two weeks leveraged their threats into either significant changes to the bill text (Nelson and especially Lieberman) or significant 'bonuses'/bribes for their states (Landrieu and Nelson). To announce one's opposition now would probably just kill the bill outright, and fail to extract any such concessions. Therefore, this seems unlikely, although it's certainly not impossible. The odds probably improve from 'very unlikely' to merely 'unlikely' if the Republicans succeed in delaying the floor vote until after Christmas.

2) There is a 'surprise' liberal vote against cloture. As Chris Bowers has pointed out, while Democrats like Bernie Sanders and Roland Burris have threatened not to vote for the bill upon final passage, none have yet threatened -- much less pledged -- to vote with the Republicans on a filibuster. Also, the amendments forced by Nelson appear to be somewhat milder than what I had been anticipating, and Reid has also introduced a couple of changes that the liberals should like, such as a ban on lifetime coverage limits. So, although the senators we are dealing with -- particularly Roland Burris -- are somewhat unpredictable, this too seems unlikely.

3) The bill receives 60 votes for cloture, but fewer than 50 for final passage. We mention this for the sake of completeness, but it seems extremely unlikely as most of the 'veto points' in the Senate, like Nelson and Evan Bayh, have essentially been treating their cloture vote as equivalent to an up-or-down vote. Nor is there enough potential liberal opposition. If Nelson, Lieberman, Bayh, Landrieu, and Lincoln (from the right) and Burris, Sanders and Feingold (from the left) all voted against final passage, that would still leave the bill with two extra votes to spare.

4) The House votes against the conference report. According to many sources, including the White House in their Thursday conference call, there is still highly likely to be a conference report in order to reconcile the House and Senate versions of the bill -- which of course contain significant differences, including the public option.

This is arguably the most likely avenue for the bill's defeat; the measure, after all, passed the House with only two extra votes, and I'd expect some liberal groups to shift their attention to the House and urge progressives to kill the bill. However, that neglects the fact that some moderate and conservative Democrats who voted against the bill the first time around will probably now vote for the compromise with the Senate, which will be significantly more moderate. It also neglects the fact that Nancy Pelosi is a significantly more skilled vote-whipper than Harry Reid. So, this is perhaps the most interesting thing to watch, but it again seems unlikely that the bill will fail to clear the hurdle.

EDIT/UPDATE: Opposition from pro-life Democrats to the Senate bill's milder abortion language could still be a significant flashpoint.

5) The Senate filibusters the conference report. Yes, conference reports can be filibustered, although they can't be amended, which reduces the likelihood of brinkmanship gone awry. Once the bill has been reported out of conference, you can't threaten to vote against cloture in order to extract concessions because you won't get any -- you can simply vote against cloture to kill it.

Of course, it's that qualifier that matters -- once the bill has been reported out of conference. The fight, to the extent there is one, is liable to take place in the conference committee itself. At the end of the day, though, I figure there are probably a majority of votes in the House for the Senate bill as is -- for every liberal vote that is potentially lost, a Blue Dog vote is potentially gained. And so long as there is that daylight, the Democrats are highly likely to find it. That's not to suggest that there won't be some real issues to be hammered out, or that there isn't some chance of best-laid-plans going awry, but again this isn't a likely outcome.

Overall, the safe and sensible assumption is that the bill is in the 80-90 percent likelihood range for moving to the President's desk and becoming law.

UPDATE: The CBO score is out. It appears that the bill will be marginally more expensive than the previous version, but will also raise marginally more revenues, so the net effect on deficits (vis-à-vis the original version) is basically zero. Also, the CBO has stated that the changes are unlikely to significantly alter the premiums that taxpayers are expected to pay under the bill; the public option would have saved the government some money by reducing the amount of subsidies, but would not have had a significant effect on the premiums that individuals pay.

* * *

Another important point: Nelson has stipulated that his vote is contingent upon there not being very many changes in conference committee. So while, on the one hand, the changes to the Senate's bill are milder than what many had anticipated (and some of the changes push the bill in a more progressive direction), on the other hand, they may represent a bit of a 'pre-compromise' with the House.

I would hope that the House has some leverage, however, with respect to the magnitude of the subsidies provided to lower-income individuals and families; this is an area in which the White House has indicated it may be actively involved.
Last edited by racehorse on 12-19-2009 09:17 PM, edited 1 time in total.

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Post by racehorse » 12-19-2009 10:41 PM ... F6CFFA605D

Payoffs for states seal Senate deal

By: Chris Frates

December 19, 2009 07:56 PM EST

Ben Nelson’s “Cornhusker Kickback,” as the GOP is calling it, got all the attention Saturday, but other senators lined up for deals as Majority Leader Harry Reid corralled the last few votes for a health reform package.

Nelson’s might be the most blatant – a deal carved out for a single state, a permanent exemption from the state share of Medicaid expansion for Nebraska, meaning federal taxpayers have to kick in an additional $45 million in the first decade.

But another Democratic holdout, Sen. Bernie Sanders (I-Vt.), took credit for $10 billion in new funding for community health centers, while denying it was a “sweetheart deal.” He was clearly more enthusiastic about a bill he said he couldn’t support just three days ago.

Nelson and Sen. Carl Levin (D-Mich.) carved out an exemption for non-profit insurers in their states from a hefty excise tax. Similar insurers in the other 48 states will pay the tax.

Vermont and Massachusetts were given additional Medicaid funding, another plus for Sanders and Sen. Patrick Leahy (D-Vt.) Three states – Pennsylvania, New York and Florida – all won protections for their Medicare Advantage beneficiaries at a time when the program is facing cuts nationwide.

All of this came on top of a $300 million increase for Medicaid in Louisiana, designed to win the vote of Democratic Sen. Mary Landrieu.

Under pressure from the White House to get a deal done by Christmas, Reid was unapologetic. He argued that, by definition, legislating means deal making and defended the special treatment for Nelson’s home state of Nebraska.

“You’ll find a number of states that are treated differently than other states. That’s what legislating is all about. It's compromise," he said.

It was Nelson who proved that he who plays hardest to get, gets the most.

He forced Reid to redraft the bill’s restrictions on federal funding of abortion. And while most insiders were focused on that deal, Nelson was quietly ensuring that his state would never have to pay for the Medicaid expansion being written into the bill – an agreement that had been in the works for weeks.

Medicaid is usually paid for with a mix of federal and state funding, but Nelson's carve out means that any Medicaid beneficiaries who join the program under the bill will be fully paid for by the federal government.

It's an important deal considering that many governors are worried that the Medicaid expansion will further strain already stressed state budgets – and one that came after Nebraska Gov.Dave Heineman called on Nelson to vote against the bill.

"The State of Nebraska cannot afford an unfunded mandate and uncontrolled spending of this magnitude,” the governor wrote to Nelson.

Nelson deferred all questions on the provision to Reid, saying only that he was “comfortable” the deal took care of Nebraska.

But Nelson’s deal could be a pittance compared to where the Nebraska compromise might ultimately lead – to 49 other states demanding that the feds pick up their share of health reform’s new Medicaid burden when it kicks in during 2017.

"When you look at it, I thought well, God, good, it is going to be the impetus for all the states to stay at 100 percent [federal funding]. So he might have done all of us a favor," Sen. Tom Harkin (D-Iowa) said of Nelson’s dealings.

Nelson and Levin also pushed a provision that exempts non-profit insurers in Nebraska and Michigan from an annual multi-billion dollar excise tax on insurance companies.

Not surprisingly, both states are home to non-profit insurers who control a high-percentage of the industry’s profits. In Michigan, non-profit insurers control 76 percent of the industry’s profits – one of the highest percentages in the nation – while Nebraska non-profits control 46 percent of their state’s profits.

And in an example of how closely senators guarded details, Levin’s office did not answer any questions about the proposal when asked about it on Friday.

Republicans, meanwhile, expressed outrage at the wheeling and dealing, as if their party had never cut a legislative deal in its 150-year history.

“This bill is a monstrosity, a 2,100-page monstrosity full of special deals for people who are willing to vote for it,” said Senate Republican Leader Mitch McConnell. “And they’re playing these kind of games with the nation’s health care. This is an outrage.”

But Sanders didn’t sound outraged when he talked about the extra Medicaid funding Vermont will get for six years. Massachusetts, meanwhile, received three years worth of additional Medicaid funding. Under the original bill, neither state had qualified for the money.

Republican Sen. Mike Enzi accused Democratic leaders of favoring Medicare Advantage beneficiaries in Pennsylvania, New York and Florida at the expense of seniors in other parts of the country.

“The Democrats are playing ‘Let’s make a deal’ with trillions of your hard-earned tax dollars. You and all the American people should know that the majority leader is buying his votes with your money,” said Enzi (R-Wyo.) “The Reid bill gives sweetheart deals to a few states and the rest of the country will foot the bill. Making unfair deals like this is the wrong way to legislate and the American people know it.”

And while there were plenty of state-specific deals, some of the changes were clearly aimed at pleasing specific Democratic factions. For instance, tightened insurance regulations went a long way toward putting a smile on the faces of liberal senators who have lost their much-loved public option.

The amendment mandates that insurers spend no less than 80 percent of their premium revenues providing medical care. Currently, insurers spend about 70 percent of their premiums paying for health care. The bill also eliminates insurers’ ability to cap annual coverage amounts.

In brief remarks at the White House, President Barack Obama also highlighted some new provisions, including penalties for insurers who “arbitrarily jack up rates” and an immediate prohibition on insures’ ability to deny children coverage.

Obama, too, talked of the deals as just the cost of doing business in Washington.

“As with any legislation, compromise is part of the process,” Obama said. “But I'm pleased that recently added amendments have made this landmark bill even stronger.”
Carrie Budoff Brown and Jake Sherman contributed.
Levin, Nelson, and Sanders lined up for deals in the health reform package. Photo: AP photo composite by POLITICO

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Post by joequinn » 12-20-2009 09:35 AM

As Rabelais said with his dying breath, "ring down the curtain! the farce is OVAH!"

Why am I not reading this morning about blood-crazed mobs of people, armed with torches and pitchforks, attacking the White House, intent to make sure that the ground is sown with salt and that not one stone remains on top of another, as a warning to evil-doers? And why isn't Wall Street on fire from one end to the other? And why aren't the rich being hacked to death in the gutter with axes? Why am I not reading this morning about such things? Why?
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Post by Live365 » 12-20-2009 11:01 AM

While Nelson is a Democrat, Nebraska is still a very, very red state, and confidence is high that he will get a butt-whooping over this at election. If this legislation is a success, he will have erred on the side of rightousness. If it's a disaster, the "Cornhusker Kickback" will be his death knell. The headline of the Omaha World Herald this morning quotes Nelson: "Health Care Bill to Stand the Test of Time". I hope it doesn't flunk.
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Post by Cherry Kelly » 12-20-2009 12:10 PM

joequinn -- why you aren't seeing that -- could have something to do with the snow that has fallen - how are people supposed to get there? :)

okay - fun aside -- bribery from DEMS to DEMS -- and where is THAT bribe money coming from - oh ya we the rest of the people across USA...


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Post by racehorse » 12-20-2009 01:17 PM ... _care.html

December 20, 2009

Kenneth P. Vogel

09:52 AM

McCain: GOP can't stop health care

Sen. John McCain (R-Ariz.) concedes that Republican senators won’t be able to stop Democratic health care reform legislation from passing the Senate before Christmas.

“We will fight until the last vote,” McCain told "Fox News Sunday" host Chris Wallace. “We owe that to our constituents, because we must do everything – we must look back and say we did everything to prevent this terrible mistake from taking place.”

Democrats recently reached a deal with hold out members of their own caucus to cobble together the 60 votes necessary to pass the bill - and McCain, in response to a Wallace question, said there’s “probably not” anything the GOP can do to block the bill. “But what we can do is continue winning the battle of American public opinion.”
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Post by racehorse » 12-20-2009 08:19 PM

Posted on Sun, Dec. 20, 2009

Health Care bill faces key Senate test vote

AP Special Correspondent

Senate Democrats confidently advanced heath care legislation Sunday toward a make-or-break test vote in a push for Christmas-week passage. Republicans vowed to resist what they appeared unable to stop.

In the run-up to the vote, the escalation in rhetoric was remarkable on both sides of an issue that has divided the two political parties for months.

"This process is not legislation. This process is corruption," said Sen. Tom Coburn, R-Okla., referring to the last-minute flurry of dealmaking that enabled Majority Leader Harry Reid, D-Nev., and the White House to lock in the 60 votes needed to approve the legislation.

Democratic Sen. Sheldon Whitehouse of Rhode Island responded in near-Biblical terms. In a speech on the Senate floor, he said Republicans are embarked on a "no-holds barred mission of propaganda, obstruction and fear. ... There will be a reckoning. There will come a day of judgment about who was telling the truth."

Whatever else it was, the legislation represented the culmination of a year's work for Democrats, pressed by President Barack Obama to remake the nation's health care system.

Under Senate rules, Democrats needed 60 votes on three separate occasions to pass the measure. The first and most critical test was set for about 1 a.m. Monday. Democrats said Nebraska Sen. Ben Nelson's announcement Saturday that he would vote for the bill gave them the support they needed.

Nelson came in for strong criticism from Republicans in Washington, who complained that he had won favorable treatment for his home state's Medicaid program. In a bit of political theater, they sought to open the bill up to extend it to all 50 states, but Democrats objected.

Nelson's agreement to an abortion-related change in the bill drew criticism from Nebraska Right to Life, a longtime supporter, and the state's Catholic bishops, who issued a statement that they were "extremely disappointed" in him.

Asked if Republicans could prevent the bill's passage, Sen. John McCain, R-Ariz., said: "Probably not. But what we can do is continue winning the battle of American public opinion."

Democrats hoped Republicans would relent in the face of a clear 60-vote majority, but if GOP critics choose to do so, they could delay a final vote on the bill until early Christmas Eve.

The House has already passed legislation, and attempts to work out a compromise are expected to begin in the days after Christmas.

The Senate legislation is predicted to extend coverage to more than 30 million Americans who lack coverage and would ban industry practices such as denial of insurance on the basis of pre-existing medical conditions. The Congressional Budget Office said it would reduce deficits by about $132 billion over a decade, and possibly much more in the 10 years that follow.

At its core, the legislation would create a new insurance exchange where consumers could shop for affordable coverage that complies with new federal guidelines. Most Americans would be required to purchase insurance, with subsidies available to help families making up to $88,000 in income afford the cost.

In a bow to Senate moderates, the measure lacks a government-run insurance option of the type that House Democrats placed in their bill. Instead, the estimated 26 million Americans purchasing coverage through new insurance exchanges would have the option of signing up for privately owned, nonprofit nationwide plans overseen by the same federal agency office that supervises the system used by federal employees and members of Congress.

The full extent of Reid's maneuvering was still unclear.

Nelson won numerous changes, including tougher restrictions on abortion coverage and an estimated $45 million in federal Medicaid funds, enough to completely cover his state's costs of complying with an expansion of the program mandated by the bill.

Vermont and Massachusetts also won additional Medicaid funds; plastic surgeons were persuasive in their bid to strip out a proposed tax on elective plastic surgery; hospitals in the Dakotas, Wyoming and Montana won additional Medicare funds; and there was more money for hospitals in Hawaii to treat the uninsured.

While Nelson's vote was the decisive one to fall into place for the Democrats, only an unpredictable series of events has left them with the ability to gain 60 without any help from Republicans.

They began the year with a caucus of 58, including 56 Democrats and two independents. Pennsylvania Sen. Arlen Specter added to their ranks in April when he suddenly bolted from the Republican party, and Sen. Al Franken made it 60 when he was sworn into office in July after a long Minnesota recount.

It was only a few weeks before Massachusetts Sen. Edward M. Kennedy, a longtime advocate of universal health care, succumbed after a long battle with brain cancer and Democrats reverted to 59 seats.

With a heavy push from Reid and the White House, and a request Kennedy wrote not long before his death, Democrats in the Massachusetts Legislature quickly changed state law so Gov. Deval Patrick could appoint a temporary replacement.

Paul Kirk, a longtime Kennedy associate and former chairman of the Democratic National Committee, was sworn in Sept. 25. "We're prepared to go to work," he said.

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