Progressive Breakfast: Health Care Reform for the Holidays

Depending on your outlook, it's either "Bah Humbug" or a "Happy Holiday," as Senate Democrats approach a historic Christmas Eve vote for the biggest expansion in health care in decades.

The particulars of the health care reform package will be the subject of debate (and revision) for sometime to come. Some of the "winners and losers," thus, will be determined over time. But there are, of course, various takes:

• Politico's Ben Smith says the same insurance insider who had declared to him via email "WE WIN", has since revised that to "not so much": "The last time I checked we didn't get an 80 billion "deal" in exchange for removing our biggest legislative issue. In fact, while the govt run plan has been removed which is a win for taxpayers and for health plans, the fact is this bill is far from a "give away" to insurers."


• Smith's anonymous insurance insider may have a point. Time's Kate Pickert notes that the Senate bill contains a measure that could do what progressives hoped a public option would do: keep insurers, "fattened by billions of dollars in new government subsidies and a new requirement that most Americans purchase insurance" from "jacking up prices and padding profits and executive salaries" by setting minimums on what portion of premiums must be spend on health care.

  Insurance companies have a very technical term for this proportion — "medical loss ratio" (MLR) — and critics say the terminology itself illustrates the callousness of the health insurance business. Companies that sell coverage consider revenues that go to pay for medical costs "losses,"; minimizing these losses by dropping sick customers and cherry-picking healthy ones is one way insurers currently stay profitable. But thanks to a provision inserted into the Senate health care bill at the last minute, the federal government may soon require insurers to "lose" 80% of premiums collected in the large group market and 85% in the individual and small group market. Insurers who don't operate at or above these thresholds would have to send rebates to customers. (MLRs are generally higher in the large group market because selling and administering one policy for many people at once requires much less overhead than designing, marketing and carrying out policies on an individual basis.)

  The original Senate bill called for lower thresholds — 75% and 80% respectively — while the House bill calls for an 85% limit across the board; crucially, both of those bills would have ended the requirement in 2013, the year much of health reform only begins to take effect, while Reid's new provision would maintain the regulation in perpetuity. Former Democratic National Committee Chairman Howard Dean, who had advocated killing the public option-less Senate bill, said Monday on MSNBC that of the last-minute changes to the Senate bill made by Reid, the strengthening of the MLR regulations was "the most important thing of all ... It requires insurance companies not to take quite as much off the top of your premiums as they have in the past." MLR regulations are just one of the discrepancies, including the public option and abortion funding, between the House and Senate bills that would have to be reconciled in conference committee before a final piece of legislation could be voted on and sent to President Obama. Rockefeller intends to fight hard in conference to ensure the final legislation includes the new Senate provision.



• Plus, the president emailed supporters, saying "Insurance companies that try to jack up their rates do so at their own peril..."


• John Farrell of U.S. News & World Report declared is "a win for the middle class": "The Democratic Party (God-willing, the creek don't rise and Robert Byrd avoids a fatal cold) is about to give millions of hard-working American families a holiday gift of historic proportion. With all its imperfections, the Democratic healthcare bill is a triumph of political perseverance, and a sturdy foundation on which future generations can continue to build an efficient, modern, universal American healthcare system. But in the near term the legislation is, most of all, a godsend for the "little guys" and gals that the Democratic Party has, throughout our history, claimed to champion. Working class families that play by the rules and slave and sweat to make ends meet are about to receive $900 billion in aid from the rest of us. No one deserves it more."


• Katrina vanden Heuvel calls a win for community health centers, thanks to Sen. Bernie Sanders: "Without fanfare, the good Senator from Vermont, Bernie Sanders, has continued to work behind the scenes to champion community health centers--something he has done for years (also here). These non-profit, community-based facilities provide primary healthcare, dental care, mental health services, and low-cost prescription drugs on a sliding scale. As amendments were added in recent days to win over the Liebermans and Nelsons of the "greatest [undemocratic] deliberative body" in the world, Sanders made sure that a $10 billion increase in funding for the health centers was included. "


• The cosmetic surgery and botox industries scored a win, successfully lobbying Senate Democrats to pull a 5% tax on elective cosmetic surgery.


• Tanning salons — and certain members of House Republican leadership — may endure a loss if the proposed 10% tax on indoor tanning services.

The passage of the Senate health care reform bill appeared to be all but a done deal once Republicans essentially acknowledged defeat, made a deal to cut short the debate, and turned their eyes towards the 2010 election. Washington Post: "Even Senate Republicans appeared ready to admit defeat, as Minority Leader Mitch McConnell (Ky.) cut a deal with Majority Leader Harry M. Reid (Nev.) to hold a final vote on the Senate bill at 8 a.m. Thursday, allowing senators to head home hours earlier than expected. Under Senate rules, Republicans could have forced senators to stay at their desks until nearly 10 p.m. during what will be the Senate's first Christmas Eve session since 1963. ...Republicans view the soaring national debt as a potent political issue heading into the 2010 congressional elections and want to use a lengthy Senate debate to focus attention on the issue just as Obama is preparing to address Congress and unveil his second budget request."

Republicans did not go down to defeat, however, without denouncing the dealmaking process that gave Democrats as fragile 60-vote coalition to keep together long enough for a final vote. Some even called for the president to condemn the deals and dealmaking.

How soon they forget. Media Matters' Eric Boehlert provides a flashback to the GOP's own history: "For anybody who's spent more than three weeks inside the Beltway, the allegations of legislative arm-twisting certainly sound naive, since that's how the D.C. game has been played for going on two centuries now. But nonetheless, conservatives insist Democrats have stooped to some kind of historic low. But I can't help wondering what Nick Smith thinks about those claims. Because back in late 2003, when was serving as a Republican member of Congress from Michigan, Smith opposed the Bush White House's attempt to revamp Medicare when the issue came up for a vote in November. Republican leaders quickly realized that night that they didn't have the votes and started leaning on their own members..."

Maybe it's just the Republicans' dealmaking efforts failed. Smith voted no on Medicare.

No word, though, on whether that condemnation should extend to the Schumer/Nelson hunting expedition. Politico: "The perils of political hunting trips range from mockery - as with Sen. John Kerry's (D-Mass.) expensive gear — to mortal danger — as in ending up on the wrong end of Dick Cheney's 28-gauge. But Sen. Chuck Schumer (D-N.Y.) had another story in mind when he traveled recently to Nebraska, a cautionary tale told to him early in his career by an older, urban-oriented New Jersey congressman who had made the mistake of accepting a hunting invitation from a Midwestern colleague. "He shot the dog," Schumer recalled, referring to the outcome of the Jersey pol's inept marksmanship. Schumer did not shoot the dog. He bagged three pheasants. And six weeks later, he bagged Sen. Ben Nelson (D-Neb.), serving as key negotiator as Nelson held the fate of landmark health care legislation in the balance."

The dealmaking isn't nearly done, either. There's still the conference committee, and another round of sausage-making. McClatchy: "If the bill passes, it will need to be reconciled with the version the House of Representatives passed on Nov. 7. That job falls to a House-Senate conference committee, a group that likely will consist of a handful of senior lawmakers loyal to party congressional leaders, and working behind closed doors. To most Americans, the conference process is an enigma, rarely taught in history or civics lessons. Even the 'School House Rock' classic animated step-by-step primer, 'I'm Just a Bill,' skipped over the conference committee's role. On Capitol Hill, however, it's a tradition steeped in late-night, closed-door deals and howls of protest from the frozen-out minority party."

Chris Bowers gives an overview of the remaining conference committee fights. On his list: reproductive rights, the excise tax, the employer mandate, subsidies ($574 billion vs. $338 billion), Medicaid (at 150% or 133%), exchanges (national vs. state), and anti-trust exemption.

Republicans weren't the only ones with one eye on the 2010 elections.Taegan Goddard of Political Wire points to reports noting that Democrats are getting tips on selling health care reform after passage. Politico: "At their luncheon today, Senate Dems will get tips on selling health care that include focusing on immediate benefits and the historic nature of the achievement. In a memo to be presented to senators, Democratic pollster Mark Mellman argues: 'The public continues to trust Democrats and the President over Republicans to deal with the issue. The news media has recently highlighted polls showing double-digit margins in opposition to the current healthcare plan. But these cursory stories … often ignore the fact that a chunk of opposition to the current plan comes from those who support reform, but would like to see Congress go further.'"

Obama's Option

In an interview with the Washington Post, President Obama defended the Senate bill, deflected criticism of the bill, and distanced himself from the public option:

In the interview, Obama vigorously defended the legislation, saying he is "not just grudgingly supporting the bill. I am very enthusiastic about what we have achieved."

"Nowhere has there been a bigger gap between the perceptions of compromise and the realities of compromise than in the health-care bill," Obama said. "Every single criteria for reform I put forward is in this bill."

In listing those priorities, he cited the 30 million uninsured Americans projected to receive coverage, estimated savings of more than $1 trillion over the next two decades, a "patients' bill of rights on steroids," and tax breaks to help small businesses pay for employee coverage.

Those elements are in the House and Senate versions of the legislation; their competing proposals will have to be reconciled in conference committee next year. The House bill includes a government-run insurance plan favored by progressive Democrats; the Senate version does not. "I didn't campaign on the public option," Obama said in the interview.

Jerome Armstrong at MyDD responds with a question, "How big do you think this whopper is?", a picture, and a YouTube video.

Breakfast Sides

Christmas is coming, but the economic news doesn't inspire visions of sugar plums. States' jobless funds are nearly tapped out in the recession, which doesn't portend well for the unemployed — or taxpayers. Washington Post:

The Senate passed a trade bill that had been stalled by that custody battle in Brazil.

Success, the saying goes, has a thousand fathers, but failure is an orphan. And so, in the aftermath of an underwhelming or disappointing climate summit in Copenhagen, the blaming begins and the E.U. is first in line. New York Times: "European Union leaders on Tuesday sought to deflect criticism that they had fumbled their strategy at the Copenhagen climate summit meeting, just as a feud between the British and the Chinese over whom to blame for the outcome worsened. ...The E.U. went into the conference with a strategy of leading by example on emissions cuts, but has been widely criticized by industry and environmental groups for not marshalling other nations to follow and for ending up sidelined at the summit meeting."

The GOP may have welcomed Alabama Rep. Parker Griffith with open arms when he announced a decision to change parties, but Ezra Klein reports that Griffith may still have to watch his back in his new party.

Not only did ACORN not break the law, according to a Congressional Research Service report, but the undercover filmmakers who "broke" the story may have violated state law.

Imprecatory prayer changes things, and sometimes backfires. Following Sen. Coburn's lead, a tea-bagger and C-SPAN caller fears he may have prayed Sen. Inhofe away from the cloture vote. Via Daily Kos.

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