The House Will Make Sure the Senate Includes a Robust Public Option

This is the moment when Senate Finance Committee Chairman Max Baucus and Majority Leader Harry Reid (and President Obama) should make history by producing a Senate health reform bill that

• makes health insurance truly affordable for all Americans,
• creates a strong public option to give private insurers real competition,
• and doesn’t destroy Democratic re-election hopes by taxing hard-won middle class health benefits. 

Last week the Finance Committee became the last of five Congressional committees to pass a health reform bill —this one by far the weakest of all the bills.  Almost immediately, a small group of senators—Reid, Baucus, and acting Health, Education, Labor and Pensions Committee Chair Christopher Dodd—huddled with a White House team led by Chief of Staff Rahm Emanuel to begin the mysterious process by which the more progressive HELP committee bill will be melded with the product of Baucus’s mostly fruitless negotiation with Senate Republicans, only one of whom, Maine Senator Olympia Snowe, deigned to vote for the final Finance bill.

Reid and even Baucus say they personally support a public option, but they repeatedly point to the so-called “moderates” in their own party whose support is necessary to get to the 60-vote majority needed to overcome a Republican filibuster and pass a health reform bill in the Senate.  With a smart legislative strategy, the 60 Democratic votes (which with Snowe would total 61) could be called upon just to overcome the filibuster, clearing the way for a 50-vote majority to pass a strong health reform bill—while letting more conservative Democrats vote against it. [More on this anti-filibuster unity strategy in columns to come.]

Most importantly, Reid and Baucus need to realize that even “moderate” Democrats are rethinking their positions on health reform right now. Concentrating their minds is the realization that they are about to vote to force every American over the age of 25 to purchase health insurance. Moderate Democrats are the ones most receptive to the demands of the insurance industry, and the price the insurance industry is demanding in exchange for insurance reform (like preventing companies from discriminating against people with preexisting conditions) is the “individual mandate” – which means voters are forced to buy insurance, whether they can afford it or not.

At this moment, all Democratic politicians, even the most conservative, are realizing that their voters will blame them, not the insurance companies, if the policies the voters are required to buy are so expensive that premiums consume over 20 percent of those voters’ annual incomes. Suddenly, more generous tax subsidies to cover middle-class premiums seem like a good idea. And if the public option can bring down the cost of premiums those subsidies have to pay for, then the overall size of the reform price tag can be kept under control – a long-time demand of moderate Democrats.

Everyone knows that the three House bills contain more ample subsidies, two of the three have a strong public option, and none of them tax hard-won worker health benefits. On Friday, the Congressional Budget Office reported that the most progressive of the House bills produces more affordable premiums, while coming in around the 10-year cost of $900-billion goal set by moderate Democrats and President Obama. Here’s the headline on Lori Montgomery’s story: CBO Estimates House Health Bill at $905B or Less [1]

On the Health Care for America Now Blog, Jason Rosenbaum does a nice job [2] of teasing out the implications of these findings at this moment when moderates are figuring out how to achieve their fiscal goals, while avoiding being blamed for bad outcomes:

As a refresher, the bill being considered in the House is a much better bill than what Finance passed on Tuesday. It has a public health insurance option, it asks employers to pitch in their fair share, it is fairly financed [3], and it has much more generous subsidies (read: tax credits) to make health care affordable for everyone.

So, why, with all that good stuff in there, does it look like the CBO will say the House bill still covers millions more people and costs just as much, while remaining deficit neutral [4]? Because things like employer responsibility, fair financing, and the public health insurance option save money.

That's right. The public option saves money. The CBO has said so before [5], and it looks like they're saying it again.

Combine that with raising money by taxing households that make over $350,000 per year instead of the middle class [3], and asking employers to chip in for their employees health care, and you've suddenly got a lot more money to work with. Which means you can give middle class people more generous subsidies than the anemic Finance bill. Which means you and I won't be on the hook for 16.5% of our income paid towards health care costs [6], the level a typical middle class family would have to pay under the Finance bill.

  Reid and Baucus (and the White House) should step up to the plate and borrow the strongest parts of the HELP bill to write the final Senate health reform legislation. If they don’t, the House of Representatives, led by Nancy Pelosi and the Progressive Caucus, will force them to strengthen their bill in conference committee. But if the Democratic leaders in the Senate dare to lead, the House will back them up—and even the most moderate Democrats will support them as they make history by winning affordable health care for all.