Rockefeller, Harkin Sparring With Insurance Industry

(Sick for Profit)

Senate Democrats are trying to extract some embarrassing information from the insurance industry about their deceptive practices.

First, Tom Harkin, who is seeking to subpoena insurers for failing to provide information requested by his committee.

Harkin, the chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, said his committee may demand information from health insurance companies about the reasoning for steep increases in premiums faced by small businesses.

"I've been inundated with letters and information about the exorbitant increases in premiums for small businesses in this country," Harkin said during an appearance on MSNBC. "I asked them to come and testify at a hearing I had yesterday. They refused."

"So now I'm asking them to give us information on which we can make some decisions on why these premiums are going up so much for small businesses," he added.

Here's the video:

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Jay Rockefeller also wants some information about the industry's "medical loss ratio," and how they cook the books to pretend that they spend a substantial amount of premium money on treatment and care.

The New York Times reports: "The health insurance industry likes to cite figures showing that 87 cents of every dollar in premiums is spent on medical claims. But a new Senate analysis suggests that for-profit insurance companies are spending much less than that, especially for policies sold to individuals and small businesses. Instead, as little as 66 cents of each dollar paid in premiums goes toward doctor and hospital bills, while the rest covers administrative expenses, marketing and company profits, according to the analysis. .... The [health reform] legislation that may reach the House floor later this week would initially require insurers to spend at least 85 cents of every dollar in premiums on medical claims."

A long-standing complaint from individuals and small businesses is that they get less for their money. "But insurance companies generally do not disclose how much they spend in different segments of the market. The Senate analysis of the figures does not include information from California, because that state's filings are not available through the National Association of Insurance Commissioners. ... The insurance industry's trade group, America's Health Insurance Plans, said Monday that the 87-cent figure it cited as the industry average was based on information collected by the federal government and was an accurate reflection of how much of each dollar in premiums was spent on medical claims." (Abelson, 11/2).

This comes at a time when the Senate is about to unveil their health care bill. This information could be crucial to massing public opinion against the industry and keeping the entire Democratic caucus on board with reform.

The Senate Progressive Block

Jason Rosenbaum has the news on that secret letter I was talking about yesterday that Senate Democrats were pushing, demanding that Harry Reid include a public option in the bill that comes to the floor. We now have the letter, and it calls for a "robust, Medicare-like" public option, which is right where the House Progressives have drawn the line. The letter has 30 signatures:

Sherrod Brown (D-OH) John D. Rockefeller (D-WV)
Russell D. Feingold (D-WI) Patrick J. Leahy (D-VT)
Daniel K. Akaka (D-HI) Tom Udall (D-NM)
Kristen E. Gillibrand (D-NY) Roland W. Burris (D-IL)
Ron Wyden (D-OR) Debbie Stabenow (D-MI)
Barbara Boxer (D-CA) Sheldon Whitehouse (D-RI)
Michael F. Bennet (D-CO) Dianne Feinstein (D-CA)
Jack Reed (D-RI) Jeff Merkley (D-OR)
Frank R. Lautenberg (D-NJ) Benjamin L. Cardin (D-MD)
Al Franken (D-MN) Robert P. Casey, Jr. (D-PA)
Barbara A. Mikulski (D-MD) Daniel K. Inouye (D-HI)
Edward E. Kaufman (D-DE) Arlen Specter (D-PA)
Maria Cantwell (D-WA) Robert Menendez (D-NJ)
Bernard Sanders (I-VT) John F. Kerry (D-MA)
Herb Kohl (D-WI) Paul Kirk (D-MA)

Some VERY interesting names on this list. Michael Bennet. DiFi (!). Arlen Specter. Newest Democrat and former pharma lobbyist Paul Kirk. Ron Wyden.

To be sure, nobody here is saying that they won't vote for a bill without a public option in it. But these would be the main possibilities for such a strategy. And you would only need 11 of these 30 to pull that off. And really, you would only need one, if you're tying it to a 60-vote filibuster-proof hurdle.

Despite the rumors and compromises being floated, it is NOT a given that Harry Reid puts a public option in the merged bill. This show of support by fully 1/2 of the caucus - and with public option supporters who voted it out of committees not on this list, the real number is higher - is very important to reaching that goal.

Everyone Loves An Opt-Out

Here we have yet another compromise on the public option that sets moderates in Washington stirring. The "opt-out" national public option, which would offer states a chance to eliminate it for their own jurisdiction, is gaining support on Capitol Hill. Chuck Schumer says it's being "very seriously considered". Max Baucus says through an aide he would consider supporting it. Howard Dean said he'd support it if he were a Senator. Richard Kirsch from HCAN says it's better than triggers, co-ops and opt-ins, which is faint praise but praise nonetheless.

I think there's some good and bad to it. We don't know what the opt-out would look like - a referendum? Gubernatorial veto? Federal waiver? A policy bill with a hurdle in state legislatures? Tied to funding? - and how easy it could be surmounted, as well as how easily gamed by special interests. Insurance companies are spending $1 million a day to beat the public option in Congress, you don't need that much to beat it in the states. Would this have a chilling effect on all federal legislation, with every big bill subsequently requiring a state opt-out, balkanizing the country? Or would every red state Governor bluff at opting out, and then, after seeing the numbers for how this would really help people, grudgingly accept it? We also don't know what kind of public option this would bring into being. Would it be Chuck Schumer's weak conception with no tie to Medicare bargaining rates? Or a robust public option with Medicare + 5% rates and Medicare's provider network? I think Nancy Pelosi is doing something very smart by scoring both versions just so the fiscal conservatives can choke on the numbers.

Speaker Nancy Pelosi (D-Calif.) will submit multiple versions of the House's healthcare bill for cost estimates, she announced on Thursday.

The first proposal will include a "robust public option," which would tie doctor reimbursement rates to that of Medicare plus five percent. The remaining two drafts submitted for the Congressional Budget Office's consideration would include a public option based on "the negotiated rates that some in our caucus have supported and which was passed by the Energy and Commerce Committee," the speaker explained during Thursday's press briefing.

"And then we'll see back from the CBO what the scoring is on all of that," Pelosi said. "And, of course, we have promised not a dime to the deficit. This is our promise. We will not take a bill to the floor, the president will not sign a bill that adds a dime to the deficit."

We already know that the CBO considers the robust version to save $85 billion more than the weak version, so this will just cement that even more.

All the while, House Progressives, which have formed a block requiring a straight national public option with no opt-out and ties to Medicare rates, continue to say they won't compromise, won't blink, and claims that they have the votes they need to pass their plan in the House, although some have questioned the numbers.

I think the strategy should be maximalist - pass the best of what you can in the House, and the best of what you can in the Senate, so that when the two bills are merged, you at least are dealing with the best possible from both chambers. A merger, for example, could see a Medicare-tied public option with the opt-out clause.

However, the nagging feeling is that nobody wants to stop the public option, or at least nobody wants to be responsible for it. In that case, shouldn't the plan for supporters be to say to them, "We dare you to kill this"?

"Major Power Brokers On The Left"

Last night, Rachel Maddow tells me broke some news.

We can report exclusively tonight that two major power brokers on the left have told MSNBC that they are encouraging a Senate strategy now in which the leadership would revoke chairmanships and other leadership positions from any Democrat who sides with a Republican filibuster to block a vote on health reform. Regardless of how individual senators would vote ultimately on the bill, committee chairmen or subcommittee chairmen who allowed Republicans to force a 60-vote requirement for passing health care...under this type of strategy would be in danger of losing their chairmanships.

I don't know what that means. "Two power brokers on the left"? Who? Senators? Fundraisers? People who want health reform? I'm encouraging this, am I one of the power brokers? If it's Senators, this isn't really news, as Tom Harkin said this about Max Baucus back in July, even before the vote. Jay Rockefeller has intimated it as well, with respect to having a vote on leadership and chairmanships instead of using seniority. And with Rockefeller and Baucus not even speaking to each other before this critical vote, I'm assuming that hasn't changed.

Mind you, I'd LOVE for this to be the strategy. It wouldn't take effect until 2011, and I don't know if it can filter down to subcommittees - Ben Nelson and Mary Landrieu don't chair any committee, for example - but it's one of the tools in the shed for the Senate caucus leadership. I hope they use it. This report doesn't convince me they will, however.

The Blue State Public Option

Sam Stein has a pretty major development:

Senate Democrats have begun discussions on a compromise approach to health care reform that would establish a robust, national public option for insurance coverage but give individual states the right to opt out of the program.

The proposal is envisioned as a means of getting the necessary support from progressive members of the Democratic Caucus -- who have insisted that a government-run insurance option remain in the bill -- and conservative Democrats who are worried about what a public plan would mean for insurers in their states.

"What folks are looking for is what gets 60 votes," said a senior Democratic Hill aide. "The opt-out idea is very appealing to people. It has come up in conversations. I know personally that a handful of members have discussed it amongst themselves."

In conversations with the Huffington Post, sources have said that while the opt-out approach to the public plan is in its nascent stages it has been discussed with leadership in the Senate. It was pulled out of an alternative idea, put forth by Sen. Tom Carper (D-Del.) and, prior to him, former Senate Majority Leader Tom Daschle, to give states the power to determine whether they want to implement a public insurance option.

But instead of starting with no national public option and giving state governments the right to develop their own, the newest compromise approaches the issue from the opposite direction: beginning with a national public option and giving state governments the right not to have one.

Essentially you'll end up with a blue-state public option, with the possibility of a few referenda to remove it in the states that allow ballot initiatives. Although, as we saw on the stimulus, threatening to opt out of a federal program is far easier than actually doing it. I'd guess that most states would go ahead with it.

As compromises go, this is about as good as anything that's been discussed, certainly better than triggers, co-ops or Tom Carper's "opt-in" proposal. It needs to be a good public option, one with Medicare's provider network and hopefully some relationship to Medicare rates, but if that's the case then it probably even beats Schumer's weak natonal proposal.

The entire exercise is to get to the conference committee with some kind of public option in both houses. That way, getting something out of conference is virtually assured. If you have no public option in the Senate bill, you're not going to get one in the final bill. That's just an educated guess. So Democrats are trying to figure out something that can get through a Senate vote. It's a difficult lift.

Outside pressure remains a factor here. But we're now talking about which kind of public option to have, not whether or not to have one at all. That's a better place to be.

Feingold's Czar Hearing

I'm a big Russ Feingold fan - that should come as no surprise to any longtime reader. And at a certain level, I do understand his hearing today about executive branch czars. While George W. Bush had more czars than Barack Obama, it is true that the numbers of them have expanded over the years, and we should wonder if the executive branch is using these policy coordinator positions to avoid legislative oversight. Feingold correctly explains that "czars" has become a catch-all term, and some who have fallen under that title in the media are filling positions created by statute, or hold positions inside a federal agency and report to an cabinet officlal. All of the so-called "czars" in these categories have either been confirmed by the Senate or routinely testify before Congress. He's primarily interested in the portfolios housed inside the White House instead of those more readily available to the process of checks and balances.

“I am most interested in the third category of positions, and I think we are talking about fewer than 10 people, in part because we know the least about these positions. These officials are housed within the White House itself. Three weeks ago, I wrote to the President and requested more information about these positions, such as the Director of the White House Office of Health Reform and the Assistant to the President for Energy and Climate Change. The response to that letter finally came yesterday, and I will put the response in the record and plan to question our witnesses about it.

“The White House decided not to accept my invitation to send a witness to this hearing to explain its position on the constitutional issues we will address today. That’s unfortunate. It’s also a bit ironic since one of the concerns that has been raised about these officials is that they will thwart congressional oversight of the Executive Branch.

“The White House seems to want to fight the attacks against it for having too many ‘czars’ on a political level rather than a substantive level. I don’t think that’s the right approach. If there are good answers to the questions that have been raised, why not give them instead of attacking the motives or good faith of those who have raised questions?

Michael Scherer calls this a plea for a more civil discourse. But there are several points to make:

• The forces on the right who have elevated the "czar" issue aren't interested in a civil debate. They just want to collect scalps, and kick up some nefarious scent of "scandal" inside the White House. They could care less about the Constitutional issues, as evidenced by the fact that fewer than 10 of the 32 czars on that infamous Fox News "list" could possibly, under any reading, have any Constitutional issue to speak of, and probably not then. Feingold is giving these concerns far too much weight.

• The White House has appeared to give "good answers to the questions that have been raised" with a thorough listing of all the so-called "czars" and the functions they serve and how none of them raise Constitutional issues, or are outside the bounds of oversight, given the possibility for testimony and FOIA requests for documents.

• "Czars" are a media term, not a term regularly used by any White House other than to assure some attentiveness to the particular issue once raised by the media. Feingold should have the Presidents of the news agencies answer questions on his panel about why they call any advisor with a narrow policy focus a "czar."

• At the same time, to the extent that the White House has retrenched and set up offices without the same kind of advise and consent from the Senate, it's because the Senate confirmation process has gotten completely out of control. Republicans routinely put holds on qualified nominees for no discernible reason attached to that individual, but to pick other fights on unrelated subjects. It's no surprise that a President who needs to get things done would try to leapfrog, at least in some small way, that fruitless battle over confirmation which has become nothing but a sideshow. Feingold would do well to ask his fellow Senators if freezing out a nominee for the Justice Department Office of Legal Counsel, for example, over concerns about her views on abortion, which have absolutely nothing to do with the position, represents a good use of advise and consent. It's debilitating to the country to have the Senate become a giant bottleneck.

This is an election year upcoming for Feingold, and I assume he's being coy here and playing to same cluster of independents in Wisconsin by having this hearing. In reality, it's hard to see how these positions raise any Constitutional flags. And it's hard to see how this hearing really helped matters.

DE-Sen: Castle v. Biden

For a small state, that's going to be a big matchup. Mike Castle is considered a moderate and hasn't lost a race in Delaware since 1966. Beau Biden is the son of the Vice President, who also never lost a race in Delaware, and he's the Attorney General in his own right.

Rep. Mike Castle (R-Del.) will be running for Vice President Joe Biden’s old Senate seat in Delaware, according to two GOP sources connected to the congressman, instantly giving Republicans the opportunity to flip a traditionally-Democratic seat in their column [...]

But Attorney General Beau Biden, just back from military service in Iraq, is considering running for the seat and would be a formidable opponent.

A recently-released Rasmussen poll conducted this month showed Castle leading Biden by five points, 47 to 42 percent.

That's instantly a toss-up seat. Bad news for Democrats, although it's mitigated slightly by the fact that Castle's House seat probably flips now, as he was pretty much the only man in Delaware who could keep it.

Democrats had better do something with their 60-seat Senate majority in the next year, because they are highly unlikely to keep it or grow it.

...Jack Conway looks pretty good in Kentucky, but needless to say the trade of Ted Kaufman for a Southern Democrat is a net negative for a progressive agenda.

...Open Left sees a 3-5 seat pickup for Republicans right now, although it is early and they add some caveats.

...Interesting theory from a pollster suggesting that Castle is only ahead due to name recognition. Also, with a likely anti-incumbency mood out there, will Castle really be able to avoid charges that he's part of the problem in Washington?

The Waiting Is The Hardest Part

Determining whether a public insurance option will be in the final health care bill from Congress has been excruciating, and it's not about to get any better. I guarantee you it's going to look dead and buried or a rock-solid cinch about half a dozen more times before this is over. Here's what happened just today:

• Raul Grijalva said that his public option whip count is down to 46, from 60. And he wouldn't announce the names, which made it look like he was shielding the members who dropped off. Bad!

• Later, 51 Democrats in the House write to Steny Hoyer and Nancy Pelosi affirming their strong support for the public option. Good!

• Harry Reid backed off his remark that the final bill will have a public option. Bad!

• Later, we learn that the Grijalva whip count is probably bigger than 46 members; they just stopped the whip count once they had enough votes to block anything without a public option. Good!

• There's now a new whip count of all members of the Democratic caucus, on a public option tied to Medicare +5% rates. So far 170 members of the caucus support this. Good! But they need 218 for passage. Bad! But they're not done yet and Chris Bowers hears it's higher. Good!

• Andy Stern says there will be a price to pay for any Democrat who joins a Republican filibuster of a health care bill, regardless of whether a public option is in there or not. Good!

• Nobody wants to be the one to kill a public option. That's actually good! But they'll try to call whatever compromise that's inoffensive to the insurance companies a public option as a way out. That's bad!

I would recommend David Waldman's piece, because I think it's closest to the actual scenario on the minds of the Senate and the White House right now. Chasing this rumor or that can make you weary, however.

What's In A Name?

What's In A Name?

by dday

Harry Reid is now saying there will be a "public option" in any final health care bill. I'm sure nobody knows precisely what he means by that.

U.S. Sen. Harry Reid, D-Nev., said today there will be a "public option" in whatever health insurance reform bill comes out of Congress.

"We are going to have a public option before this bill goes to the president's desk," Reid said in a conference call with constituents, referring to some kind of government plan.

"I believe the public option is so vitally important to create a level playing field and prevent the insurance companies from taking advantage of us," he said.

Tom Harkin said almost exactly the same thing today - and he said that Republicans wouldn't be at the table when the two Senate bills get merged together.

Here's the good news about this. Reid is acknowledging that he absolutely cannot get away with having a final bill without something he can call a "public option." And progressives have done a good job of very specifically separating out triggers and co-ops as something that would not fit that definition. This is almost entirely due to grassroots activism. The public option would have been thrown out months ago if nobody was advocating for it from the bottom up. It was certainly not the intention of anyone in Washington to go into October with this issue still up for grabs. They were perfectly content to jettison it to protect insurance industry profits.

That said - there is no definition here for what public option means. And if you asked Sen. Reid point-blank, I'm sure he wouldn't give you a definition. He wants something that he can call a public option so the grassroots can be satisfied. What will that be? Probably not co-ops or triggers because they've been too well-defined by the grassroots. There are other alternatives coming in their place.

Tom Carper is pushing the idea of giving the states the ability to create a public option, which states could then link together for increased bargaining power. They wouldn't be able to use Medicare bargaining rates and they wouldn't have Medicare's provider network. And being state-based, they wouldn't have much leverage to gather the client base necessary to force a lot of competition with the private market. Of course, a lot of the "public options" out there offer weak, "level playing field" provisions similar to Carper's amendment. Jon Cohn says that actually, this is already in the bill:

One interesting question is whether the proposal is already redundant, thanks to an amendment that another member of the Finance committee, Ron Wyden, introduced that Chairman Max Baucus accepted before the hearings even began.

It's Wyden amendment C8, which appears on page two of the modified bill Baucus introduced formally for markup:

Amend Title I, Subtitle A to allow a State to be granted a waiver if the state applies to the Secretary to provide health care coverage that is at least as comprehensive as required under the Chairman’s Mark. States may seek a waiver through a process similar to Medicaid and CHIP. If the State submits a waiver to the Secretary, the Secretary must respond no later than 180 days and if the Secretary refuses to grant a waiver, the Secretary must notify the State and Congress about why the waiver was not granted. – Insert at the end of b)(1) ―and with citizen input through a referenda or similar means;‖ – In b)(2) strike ―a‖ and insert ―this‖ – Insert b)(4) ―the State submits a ten-year budget for the plan that is budget neutral to the Federal government.‖ – Insert at the beginning of c)(2) GRANTING OF WAIVER.— The Secretary shall approve the plan only if it meets criteria consistent with that of the America’s Healthy Future Act, including that it shall lower health care spending growth, improve the delivery system performance, provide affordable choices for all its citizens, expand protections against excessive out-of-pocket spending, provides coverage to the same number of uninsured and not increase the Federal deficit.

What does the gobbledygook mean? Wyden's staff says it's designed to encourage state experimentation. I haven't yet gotten an official reading from Finance Committee staff on their interpretation.

But my own reading, which I've run by a few analysts, is that it gives states the ability to implement coverage schemes that bolster coverage, control costs, and improve quality at least as well--and hopefully better than--the Senate Finance bill. That would include creating a public option. (You could even read it to allow a state-based single-payer plan.) So it's the Carper amendment, but without the restrictions.

Cohn notes that the HHS Secretary would have to rule, in the Wyden Amendment, on whether any state proposal met the proper criteria. Which means that, under a Republican Administration, you could see nothing helping people allowed to go through, or even scale-backs to benefits (though there is presumably a federal floor).

Still, maybe this is what Reid will determine as a "public option." Or maybe he'll dump Wyden's amendment and pick up the Carper idea and call that a public option. Or maybe Maria Cantwell's proposal, which allows states to negotiate on behalf of the uninsured below 200% of poverty level for a basic plan, will fit the bill, even though it sounds like a good policy but in no way a substitute for the public option.

The point is that all the activism and advocacy has gotten us far further than we would normally be in this debate. But there are still plenty of compromises out there that politicians will call "the public option" as an escape valve. It will be important to see these policies for what they are, instead of applying the name and being done with it.

Tracking The Public Option Through The Senate

Those who have been paying attention understand that today was actually a pretty good day for the public option. We learned that Sens. Wyden, Carper and Nelson (FL) support it in some form, and that there are at least 51 votes for it in the Senate. However, yesterday Chuck Schumer did acknowledge that there aren't 60 votes at this time. Ezra Klein asks the right questions:

There are two questions here. The first is "60 votes for what?" Do they not have 60 votes in favor of a health-care plan that includes a public option? Or do they not have 60 votes against a filibuster of a health-care plan that includes a public option? If it's the former, that's okay: You only need 51. If it's the latter, that's a bigger problem. But I'd be interested to hear which Democrats will publicly commit to filibustering Barack Obama's health-care reform bill. If that's such a popular position back home, why aren't more Democrats voicing it loudly?

Second, why give up the public option now? If these moderates want to kill the measure, let them get full credit for doing so on the floor. They can sponsor an amendment to strip it out of the final legislation and go home to their districts having played a clear and undeniable role in the elimination of the public option.

The former is really the question. There are definitely 51 votes for a public option. It's unclear whether there are 60 for a final bill with a public option. And more specific than that, are there 60 to allow a vote on a final bill with a public option?

Mary Landrieu has come the closest to saying that she would filibuster a bill with a public option. Ben Nelson and Joe Lieberman are probably right with her. But I'd sure like to see them try to defy the President and doom a health care bill 40 years in the making over one provision. Reconciliation is always an option, given that you would only need 51 votes, but it's highly unlikely to get a public option that way. The main reason is that the Budget Committee would control the process, and Kent Conrad just voted against public option amendments yesterday, and would be highly unlikely to allow one to go through a 51-vote process. Heck, he doesn't want reconciliation at all. So Chris Bowers surmises that Harry Reid and the White House are the real pivot points right now, when the Senate merges the bill from their two committees:

The next step in the process does not actually involve Kent Conrad's Budget Committee, as I had previously reported (the Budget Commitee only comes into play with reconciliation). Instead, a source on the Hill confirms to me the Senate HELP and Senate Finance committees will be merged by an informal, behind the scenes process involving the four major players in the Senate: Tom Harkin (Chair of HELP), Max Baucus (Chair of Finance), Harry Reid (Majority Leader), and the White House. Together, these four will meet and decide what sort of bill to send to the Senate floor for debate and amendments.

During this process, we can guarantee that Harkin will push for a HELP or Schumer-like public option to be sent the floor, while Baucus will push for no public option to be in the bill at all. Given his recent statements, the best bet is that Reid will probably push against a public option too, and instead favor either triggers (which he has called a good idea) or co-ops (which seems to be the sort of public option he likes best). With two against and one in favor, this means that the only way a public option ends up in the bill that is sent to the Senate floor will be if the fourth major player, the White House, demands it.
It is all up to the White House now. If it pushes for a public option to be included in the health care bill sent to the Senate floor, then a public option will pass as part of health care reform (at that point, all we would need are 60 votes for cloture, and from what I hear we have 57 already). However, if it allows a health care bill to go to the floor without a public option, it is pretty unlikely that a public option will pass as part of health care reform.

Bowers doesn't think any floor amendment would need less than 60 votes, and while there are conflicting reports on that, he's probably right. He also doesn't think conference committee is an option, but I'm not sure I agree there. The House will almost certainly pass a bill with a public option. So it would depend on the White House umpiring that argument in committee. And that will almost certainly be decided by what they think can pass. If the Progressive Block in the House holds firm, and looks like a higher mountain to climb than getting 3 Democrats just to flip on cloture, the White House could go the other way at any step of this process.

Igor Volsky thinks we may see a new compromise floated:

Instead, the very same Democrats who defeated the national program during mark-up, will likely resurrect a discarded idea floated by the New America Foundation and momentarily embraced by the White House. That compromise will create a network of public options modeled on state employee benefit plans. The proposal could be triggered by Snowe’s amendment if reform did not meet a low affordability measure, but any state-based proposal would lack the market clout to lower overall health care spending, reform health care delivery, or hold private health insurers accountable.

Today may have been the death of the public option and the birth of state-based public options.

State-based plans won't have the economies of scale to really pressure insurers, but neither would Schumer's "level playing field" public option. Therefore, given that we're going to have to improve whatever inevitably comes out of the legislation, I'm inclined to say this is better than nothing. Apparently Tom Carper has started floating this behind the scenes.

I'm not as optimistic as Robert Creamer, but I do think that the public option still has a chance to survive in some form, and can be improved after the fact.

The P.O. Yo-Yo

Harry Reid pulled the yo-yo trick today. First some anonymous staffers were quoted in the NYT that the Majority Leader's merged bill that will go to the Senate floor would not include a public insurance option. Then Reid's spokesman denied it to Greg Sargent.

These yo-yo maneuvers really dispirit people, and I don't know if they're meant to be trial balloons or what, but the leadership needs to at least try to crack down on the leaks. Anyway, the public comments are quite enough, thanks. Reid himself called Olympia Snowe's trigger option "pretty doggone good" last weekend. Bill Clinton did the same thing on Meet the Press. There's no need for an additional article contributing to the death narrative. It saps the energy for reform from the most vociferous reformers, and that's probably by design.

The public option will come up for a vote in the Senate Finance Committee as soon as tomorrow. Liberal supporters admit they don't have the votes. But it will force many centrists to go public on the issue, opening them up to criticism. And even if Reid doesn't include the provision in the bill, he'll certainly allow amendments to that effect on the floor. So this is really just the beginning of a fight that will continue right through to the conference committee.

In the end, whether or not the public option survives depends on the White House's advocacy. So the only tea leaves worth reading are the ones about which politicians they are pushing to support the bill.

...I've now seen a couple assertions that 60 votes will be required for any strengthening amendments on the Senate floor. I'm not sure where people are getting this, but historically that has been something used to preserve the final bill. If this is the case, then, as Chris Bowers writes, Reid's inclusion of a public option in the merged bill really is the hinging point for whether or not it will ultimately be included.

The Art Of The Deal

The Senate Finance Committee preserved the White House deal with Big Pharma yesterday, but the vote was extremely close. So much so that I'm not convinced they'll be able to hold that deal on the Senate floor.

During the third day of the committee’s markup of the legislation, the vote on the Medicare amendment introduced by Sen. Bill Nelson (D-Fla.) provided the most awkward political moment yet for committee Chairman Max Baucus (D-Mont.) — not to mention the White House, which made a deal with drug makers to limit their exposure.

Baucus and Democratic Sens. Tom Carper (Del.) and Robert Menendez (N.J.) joined the panel’s Republicans in beating back the amendment on a 10-13 vote.

Despite Nelson’s failure to attach the language to the committee’s bill, the argument among Democrats is far from over. Senate Majority Leader Harry Reid (D-Nev.) promised to support the amendment when the bill reaches the Senate floor, Nelson said. The House’s healthcare reform bill includes similar provisions.

Maybe Ben Nelson or Evan Bayh or Mary Landrieu agree with these three - Delaware and New Jersey are big pharma states, but I don't see Ted Kaufman (who's a short-timer and who voted for cramdown in bank-heavy Delaware) or Frank Lautenberg giving in on this. I'm just not seeing 10 votes among Democrats against this policy. Blanche Lincoln voted for this in committee. So did Kent Conrad. It was Bill Nelson's amendment. Who are the conservaDems left?

I wouldn't be surprised if the White House twisted enough arms to get their deal, but I don't see a whip count that gets them there. We'll see.

Gangs Of Washington

Charles Grassley, having been kicked out of the Gang That Couldn't Shoot Straight, has posted a flyer on the Senate's grey utility pole seeking out members for a new Hole-in-the-Wall Gang:

Sen. Chuck Grassley (R-Iowa) said Wednesday he's begun reaching out to other colleagues in both parties about reshaping the health bill through amendments on the Senate floor.

Grassley, the ranking member of the Senate Finance Committee, said in a conference call with Iowa reporters that he has had conversations with senators not on either committee handling health reform legislation about assembling a new bipartisan agreement.

"I've had discussions with senators that aren't on the committee that could possibly work with us to try to get back into a bipartisan mold," Grassley said. "I think, though, that it'd be very helpful for people who aren't on the Finance committee or even the HELP committee...would kind of take the bull by the horns themselves and try to coalesce around something that could eventually become more bipartisan."

Grassley, who said that the health care bill may "pull the plug on Grandma," tried to raise money in his own state to "defeat Obamacare" and claimed that it would have left Ted Kennedy without treatment, seems like the perfect candidate to lead a group seeking to improve the health care bill.

I'm thinking he may find some takers, though. The Senate Wanker Caucus can seat up to 60, depending on the policy. Witness, for example, Bill Nelson, trying transparently to preserve corporate welfare for insurance companies.

Mr. Nelson, a Democrat, has a big problem. The bill taken up this week by the committee would cut Medicare payments to insurance companies that care for more than 10 million older Americans, including nearly one million in Florida. The program, known as Medicare Advantage, is popular because it offers extra benefits, including vision and dental care and even, in some cases, membership in health clubs or fitness centers.

“It would be intolerable to ask senior citizens to give up substantial health benefits they are enjoying under Medicare,” said Mr. Nelson, who has been deluged with calls and complaints from constituents. “I am offering an amendment to shield seniors from those benefit cuts.” [...]

Mr. Nelson said he had received 56,000 telephone calls, letters and e-mail messages on the legislation since June.

Some of those callers have been mobilized by insurance companies.

Humana, one of the nation’s largest insurers, has urged subscribers to contact their members of Congress and register their opposition to the cuts. “Millions of seniors and disabled individuals could lose many of the important benefits and services that make Medicare Advantage health plans so valuable,” Humana said in a recent letter to beneficiaries.

Medicare Advantage is quite simply corporate welfare and nothing else. The government pays private companies on the average 14% more than it would to produce the exact same coverage on their own, for no increase in quality, despite Nelson's claims. It's a pure subsidy.

Pair Grassley with the Nelson twins, a Lieberman, maybe a Mark Warner, and who knows? They could put the old gang back together.

MA-Sen: Paul Kirk For Appointment

Major Garrett sez that former DNC Chair and Kennedy family friend Paul Kirk will be named as the temporary Senator from Massachusetts tomorrow. Many expected Mike Dukakis to be the pick, but Kirk, as a former DNC Chair, is probably a much safer choice from the standpoint of following leadership. And the Kennedy family reportedly sought him out.

He'll basically be Roland Burris for a few months until Massachusetts elects a new Senator. Don't expect bold leadership from Paul Kirk.

...there is this troublesome bit, that the bill needs to be passed with a 2/3 vote under emergency rules in order to take effect immediately. Alternatively, Deval Patrick could call an emergency and sign the legislation, but that would probably elicit a court challenge and tie up the seating of any Senator. The bills, when passed, did not get a 2/3 vote, by the way.

Lisa Murkowski Plans To Melt The World

The Senate is a club bound and determined to do absolutely nothing in the most boisterous and attention-grabbing way possible. It is filled with the kind of people who get angry when told they're a bunch of do-nothings while holding fast to the ideal of doing nothing. Indeed, there are US Senators like Jim Inhofe who plan to lead a delegation to Copenhagen to tell the world proudly that the Senate will do nothing on climate change.

This is what the Administration has to deal with. So, unsurprisingly, faced with the prospect of Copenhagen fracturing, and rather than being left in China's wake as the world's biggest polluter without a strategy to deal with a warming planet, the White House instructed the EPA to come up with some goals under the law to reduce greenhouse gas emissions. The Supreme Court essentially ratified this already. So as a last-ditch attempt to do absolutely nothing, Lisa Murkowski wants to stop the EPA.

WASHINGTON — Environmentalists say they're disappointed in a proposal by Sen. Lisa Murkowski to force the Environmental Protection Agency to hold off for a year on regulating so-called "stationary" emitters of greenhouse gases, such as power plants.

The Alaska Republican's proposal essentially forbids the EPA from working to regulate greenhouse gas emissions from power plants and large manufacturers while the Senate continues to work on its own global warming proposal. It would not keep the agency from continuing work on emission standards from mobile sources, such as automobile emissions.

"The Senate is moving so slowly it's disingenuous to say we just need a time out," said Frank O'Donnell, president of Clean Air Watch. "They want to handcuff the EPA."

Murkowski, the top Republican on the Senate Energy and Natural Resources committee, plans to introduce the proposal in an amendment to a spending bill. Her proposal does not have the backing of the EPA, which is currently working to comply with a 2007 Supreme Court decision, Massachusetts v. EPA, which requires the agency to determine whether certain greenhouse gas emissions are harmful to the environment and public health.

Believe it or not, Murkowski is seen as one of the gettable votes in the Senate on climate change.

While the Senate dithers, the courts have consistently ruled, including just this week, that carbon is a pollutant and governmental entities can sue or create regulations to limit those emissions. Only some members of the Senate want to revoke that power, and they plan to use multiple steps to force the hand of the other branches.

It's quite a political system we've got here.

Teddy's Replacement Coming Soon

The Massachusetts State Senate just passed the bill allowing for a temporary appointment to the US Senate seat held by Ted Kennedy. The Governor will sign and the Democrats will be back to 60 seats perhaps by the end of the week.

This is probably the best practice for Senate vacancies - a temporary appointment because of the disproportionate impact of losing one Senator out of 100, followed by a quick election within a few months. It ought to be the standard.

Most speculation on the seat has centered on former Governor Michael Dukakis, or someone with ties to the Kennedy family or Teddy himself, like a former staffer. At any rate, that vote will certainly be fairly Democratic.

Obviously this raises the possibility of demanding Democratic unity on allowing a final vote on health care to go forward, even if they don't approve of the final bill. There's the matter of Robert Byrd (who ought to resign and live the rest of his life in peace), but essentially, Democrats will have the votes to block a filibuster if they hang together. And if Harry Reid cannot figure out how to enable a vote the the overwhelming majority of his caucus supports, then he doesn't have any power whatsoever. Reid is still raising the possibility of reconciliation, but that's a bluff for Republicans. It's the Democrats in his own chamber who need the nudge, although perhaps reconciliation is a warning to them as well.

Uh-Oh

Robert Byrd is 91 and quite unwell. Ambulances raced to his house today because he got up too fast. Democrats may gain one seat in Massachusetts by the end of the week if the appointment law goes through, but Byrd has been in and out of hospitals for months and is rarely seen on the Senate floor.

Nobody wants to tell Robert Byrd to retire - he's been in the Senate since 1958 and he probably wants to die right there on the Senate floor. But for the good of the country he ought to resign and not have his illness affect the quality of life for millions of Americans. West Virginia allows for a temporary appointment, Governor Joe Manchin is a Democrat, and within a matter of days the Democrats could have 60 able-bodied members. But instead of that, and instead of coming up with a process where Byrd can vote by proxy, we are hampered with endless filibusters based on Robert Byrd's physical health, which I don't think was the founders' intentions.

The Political Problem of Climate Change

The President spoke this morning at the UN Summit on Global Climate Change, in an effort to return that issue to the forefront in advance of global talks in Copenhagen.

The renewed emphasis on climate change and reducing carbon dioxide emissions comes at a crucial time: Negotiators are entering the home stretch in a drive to unveil a comprehensive international agreement to curb rising temperatures at a December conference in Copenhagen.

With key divisions remaining among the major industrialized nations, as well as with developing industrial powers and poorer nations, there is concern that negotiations leading up to Copenhagen could be bogging down. Obama administration officials, while admitting the seriousness of the challenges, hold out hope for a deal.

The article goes on to list nine points of contention that Obama and his team will have to deal with if they are to get both a climate change bill through Congress and an agreement in Copenhagen that the Senate can ratify. While Europe is grumbling on the sidelines about American inaction, it's really a function of an undemocratic Senate. I still believe Obama can get something done, but he has to slide anything past the likes of Blanche Lincoln and Ben Nelson, instead of just being able to implement the agenda he feels is right. I think that Obama will look to highlight the work of EPA rulemakers more than the Senate in vowing to keep to any commitments made in Denmark. Unfortunately, we don't have a political system that attunes itself well to long-term structural environmental changes where the future is unknown. Actually, the system doesn't attune itself well to much these days.

...Obama called the US determined to act in his remarks, but of course the problem is that over 40 Americans are determined to not act, and they happen to be US Senators who can easily blow up the whole thing... Obama's remarks.

...I did not realize that Boxer would release her draft next week. I like the idea of doing it in the shadow of the health care debate, to lessen the attention from the right. She's also raising the cap to 20% below 2020 levels instead of 17%. I'd be shocked to see the Senate bill improve on the House bill's numbers, but I certainly hope that can happen.

One Step Closer To 60

Yesterday the Massachusetts House passed a bill that would allow Deval Patrick to appoint a temporary successor for Ted Kennedy until the outcome of a special election in January. The bill now moves to the State Senate, where Democrats have an enormous advantage as well. Republicans could hold up the bill through some procedural maneuvers, but they cannot stop it. The expectation would be that final passage could happen by the middle of next week. This would obviously be a huge boost to Democrats to have a consistent voting partner and a 60-vote majority in the Senate once again.

Regardless of the appointment process, there will be a special election, with a primary in December and a general election in January. With some of the big names on the Republican side begging off the race, the winner of the Democratic primary is highly likely to win the general. Right now the field on the Democratic side includes Attorney General Martha Coakley, Rep. Michael Capuano, and co-owner of the Celtics Stephen Pagliuca. Coakley, a statewide officer, has higher name recognition and thus a big lead. But Capuano is a pretty strong progressive.

By contrast, her main rival, MA-8 congressman Mike Capuano, has a ten year record on national issues. Basically it’s a record of being really, really liberal. He’s member 18.5 in the 111th House, he was 30.5 in the 110th House, 40.5 in the 109th, 10 in the 108th, and 8 in the 107th—firmly on the left side of the Democratic caucus. He’s the former mayor of Somerville, a dense walkable urban area, who likes to talk about mass transit, he’s pushing from the left on Afghanistan and Iraq, he favors single payer health care but says he won’t “let the perfect be the enemy of the good.”

Capuano, recognizing that he needs to introduce himself to voters outside his district, has already put up an ad on statewide TV, and it's striking how hard he pushes his progressive credentials.



A Senator from Massachusetts needs to be as far to the left as possible - there aren't many states out there as blue, if any. Capuano looks pretty good to me; Coakley may be great, but she needs to reveal herself on the issues she hasn't faced as Attorney General.

If The Congress Won't Do It, The EPA Will

Harry Reid is signaling that health care and financial regulatory reform will take precedence in the Senate over the climate change bill, which could push the legislation into next year. The problem with that is the Copenhagen conference coming up in December, and the need for the US to bring something tangible to the table if there is any hope for an agreement. Indeed, the Europeans are already angry at the US approach, and not having some movement on the climate in hand will probably kill it completely. So the Administration has taken the law into their own hands, as allowable under the Supreme Court mandate to regulate greenhouse gas emissions.

The Obama administration on Tuesday formally proposed new fuel efficiency standards for cars and trucks, a move that signals the first federal limits on greenhouse-gas pollution.

In May, President Obama announced in a Rose Garden ceremony that cars would be held to a higher environmental standard. On Tuesday, officials filled in the details, linking fuel economy to emissions from vehicles.

The net effect would be to require manufacturers to ratchet up fuel economy 5 percent per year. In 2016, new cars and trucks would have to achieve an average rating of 35.5 miles per gallon. Cars currently must average 27.5 miles per gallon; light trucks must average 23.1 miles per gallon.

If this is any indication, it's only a first step, leading to other command-and-control measures from the EPA and other regulatory agencies in the absence of a climate deal from Congress. Power plants, one presumes, would be next. In fact, they've already started revising the rules on waste discharges from coal plants.

It's probably not the best practice, but under the current gridlock, it's the only tool available to the Administration. So members of Congress, particularly Republicans, have a choice to make. Legislation or regulation?

Polluting industries certainly didn't give up the fight against legislation in the face of regulation, and they'll continue to fight tooth and nail against the regulation in an attempt to run out the clock and maximize profits. David Roberts says that's why Obama needs to get involved and get a climate bill passed.

The war against EPA regulations will also be waged with aggressive public relations campaigns. There will be great hue and cry about the economy-destroying burden that command-and-control regulations impose on American business. And unlike with a climate bill, responsibility (read: blame) cannot be dispersed. There is no hint of bipartisanship. Responsibility for EPA regulations will fall entirely on Barack Obama and his administration, not on Congress—which is probably how Congress prefers it. If it’s a total mess, or demagogued as one (as is all but certain), it’s Obama that takes the hit. That is yet another reason he’d rather avoid it.

Greens are fighting to preserve EPA authority in the climate bill. Some have even said that it would be preferable for legislation to fail and the EPA to take over. It’s not hard to understand why—something needs to be done about existing coal plants, and there aren’t many tools in the climate bill toolbox to address them. But no one should be under any illusions. The NSR/PSD/BACT approach is grossly suboptimal for the job that needs doing. It might have the intended effect—killing coal plants—but there’s potential for unintended effects as well, including substantial political blowback.

Both sides, greens and industry, have reason to fear if the climate bill fails. It’s terra incognita, a volatile and unpredictable situation. Obama doesn’t need any more problems like that. That’s among the reasons he is likely, this fall, to put some of the time and energy toward lobbying for a good climate bill. From his narrow political perspective, virtually any bill is preferable to catching the EPA tiger by the tail. That tiger eats bunnies.

In this case, the House has already passed a bill, so really we're looking at the Senate as the holdup here. But the dynamic of Senators not wanting to be responsible, pushing all the political liability on to the President, will be difficult to change.