Health Summit Comes and Goes--Nothing Changes     Permalink

Democrats and Republicans held a health-care summit yesterday and achieved nothing but the emission of much hot air (which in the current weather is probably worth a little bit). No serious observer of Washington had expecting anything else, however. The Democrats are now in a position where they desperately need a health-insurance reform bill to have any credibility in the midterm elections and the Republicans are dead set against giving them this credibility. Even under the best of conditions, where the two sides really want to achieve the same goal (which is certainly not the case here), having the negotiating done by a huge, unwieldy, pompous group on national television isn't the usual way to go about it.

What happens next is that the real battle starts in earnest. Everyone in Washington knows what has to happen, but knowing isn't doing. The Senate and House Democratic leaders must agree on what will be in the bill and then pass it (probably first) in the House and then in the Senate (using the budget reconciliation procedure, which requires only 50 votes). The real problem is that the Democrats are hopelessly divided between Senate and House and between liberals and conservatives. While all of them agree on 95% of the bill, almost everyone wants to get his or her way on the last 5% and that is where all the trouble comes in. The most contentious issues are:

• How to pay for covering an additional 30 million people
• Who will be considered poor enough to qualify for Medicaid
• Up to what income level do middle-class people get subsidies to buy insurance
• How much to penalize people who do not buy insurance
• Whether to force (large) employers to cover their employees
• Whether the new insurance exchanges will be state-based or national
• How far should the Medicare "donut hole" be closed
• How much more can insurance companies charge old people
• Whether to give the federal government the power to regulate insurance rates
• Should illegal aliens be allowed to buy insurance on exchanges with their own money
• Should the health-insurance industry's antitrust exemption be repealed
• How to handle the always-thorny issue of abortion coverage

A more complete list of issues can be found here.

Much of the Democrats' problem has been the lack of presidential leadership. Passing the original Medicare bill in 1965 was no piece of cake either, but Lyndon Johnson knew precisely where all the levers of power were and was not at all embarrassed about using them to the fullest. He basically told Congress what he wanted and then cajoled and/or forced individual members to go along with him--or else. Whatever else he may be, Barack Obama is not the second coming of Lyndon Johnson. But from his closing words yesterday, it now seems clear that he is going to make a final push to get a bill enacted although this will not be easy.

Oddly enough, while the Senate has been the center of action for a year, getting a bill through the Senate may not be so hard, since the budget reconciliation procedure just requires a simple majority (or even 50 votes with the Vice President breaking the tie). This means that senators like Ben Nelson and Joe Lieberman can no longer hold the process hostage to their demands since their votes are not needed any more. As many as nine Democratic senators can vote no and still have the bill pass. Republicans will complain about using reconciliation, but Democrats will reply that the process is simply majority rule. Furthermore, of the 22 times reconciliation has been invoked since the start of the Reagan administration in 1981, 14 were done in a Republican-controlled Senate and 8 were done in a Democratic-controlled Senate. Polifact has more on recent uses of reconciliation.

The real problem for the Democrats will be in the House. The House bill passed with 220 votes last year. Since then, Rep. Joseph Cao (R-LA) has said he has changed his mind and no longer supports the bill. In addition, Rep. John Murtha (D-PA) has died, Rep. Robert Wexler (D-FL) has resigned, and Rep. Neil Abercrombie (R-HI) is resigning next week, so the Democrats are down to 216 votes. Furthermore, the only way to do the procedure is for the House to formally accept the Senate bill first and then pass the Senate reconciliation bill. But about a dozen Blue Dogs in the House, led by Rep. Bart Stupak (D-MI) are probably going to choke on the fact that the Senate bill doesn't ban all abortion coverage, something they are fixated on. So Speaker Nancy Pelosi will have her hands full whipping her caucus. On the other hand, she has a lot of power and is unafraid of wielding it, but it could still be a very close vote.

Crist May Run as an Independent     Permalink

Political Wire is reporting that Gov. Charlie Crist (R-FL) may pull a Lieberman and continue his run for the Senate as an independent. It wouldn't quite be the same thing since Joe Lieberman was actually defeated in a primary and then ran as an independent whereas Crist might switch before the primary. Numerous polls show Crist trailing former speaker of the state house by double digits.

An interesting question is what would happen if Crist wins the general election as an independent. With which party would be caucus. Many Republicans would be angry with him for defeating Rubio, but on the other hand, they would want his vote (just as the Democrats did not punish Lieberman for defeating their candidate, Ned Lamont). Of course it is a bit premature to speculate on what a Sen. Crist might do since (1) he hasn't jumped ship yet and (2) he hasn't won the general election yet.

Rangel Violated Travel Rules     Permalink

Rep. Charlie Rangel (D-NY), the all-powerful chairman of the House Ways and Means committee, has been found in violation of the House travel rules when the Ethics committee determined that he took corporate money for trips to Caribbean conferences, which is not permitted. The Ways and Means committee is the one that writes the tax laws, so it is not surprising that many corporations have a keen interest in currying the favor of its chairman. Whether Rangel can survive this scandal remains to be seen. For the Democrats, the best scenario would be to replace him as chairman to show that they take ethics violations seriously. The problem is that Rangel is black and demoting the most powerful black member of Congress would instantly lead to cries of racism.

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