Health Reform Update

Here I am, your intrepid reporter, with your periodic update on health reform battles. It's really hard to know what to say or where things are going right now. There have been so many surprises.

The public option appears to be close to resurrection from being dead at least twice already. Again, this would not be government take-over of health care; it would simply allow Americans to choose to buy Medicare-like insurance instead of Blue Cross. It would be up to each of us to decide what we want. The biggest plus of having a public option would be that administrative costs would be lower than in the private sector, thereby lowering the cost of the public plan, forcing private plans to lower premiums to stay competitive. Simple and absolutely right. There are at least 45 votes for the public option if they do it as part of reconciliation, where they need only 50 votes in the Senate.

Remember reconciliation? In the Senate, for normal legislation to get to a vote, there must first be a vote for cloture, which requires a super-majority of 60 votes. However, for matters affecting the budget, they can use the reconciliation process, which requires only 50 votes. And we know Joe Biden would vote yes if there were a tie. I'm reading and hearing that there are at least 45 votes for the public option. Can we squeak one out? I don't think we're going to know the answer to this one until the minute the vote happens.

And reconciliation is not simple. There are parts of the health reform bill that don't relate to the budget. So the idea is that the House would pass the bill the Senate has already passed. After that, the Senate and the House would both pass the same reconciliation bill, and we're there. However, the House doesn't trust the Senate to pass an acceptable reconciliation bill. Also, the Congressional parliamentarian -- some guy nobody knows who's never been elected to anything but who gets to referee this melee -- has said that the President has to sign the Senate bill before it can be amended through the reconciliation process, so the President has to sign a bill he, too, is not really happy with, trusting Congress -- oy, vey -- to pass the fix pretty much right away. (Oy vey being a Congressional term of art, for those of you who don't know the name of the Parliamentarian).

And then there's abortion. There are House rabid anti-abortionites who want their version of the language limiting the use of federal funds for abortion, whereas most of the world is content with the Senate version. The Senate version would allow a woman to buy an insurance policy through the exchange (the marketplace, and these would be ONLY private insurance plans) but she'd have to write two checks every month so her private money pays for the abortion coverage, even if she gets a subsidy from the government to help her pay for the rest of her policy. That way, no public dollars can be used to fund abortion. The House version just says no plan that is sold through the exchange -- meaning no plan sold by any insurance company -- can include abortion. Which means a woman can't even spend her own money to buy coverage of abortion. While pretty much everyone agrees to set aside the issue and just accept the fact that federal funds cannot be used for abortions, there are a handful in the House -- maybe enough to derail reconciliation? -- who won't accept the Senate version and so won't vote for the changes that will be contained in the reconciliation bill. To me, it seems like these members are trying to eliminate even private insurance funding of abortion, so I think it's wrong and unfair and the Senate version, which I'm not crazy about, ought to be considered good enough.

But the votes on all of this are so close. And there's such reasonable distrust in Congress and of Congress -- most people agree that ending up with the Senate bill would pretty much stink, although actually, I still think it would be better than nothing. But the Senate bill with a reconciliation fix would be pretty darn good, and the Senate bill with reconciliation that includes the public option would be a home run.

I just wouldn't bet a thin dime on any of it. Jennifer