Dems Strike Deal to Get 60th Vote in Senate

With Ben Nelson signing on to the Senate leadership's healthcare reform package, the Democrats now appear to have 60 votes in favor of their bill. Here's The Washington Post on the deal, which you can read in full as a very large .pdf here:

Under the new abortion provisions, states can opt out of allowing plans to cover abortion in insurance exchanges the bill would set up to serve individuals who don't have employer coverage. Plus, enrollees in plans that do cover abortion procedures would pay for the coverage with separate checks - one for abortion, one for rest of health-care services.

Nelson secured full federal funding for his state to expand Medicaid coverage to all individuals below 133 percent of the federal poverty level. Other states must pay a small portion of the additional cost. He won concessions for qualifying nonprofit insurers and for Medigap providers from a new insurance tax. He also was able to roll back cuts to health savings accounts.

Per The Post, the ultimate bill looks a great deal like the bill initially released by the Senate, expanding coverage to an additional 31 million Americans while reducing the deficit by about $780 billion over 20 years. The manager's amendment, however, does not include a public option.

Instead of a public option, the final product would allow private firms for the first time to offer national insurance policies to all Americans, outside the jurisdiction of state regulations. Those plans would be negotiated through the Office of Personnel Management, the same agency that handles health coverage for federal workers and members of Congress.

The Associated Press calls such a provision "a consolation prize for liberals, who failed to include a government-run alternative." For more details on the bill, here are links to coverage from The Post, The AP, The New York Times, the Los Angeles Times, and The Hill.

Update [2009-12-19 12:29:57 by Jerome Armstrong]:

My favorite part of the deal with Nelson is his effort to install an entirely federally-paid government-run Medicaid plan forever, for Nebraska alone:

As part of the deal to win Nelson's support, the federal government will pay for Nebraska's new Medicaid recipients. It's a provision worth about $45 million over the first decade. Medicaid is usually paid for with a mix of federal and state funding, but Nelson's carve out means that any Medicaid beneficiaries who join the program after the bill passes will be paid for in full by the federal government. It's a sweet deal considering that many governors are worried that the Medicaid expansion will further strain already stressed state budgets. The deal is emblematic of the kind of horse trading that gets done to win votes on any landmark piece of legislation. Senate Majority Leader Harry Reid sent $300 million in Medicaid funds to Louisiana as a sweetener to secure Landrieu's vote to begin debate on the bill. Nelson would not comment on the provision, saying that he would leave it to Reid to discuss details. "I'm comfortable it is taken care of," he said of his state. Reid defended Nebraska's special treatment saying, "You’ll find a number of states that are treated differently than other states. That’s what legislating is all about. It's compromise."Isn't that a giant step toward a government run healthcare? The polls are showing a slippage of about 5-7% week over week for HCR, now in the low 30's. I'm wondering what sort of earful that they are going to get outside the DC bubble that reflects that reality. What would probably suffice for more unity is for the House re-insert something of the Medicaid language, rolling back Lieberman, if that can be done. I think there's a strong case for putting the deal on the back of Lieberman if he wants to kill HCR or not.

Tags: 111th Congress, healthcare reform (all tags)

Comments

49 Comments

Re: Dems Strike Deal to Get 60th Vote in Senate

This is good news for the millions of Americans who directly benefit from this bill, and everyone else who will indirectly benefit. I am thrilled.

by Lolis 2009-12-19 06:37AM | 0 recs
Re: Dems Strike Deal to Get 60th Vote in Senate

 I'll lift a glass with you. A major milestone. Absolutely delighted.

by QTG 2009-12-19 06:46AM | 0 recs
Re: Dems Strike Deal to Get 60th Vote in Senate

This is only a milestone insofar as you can get the two very different versions of the bill reconciled. The house version rocks. The senate version is a give-away to the big insurance companies.

Otherwise, it will set the tone for a very negative, and very ineffectual series of reforms that will do little than simply make health insurance companies more profitable in the near term, and ultimately - America, again, the only country in the world that spends more per-capita on each citizen in healthcare costs than any other country in the world.

by Trey Rentz 2009-12-19 07:27AM | 0 recs
Re: Dems Strike Deal to Get 60th Vote in Senate

I'll be more precise. The deal to get 60 votes is a preliminary step toward the milestone called 'passage of a Senate Bill', which is a pre-requisite to another milestone called either 'Conference Bill' or 'Final Passage' (depending on whether the House chooses to vote on the Senate Bill without any changes or to go to conference), which is a milestone toward a LAW, which is a milestone toward a signing ceremony, which is a milestone toward the future changes that will be made to improve the Law in the future.

If only Ted Kennedy were alive to see this...

by QTG 2009-12-19 07:51AM | 0 recs
Re: the "nationwide plans"


http://fdlaction.firedoglake.com/2009/12 18/they-are-called-%E2%80%9Cnationwide- plans%E2%80%9D-and-they-do-gut-state-reg ulations

The Senate bill would allow for things called "nationwide plans." These plans would be based in one state, and could sell in any other state while ignoring those other state's regulations. To quote the bill section 1333:

(B) with respect to State laws mandating benefit coverage by a health plan, only the State laws of the State in which such plan is written or issued shall apply to the nationwide qualified health plan.

It clearly says right there in the bill that Aetna could set up shop in Indiana and sell insurance in New York that only meets Indiana's lower standards. This could produce a race to the bottom.

The worst part is that it is an "opt-out" and not an "opt-in" program (unless Snowe succesfully removes the opt-out). States would not be able to act in time to prevent their regulations from effectively being gutted by "nationwide plans."

Nationwide plans nullify state laws regulating what kinds of health insurance must be sold in their state.

by jeopardy 2009-12-19 06:47AM | 0 recs
Re: the "nationwide plans"

But even just glancing at the bill (it's over 2000 pages!!) I can see that there are quite a few provisions that prevent the nationwide plans from becoming just a race to the bottom.

For one thing, the only state laws which don't apply to the nationwide plan are laws mandating benefit coverage.  State laws relating to consumer protection standards, unfair trade practices, bans on mandatory arbitration clauses, etc. still appear to apply.

Also, there is some fairly specific regulatory oversight at the federal level.  Now, regulation can be effective or ineffective depending on who's in charge, but one thing to bear in mind is that insurers do not have the luxury of designing an insurance plan based upon the assumption that the federal regulator will always be some laissez-faire conservative, cause they won't.

Finally, states have the unfettered right to opt-out of the nationwide plan concept if they want.  That's right, if you're a consumer-friendly state who thinks the nationwide plans are a bunch of junk, you don't have to allow them in your state.  I honestly can't understand why FDL just dismisses this point.

by Steve M 2009-12-19 07:04AM | 0 recs
Re: the "nationwide plans"

good info. I appreciate it, thanks!

by jeopardy 2009-12-19 07:08AM | 0 recs
Re: FDL is interesting reading

 but not a particularly reliable single source. I much prefer Raw Story when I'm pressed for time and need a well-balanced analysis in a hurry.

by QTG 2009-12-19 07:09AM | 0 recs
Re: the "nationwide plans"

Looks like the Manager's Amendment did actually make things better regarding state regulations than the Senate Bill had before the amendment (yay, Reid!):

http://www.dailykos.com/storyonly/2009/1 2/19/816680/-BREAKING:-Important-Changes -in-Health-Care-Managers-Amendment

This is the most interesting provision of this section, dealing with state regulation of these multi-state OPM plans:

   (b) ELIGIBILITY.--A health insurance issuer shall
    be eligible to enter into a contract under subsection (a)(1)
    if such issuer--
    (1) agrees to offer a multi-State qualified health plan that meets the requirements of subsection (c) in each Exchange in each State;
    (2) is licensed in each State and is subject to all requirements of State law not inconsistent with this section, including the standards and requirements that a State imposes that do not prevent the application of a requirement of part A of title XXVII of the Public Health Service Act or a requirement of this title;

Since the referenced section only refers to OPM standards with respect to these plans, these "multi-state" plans are NOT the same as the nationwide "race to the bottom" plans that are contained in the underlying Senate bill. My reading is the OPM public option replacement will still be licensed and subject to BOTH state and federal regulation (whichever is more stringent).

So although this provision seems fairly weak as a replacement for the public option, it's not worse than nothing - it will depend on how strongly OPM chooses to regulate.

by jeopardy 2009-12-19 07:15AM | 0 recs
Re: the "nationwide plans"

OPM has a good track record negotiating plans for federal government employees.  Realistically this type of provision is about the closest you can get to offering people "the same coverage your Congressman gets." (What really makes your Congressman's coverage awesome is that the feds subsidize like 70% of the cost.)

by Steve M 2009-12-19 07:25AM | 0 recs
Re: the "nationwide plans"

Didn't Obama promise this during the campaign? I know people here like to keep track of Obama's "promises"?

by Lolis 2009-12-19 07:31AM | 0 recs
Re: the "nationwide plans"

That one I'm not sure about.  But I think some successful messaging could be built around this concept!  In other words, no one knows what the OPM is, but if we tell people they'll have access to nationwide plans negotiated by the same people who negotiate their Congressman's coverage - that sounds pretty good, right?

by Steve M 2009-12-19 07:42AM | 0 recs
Question for those who know

What is in the bill that keeps premiums down, and what part keep costs down?

by jeopardy 2009-12-19 06:51AM | 0 recs
Re: Question for those who know

I'm listening to the Clerk read the Bill on C-SPAN2 right now as a courtesy to those who hate the Bill. There's a whole lot in there and it's kind of hard to follow. I've been listening closely for the bad parts, but all I hear is good stuff. Too much to write down. It's live if you want to tune in.

by QTG 2009-12-19 07:00AM | 0 recs
Re: Question for those who know

could you post the info when you get it? I can't watch tv right now.

by jeopardy 2009-12-19 07:07AM | 0 recs
Re: Question for those who know

 Sure. It's available online as well.

by QTG 2009-12-19 07:22AM | 0 recs
Re: Question for those who know

If you look up Ezra Klein's blog he has an article about the cost controls in the bill.

by Lolis 2009-12-19 07:35AM | 0 recs
Re: Question for those who know

I've read it and it was mostly smoke and mirrors.

for instance, the "Medicare Commission" applies only to Medicare and not the private insurers.

And all of it assumes that regulators with little power (mostly advisory) will do their jobs correctly and not fall for any Insurance Industry excuses ("but we have to cover preexisting conditions, so of course costs have to go up!")

or saying that the mandate reduces costs. yes, it will reduce per capita costs for the insurance companies, but not health care per capita costs.

by jeopardy 2009-12-19 08:00AM | 0 recs
Re: Question for those who know

I believe the Medicare Commission was expanded to include the "whole health care field, public and private", by the Warner amendment.

by vecky 2009-12-19 08:39AM | 0 recs
Re: Question for those who know

interesting, thanks. that's good, although I am still highly skeptical that it will do much of anything.

by jeopardy 2009-12-19 08:41AM | 0 recs
This part looks good to me:

  6.  Section 10108 - Free choice vouchers: It would seem that Reid has accepted the Wyden amendment, that employees can receive a voucher in the amount of the employer's contribution and go out onto the exchange (with certain income qualifications).

Applies to employees whose employer pays for any portion of qualifying coverage AND whose contribution is between 8 to 9.8% of household income, with household income below 400% FPL.

This seems to be aimed at people who would be in the top tier of income for receiving subsidies on the exchange, but would be better off than under their employer-provided plan. This seems like a very narrow "free choice" provision, no?

by jeopardy 2009-12-19 07:27AM | 0 recs
Re: This part looks good to me:

Arg. I can't believe we're asking people to vote on christmas eve as if this entire issue is something the American people will just get up and walk away from??!?!?

"Support is slipping" is being reported in the polls at the same time the watered-down amendments came to fore.

Good lord, do we really have to run the federal government through christmas, to get a bill we really don't want?

by Trey Rentz 2009-12-19 07:42AM | 0 recs
Re: This part looks good to me:

What is important is not whether people like the bill before it is passed, but whether they like it afterwards.  That's why I find it more helpful to discuss the policy elements of the bill than to worry about the polling.

by Steve M 2009-12-19 07:44AM | 0 recs
Re: This part looks good to me:

Most people have to work through Christmas Eve -- why wouldn't we expect the Senate to do so as well?

by fsm 2009-12-19 07:53AM | 0 recs
Re: This part looks good to me:

I'm scheduled to work on Christmas Eve AND Christmas Day this year! I have also worked on Labor Day for 25 out of 40 years! Oddly, I always seem to contract 'stomach flu' on my birthday. Weird, huh?

by QTG 2009-12-19 08:05AM | 0 recs
Re: This part looks good to me:

They don't have to vote on Christmas eve. After a cloture vote the senate can give unanimous consent to proceed directly too a vote. If they don't you have to wait 30 hrs.

And guess what, the GOP is making us wait those 30 hrs. So the vote will be 7 pm on Christmas eve, when me and everyone else in the country will be a bit high on egg nogg and far away from a TV, internet or radio.

by vecky 2009-12-19 08:41AM | 0 recs
Since when is a rush job

That doesn't do what its supposed to do - called a milestone achievement?

by Trey Rentz 2009-12-19 07:31AM | 0 recs
Re: Dems Strike Deal to Get 60th Vote in Senate

Jerome, If you poll most of these items in the bill individually or even just give them a little blurb before asking their opinion, the poll numbers would change. Most past polls show support for the insurance reforms at about 80% or higher. This bill will be very popular. The individual mandate is the only thing that may not poll well, but again, it depends on how you ask. Nate at 538 shows why the recent poll that all the progressives are citing is misleading.

by Lolis 2009-12-19 07:33AM | 0 recs
I totally agree. In fact public option polls 72%

You are totally right on this point. Overall support of the bill is strong, and it can wait until after christmas to get it right.

What I really like, actually is that the house bill has a good solid public option. The senate bill may be reconciled to it.

Who knows. We'll see.

by Trey Rentz 2009-12-19 07:44AM | 0 recs
Bipartisan support


Yeah, the obsession with bipartisanship may wane after this.  That's a good thing as the kumbaya/work together approach ignored the recent history of the Republican Party.  That kind of naivete doesn't serve us well.

It's a victory of sorts for Obama and God knows, that was the focus of the White House in all of this.  I can't really blame them.  Failure to get something passed would have been very damaging.  I do think the final package will be better than nothing but this is really a great victory for the insurance companies.  Hey, that's how capitalist societies operate.  

by Thaddeus 2009-12-19 08:30AM | 0 recs
Re: Dems Strike Deal to Get 60th Vote in Senate

What about the pre-existing condition exclusions?  Is this still allowed?

by jrsygrl 2009-12-19 08:49AM | 0 recs
Re: Dems Strike Deal to Get 60th Vote in Senate

Well, for the first time in a long time, I think the bill got a bit better with the Manager's Amendment (depending of course, on how much making it harder for women to manage their reproductive health matters to you)

At the very least, some parts got better in exchange for some parts getting worse - it wasn't a unilateral capitulation to the right-wing.

Nice that the Democratic leadership finally found parts of their backbones all of a sudden.

by jeopardy 2009-12-19 08:51AM | 0 recs
Re: Dems Strike Deal to Get 60th Vote in Senate

The Managers amendment should be called the Mutual of Omaha amendment because it gives that company a specific tax break thus securing Ben Nelsons "retirement".

Not to mention the medicaid thingy. The only reason NE would have problems paying their 7% share of medicaid expansion in 2017 is because they just this year, passes a massive tax cut which put their budget even further into the red. Fools.

Basically everyone who lives in a red-state is screwed.

But I can live with it.

by vecky 2009-12-19 09:08AM | 0 recs
Re: Dems Strike Deal to Get 60th Vote in Senate

ehh, maybe I should hold off on making this declaration until more comes out about what's in the agreement.

looks like a lot of crappy stuff got slipped in.

by jeopardy 2009-12-19 09:16AM | 0 recs
WTF?

http://www.dailykos.com/storyonly/2009/1 2/19/816815/-Why-is-abstinence-only-sex- ed-in-the-HCR-bill

"Majority Leader Reid is using the health-care bill to restore funding for abstinence-only sex education programs that liberals (such as Mr. Reid himself) have spent the past three years trying to zero out."

___

WTF?

by jeopardy 2009-12-19 09:10AM | 0 recs
Re: WTF?

I hate these Dems.

Meanwhile in the House, Stupak is working with the GOP trying to sink the bill.

"  "Guys - when will we see your letters of opposition to the managers amendment?? We need them ASAP!" wrote Erika Smith, a Stupak aide, at 9:23 this morning, less than an hour after the amendment had become available.

The email's recipients included key staffers for the U.S. Conference of Catholic Bishops, National Right to Life, the Family Research Council, as well as Autumn Fredericks Christensen, aide to a top pro-life Republican Joe Pitts, and Lanier Swann, a McConnell aide.  

http://www.politico.com/news/stories/120 9/30811.html"

Awesome... Stupak working with the GOP. Isn't he just a mole in the dem caucus?

by vecky 2009-12-19 09:23AM | 0 recs
More from the Manager's Amendment:

"Is there anything our political "leaders" won't  do for the NRA? Check out this, from the new manager's amendment [pdf].

   ``(c) PROTECTION OF SECOND AMENDMENT GUN RIGHTS.--

   ``(1) WELLNESS AND PREVENTION PROGRAMS.--A wellness and health promotion activity implemented under subsection (a)(1)(D) may not require the disclosure or collection of any information relating to--

   ``(A) the presence or storage of a lawfully-possessed firearm or ammunition in the residence or on the property of an individual; or
    ``(B) the lawful use, possession, or storage of a firearm or ammunition by an individual. [p. 5]

It goes on for another page and a half about what the feds can't do vis-a-vis your precious guns.

Too bad the founders didn't create a specific amendment that gave women as much protection for their uteruses as their guns.

Update by SusanG: Mother Mags looks on the bright side, in comments:

   Well, at least they didn't mandate that
    everyone has to own a gun, and then limit our choice to one manufacturer that doubles its price every 5 years."

http://www.dailykos.com/storyonly/2009/1 2/19/816772/-Seriously

by jeopardy 2009-12-19 09:15AM | 0 recs
Re: More from the Manager's Amendment:

In case anyone asks it's sh!t like this which is why the bill is 2000 pages.

by vecky 2009-12-19 09:23AM | 0 recs
Re: More from the Manager's Amendment:

yeah.

i hope this bill doesn't undo progress made in too many other areas.

looks like many of these things would get a fierce fight from progressives if they were in stand-alone bills, but might get into law because they are in the HCR bill.

I hope the HCR bill is worth it.

by jeopardy 2009-12-19 09:31AM | 0 recs
Re: More from the Manager's Amendment:

" Too bad the founders didn't create a specific amendment that gave women as much protection for their uteruses as their guns. "

The founders were all men. Their priorities reflect their gentiles.

by vecky 2009-12-19 09:25AM | 0 recs
Re: More from the Manager's Amendment:

Sorry, not gentiles... you know what i meant...

by vecky 2009-12-19 09:25AM | 0 recs
Re: More from the Manager's Amendment:

You almost made me sic the JPFO on your ass.

by Steve M 2009-12-19 09:31AM | 0 recs
More from Firedoglake

More from the Bill:

The CBO said "jump," and Harry Reid said "how high." The new MLR set by the manager's amendment are exactly the limits the CBO said they should be:   85% for the small group market and 80% for the individual market.

This change was not made for policy reasons. This change was not made because it was best for the American people.

This change was made purely for PR reasons, so the CBO would not make some absurd claim that all private insurance was part of the federal budget and make the CBO score look bigger.

Unfortunately, the new MLR regulations have a potentially serious loophole.

   ``(d) ADJUSTMENTS.--The Secretary may adjust the rates described in subsection (b) if the Secretary determines appropriate on account of the volatility of the individual market due to the establishment of State Exchanges."

This subsection appears to give the Secretary of HHS the power to unilaterally eliminate or gut even this very low 80% MLR requirement.

I wish for the day when legislation is written by our legislators and not by some unelected accountant.

Because Reid wanted to make the CBO score look prettier, he will allow insurance companies to waste an extra 10% of your premiums on not providing health care. All hail the almighty CBO.

http://fdlaction.firedoglake.com/2009/12 19/all-hail-the-almighty-cbo-and-its-cr ippling-of-medical-loss-ratio

by jeopardy 2009-12-19 09:28AM | 0 recs
Re: More from Firedoglake

The CBO's statement regarding the 90% provision was the most outrageous statement I have ever seen from that body, for sure.

That said, I believe the House bill only said 85% anyway, so I'm not going to get too upset over the Senate's failure to make the provision tougher.  All I hope for from the Senate is to weaken the House bill as little as possible, it's unrealistic to expect them to improve it.

by Steve M 2009-12-19 09:33AM | 0 recs
Re: More from Firedoglake

I think it's going to be the other way around. The Senate version is going to be the version we get.

It's not going to be the house version slightly weakened.

by jeopardy 2009-12-19 09:39AM | 0 recs
Re: More from Firedoglake

My point is that I never expected the Senate bill to be tougher than the House bill in any particular whatsoever, so I'm not going to get too upset that we didn't get a 90% MLR requirement at the end of the day.

by Steve M 2009-12-19 09:41AM | 0 recs
Re: More from Firedoglake

of course.

but if this loophole (where it can get lowered below even the Senate's version) stays in, will that upset you?

by jeopardy 2009-12-19 09:45AM | 0 recs
Breaking

    NOW President Condems Compromised Health Care Bill;
    Women's Access to Abortion Care Traded Away

   Statement of Terry O'Neill, NOW President

   December 19, 2009

   The so-called health care reform bill now before the Senate, with the addition of Majority Leader Harry Reid's Manager's Amendment, amounts to a health insurance bill for half the population and a sweeping anti-abortion law for the rest of us. And by the way, it's the rest of us who voted the current leadership into both houses of Congress.

   The National Organization for Women is outraged that Senate leadership would cave in to Sen. Ben Nelson, offering a compromise that amounts to a Stupak-like ban on insurance coverage for abortion care.

Right-wing ideologues like Nelson and the Catholic Bishops may not understand this, but abortion is health care. And health care reform is not true reform if it denies women coverage for the full range of reproductive health services.

   We call on all senators who consider themselves friends of women's rights to reject the Manager's Amendment, and if it remains, to defeat this cruelly over-compromised legislation.

by jeopardy 2009-12-19 09:35AM | 0 recs
Re: Dems Strike Deal to Get 60th Vote in Senate

It's outrageous that these massive revisions would be dumped on a Saturday morning (intentional, I am sure) with a vote before the end of the week.  Is this going to be one of these situations where no one in congress actually reads the bill?  And I expect we won't get any substantive analysis of the revisions in  the media.  The fix is in for them to ram this through the house without any changes.  

by orestes 2009-12-19 09:59AM | 0 recs

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