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Public Option Tensions Linger
Just hours after a critical Monday morning vote in the Senate, Democrats were already talking about future changes to the health reform effort in hopes of calming a revolt among liberal activists.
Sen. Tom Harkin (D-Iowa), chairman of the Health, Education, Labor and Pensions Committee, predicted the government health insurance option long favored by liberals would be part of that second look.
“It will be revisited,” Harkin said. “This is just the beginning. … What we’re building is a starter home, not a mansion. And guess what? We have room for expansions and additions later on.”
But if progressives were relying on President Barack Obama to make a hard push for the public option during the House-Senate negotiations on a final bill — a hope that liberals held out for months — the president downplayed the importance of it Monday in some of his toughest language yet about why he didn’t consider the idea critical to reform.
“As a practical matter, this is not the most important aspect of this bill — the House bill or the Senate bill,” Obama said of the public option, adding that it “is an area that has just become symbolic of a lot of ideological fights.”
Only “a few million people” would have benefited from the public option, he said, in an interview with American Urban Radio, acknowledging the idea’s limited reach in a way Democrats had declined to do throughout the year.
Even in the afterglow of Monday’s successful test vote, which moved health care reform closer to enactment than at any point in the past two decades, Democrats are unlikely to paper over the divisions caused by the public option anytime soon.
Within minutes of the 60-40 vote, two of the final holdouts, Sens. Ben Nelson of Nebraska and Joe Lieberman, the Connecticut independent, were threatening to withhold their support if the bill drifts closer to the House bill, which includes a public option and different ways to pay for reform.
“Conferences with the House often split the difference. This is a very fragile balance that brought 60 together,” Lieberman said. “So I think it’s critically important, if we’re going to adopt health care reform legislation, that the bill that comes back from conference is essentially what passed the Senate. I know that’s asking a lot of our colleagues in the House, but that’s the practicality of where we are.”
The Senate voted Monday at 1 a.m. to begin moving the health care bill to final passage, effectively assuring its approval later this week. But Republicans yesterday signaled that they are planning to stick with their plan to force Democrats to take the final health reform vote on Christmas Eve at 7 p.m.
Republicans on Monday also continued their attacks on the reform bill, criticizing the last-minute deals cut by Senate Majority Leader Harry Reid to secure 60 votes and saying that Democrats are trying to force a bad idea on the country with a series of rushed votes and a lack of debate.
"It was quite arrogant: "We know best. You all sit down and shut up’ — meaning the American people. ‘And Republicans, we don’t need to deal with you. You just sit down and shut up, and we’ll take care of this for you.’ Very arrogant".
The President and the Leadership said, "Make history".
Well, that’s what you talk about when you don’t have the Polls on your side. And of course, a lot of things that have happened in history have not been good,” Senate Republican Leader Mitch McConnell of Kentucky said on Sean Hannity’s radio show Monday.
Next up would be a House-Senate conference to work on a final compromise. House members traditionally resent being dictated to by the upper chamber, but some House Democrats have acknowledged they may have little choice but to stick with the bulk of the Senate bill, if they hope to preserve health reform.
Reid (D-Nev.) said he has not yet focused on the compromises or concessions that could come in the conference committee.
“We have to pass this bill in the Senate first, and that is our direction, that is our guiding light,” Reid said. “And we’ll worry about next steps at a later time. We are going to finish this bill before Christmas.”
House leadership aides say they aren’t getting much sense from their bosses of what their priorities will be heading into negotiations with the Senate, but most suggest Speaker Nancy Pelosi and Majority Leader Steny Hoyer will hold out for some changes, however slight, to make sure their rank and file are comfortable.
And no one wants to hear Lieberman dictate policy to the House — even if he’s correct about the effect of changes on the delicate balance of votes in the Senate.
“I don’t think the House members care what Joe Lieberman has to say,” said one House Democratic leadership aide. “Joe Lieberman has absolutely no say in the Democratic Caucus. I don’t think anything he said makes a bit of difference. ... It shouldn’t be for the Senate to come in and say, ‘Take it or leave it.’”
Most Democrats in the House acknowledge that they don’t have much room to work with the Senate, so changes will most likely nibble around the edges of a final compromise. This might mean pushing the Senate to move up its implementation date for programs that it voted to go into effect later than their counterparts in the House bill. The Senate bill, for example, starts the insurance exchanges a year later than the House. And the House bill would close a gap in prescription-drug coverage next year, while Senate negotiators, who agreed just last week to close the gap, still haven’t settled on a start date for expanded drug coverage.
Aides in the House are split over whether abortion opponents in their caucus will accept softened restrictions along the lines of those in the Senate bill. A number of first- and second-term Democrats are listening closely to the Roman Catholic Church, which has already come out against the Senate bill. So anti-abortion Democrats in the House might have more leverage than their colleagues in the Senate to force tougher restrictions.
House leaders also might make another push to insert the public option — even though few expect it to succeed, given Reid’s inability to add it to the Senate bill.
“It makes sense for us to go one more round,” the same aide said. “It’s worth it to our base.”
But no one expects a single issue to scuttle the entire package once leaders have enough of their members on the record voting for this bill. Democrats have begun to see the finish line, aides said, which gives them an added incentive to keep from going off course.
Whatever negotiations the two chambers hold, most House aides don’t expect the talks to stretch on because the White House and the party’s congressional leaders want to wrap up work as quickly as possible so that they can pivot next year to the economy and job creation.
Senate Democrats sought to maintain the momentum from the early-morning test vote, announcing later Monday an endorsement from the American Medical Association. But at the same time, Reid was forced to defend a series of narrowly crafted provisions in the Senate reform bill that benefit individual states, saying “it doesn’t speak well” of senators who didn’t secure such deals.
“There are 100 senators here, and I don’t know that there’s a senator that doesn’t have something in this bill that isn’t important to them,” Reid said. “If they don’t have something in it important to them then it doesn’t speak well of them.”
He likened the legislation to the Defense Department appropriations bill, which passed Saturday and is thick with earmarks and other provisions benefitting individual members and even private corporations.
“That’s what legislation’s all about,” Reid said of the compromises. “It’s the art of compromise. In this great country of ours, Nevada has many different problems than does New Hampshire. Michigan has many different problems than does Georgia.”
Reid made the remarks as he accepted the AMA endorsement. The legislation lacks the group’s No. 1 priority — a permanent fix to doctors’ Medicare reimbursement rates, which perennially threaten doctors with deep cuts. But the endorsement could help the group get action on a fix after reform is finished, which is what it is pushing for now.
The so-called doc fix is one of the first elements of health care reform that Democrats would address if they pass the comprehensive bill early next year.
Asked whether Democrats would reopen the public option debate next year, Harkin said: “You never know. I believe it is so vital and so important, it will be revisited.”
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Sources: Politico, MSNBC, Keith Olbermann, Google Maps
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