For a year, critics of the Democratic health care plans have been applying the label “ObamaCare” to whatever the current draft was. That was inaccurate — because, as Democrats were eager to say, it was never quite clear to them what President Obama actually wanted out of a health care bill. Today, the questions end. The President has unveiled his own comprehensive health care bill. It borrows heavily from the Senate’s bill, adds some White House ideas, throws in some Republican-sponsored amendments, and pronounces itself ready for inspection.
The topline highlights:
— Proposes to cover 31 million Americans
who
don’t have health insurance;
— Creates a new federal facility to
help
states crack down on insurance industry abuses and unfair rate
increases;
— Includes significantly ramped up efforts to crack
down on
waste and fraud within the Medicare/Medicaid systems — this is a nod
to Republicans (Peter Roskam and Mark Kirk are behind proposals to do
just this);
— Adds a Medicare tax of 2.9% on unearned income —
hitting the wealthy; it immediately closes the Medicare Part D doughnut hole gap —
something seniors should notice before the November 2010 elections if
this gets through Congress;
— Increases tax credits to families
to
help them buy insurance; it spends $11 billion on community health care
centers;
— Endorses but adds consumer protections to the Senate’s
proposal to grandfather in insurance plans that people want to keep; it
adopts the Senate proposal to require that Americans who don’t buy
insurance pay a flat fee — but lowers the fee;
— Provides $40
billion to small businesses to help them defray the costs of providing
health benefits if taxpayers pay for the coverage; the president delays
by five years the Senate’s excise tax on so-called Cadillac insurance
plans;
— Increases fees for brand name (as opposed to generic)
drugs,
depriving the pharmaceutical industry of an extra source of profits;
—
Eliminates the Nebraska exemption for Medicare payments and adopts a
universal, phased-in approach to help states pay for the increased
costs of expanding the Medicare program. 100% of the increased costs
would be paid for three years; the bill turns the fee on medical
equipment providers in the Senate bill into an excise tax and delays
its implementation; it also delays by three years the tax on insurance
companies;
— Finally, the bill gives the executive branch $1
billion to
help efficiently implement the plan.
The political highlights:
there’s plenty in this bill for Democrats to like. But there’s no public
option. It’ll be easier to get unions on board because the excise tax
will be delayed and watered down a bit; the bill delays implementation
of several provisions, which will annoy Democrats; it spends quite a bit
of time focusing on trying to rid Medicare of waste, fraud and abuse.
There’s no nod to tort reform, so far as I can see.
So — this
is just a bill. How does it become a reality? It relies on the idea
that Democrats now really want to get something done. There is no public
option or a national exchange; the bill is still expensive and fairly
complicated; there are some carrots for those concerned about the
expensive of the House bill. It’s hard to see how any Republicans will
support the bill, although the White House is framing it in a way so as
to force Republicans to defend their opposition to it during Thursday’s
Blair House health care summit. Since the first House vote, Democrats
are down at least three votes.
The way forward: either
rank-and-file Democrats accept this bill — Obama’s bill — or they
don’t. Republicans could suddenly discover an upside in supporting it,
which is doubtful, but if they could also reduce the number of
procedural delays to help the Democrats speed its passage. If not, we
might be faced with the spectacle of Republicans trying to drag the
votes out through the midterms. This could benefit either party; it
depends on whether Americans view this bill, which is basically a
product of the bills they don’t like, as something new. The reason why
they might do this is because they never really opposed the provisions
in the bills or the goals of the bills; it was the process that
alienated them so profoundly, making health care in 2009 unlovable.
Another
arrow in the White House quiver is the decision by insurers — Anthem
in California being the best example — that decided to raise rates
precisely at this moment, allowing the White House to trump them with
its new insurance rate increase mitigation authority, a populist
proposal that
may — or may not work, but which would be hard to oppose
politically, particularly if it’s seen as the centerpiece of the plan.
That’s why the White House, which governs through the New York Times,
provided the Times with that aspect of the plan.
