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House to Vote on the Health-Insurance Bill Today     Permalink

After more than a year of proposals, discussion, debates, diatribes, accusations, rejoinders, attacks, and screaming, the House is finally going to vote on the health-insurance bill today. The outcome is not certain, but most observers expect it to squeak by, possibly by a 216-215 margin (four House seats are vacant). However, it could also lose by the same margin. Speaker Nancy Pelosi has been whipping votes and twisting arms like never before to get reluctant Democrats to sign up. You like that (sub)committee chairmanship you now hold? You do realize that I can take it away from you by snapping my fingers, don't you? You want Chris [Van Hollen, chairman of the DCCC] to help you out? I could ask him, you know.

One problem Pelosi has been dealing with is a group of representatives, led by Bart Stupak (D-MI), who won't vote for the bill unless it contains extremely strong language banning abortion. However, it is not possible to add such language to the reconciliation bill because then it would not be allowed in the Senate (reconciliation bills have to be about the budget). She probably won't get Stupak's vote, but she is working hard to peal off other members of his group, now thought to number about 5 or 6.

It is a foregone conclusion that all 178 Republicans in the House will vote no, so she can afford only 37 defections from her own caucus. While various whip counts have been published, there are about two dozen conservative Democrats, mostly from Republican districts, who are still on the fence and whose vote won't be known until after they have cast it. For what it is worth, bettors at overwhelmingly expect the bill to pass as evidenced by this graph.

Obamacare at Intrade

The reason the bettors at Intrade are so positive that the bill will pass is that in the past few days, quite a few of the undecideds have declared they will vote for it. These include representatives John Boccieri, Allen Boyd, Chris Carney, Brad Ellsworth, Suzanne Kosmas, and Tom Perriello, among others. What few people understand is how much of a chess game this is. Lyndon Johnson once said that if a bill passed by more than one vote, he gave away too much. Pelosi well understands that and is probably aiming at 216 or 217 votes, to give permission to as many nervous Democrats as possible to vote no. Priority will be for freshman in Republican districts, and then to other newbies whose reelection is in doubt. However, even if a vulnerable lawmaker gets permission from Pelosi to vote no, that does not mean the representative will be spared the wrath of other groups. For example, Michael Arcuri of NY-24 has said he will vote no and the unions are already looking for someone to run against him in a primary.

The procedure by which the vote will be taken is now clear. At first the Democrats were going to avoid a straight up-or-down vote on the bill already passed by the Senate with 60 votes by deeming the bill passed and then voting on a package of what in the software industry would be called bug fixes. This "deemed to have passed" procedure was first used in 1933 and was used by the Republicans 36 times in the last (2005-2006) Republican-controlled Congress, but Pelosi was apparently afraid to give the Republicans another talking point, so she abandoned what had become known as the "Slaughter Solution," after Rep. Louise Slaughter, chairwoman of the Rules Committee, who first proposed it.

There will be three votes today. The first vote will be to accept the rules of debate proposed by the Rules Committee. Unlike the Senate, where the same rules govern every bill, in the House, each bill comes equipped with its own set of rules, which govern items like how much debate time is allowed, whether amendments can be made, and so on. After the rules are adopted (which is a certainty), then the House will vote on the changes to the Senate bill. Many House Democrats are leery of the possibility of their voting for the Senate bill and then not getting the changes through, so they will vote for the changes first. If it passes, it will have to go to the Senate, where as part of the budget reconciliation process, it will get a straight up-or-down vote. Finally, the House will vote on the bill the Senate passed Christmas Eve. If that bill passes, it will go directly to the President, who is expected to sign it today before leaving for Asia.

A very strange battle will then ensure in the Senate. If Obama today signs the bill that the Senate passed on Christmas Eve, then the Cornhusker Kickback, Louisiana Purchase, high excise tax on gold-plated health plans, etc. will become the law of the land. The Senate fight will be about eliminating these unpopular measures. Thus if the Republicans try to stop the sidecar bill, they will actually be saying: "We want the Cornhusker Kickback, etc. to remain the law of the land." The Democrats are unlikely to explain to the voters what the fight is all about since then they would have to explain why they put these things in there in the first place. So it is a safe bet the upcoming Senate battle will be totally unclear to nearly everyone--which gives the media a clear role for explaining it, but it is unlikely it will be up to the job.

What Does the Bill Actually Contain     Permalink

With all the infighting about the process, it is not surprising that many people do not know what is actually contained in the bill. Here is a brief rundown of its key features.

  • Everyone will be required to have health insurance or pay a fine
  • People who cannot afford insurance will get it for free (Medicaid) or get a subsidy
  • Each state will have an insurance exchange where some individuals can buy approved insurance plans
  • Insurers will not be allowed to deny coverage to sick people (children in 2010, adults in 2014)
  • Insurance companies will be forbidden from dropping people when they get sick
  • Companies with more than 50 employees will be required to offer insurance or pay a fine
  • Annual and lifetime limits on claims will be eliminated
  • The Medicare donut hole on drug coverage will be phased out
  • Health plans above a certain level will be subject to an excise tax in the distant future
  • People making over $250,000 a year will pay a new tax on unearned income

Probably the most controversial aspect of the bill is the requirement that everyone buy insurance or pay a fine of about $700 (and get nothing). The Republicans will probably try to rally their opposition around this feature but it remains to be seen how many votes this will really win. After all, most people want insurance and have been complaining about insurance companies turning them down. The number of people who don't want health/car/fire insurance on ideological grounds is probably fairly small and most of these are probably confirmed Republicans anyway so their votes were not in play in the first place.

Also controversial is giving free or government-subsidized health care to poor people. But this is hardly new. Between Medicare, Medicaid, the Veterans Administration health-care system, and plans for federal and state government employees, well over 100 million Americans already have "government health care." This bill simply increases the number who get help but it does not create any new government-run plan (much to the disappointment of people on the left).

Political Impact of the Bill is Unclear     Permalink

If the bill fails, the Democrats will acquire a reputation of being unable to govern, despite huge majorities in Congress, and will suffer an enormous defeat in November. Of that there is no doubt. The Republicans will be hugely energized by their victory on the bill and Democrats will be totally demoralized. On the other hand, if the bill passes, the debate will be about the bill itself. Republicans are sure to run on a platform of repealing the bill, something they clearly cannot do since the Senate Democrats would filibuster any attempt to repeal it if the Republicans recapture the chamber and Obama would veto the repeal bill anyway.

Nevertheless, expect every Republican running for Congress in November to say some variant of: "We must repeal this bill which takes away our freedom and turns us into a socialist country with the government running the health-care system." Of course, this is nonsense, but few voters know what it actually in the bill. Any Democrat who voted against the bill and who responds: "I know my party has been trying to do this for 60 years and my President fought for it, but I voted against it so don't blame me" is going to discover that the Republicans are going to run a scare campaign and that a vote against the bill won't help. What Democrats have to do is run on the aspects of the bill that are popular, for example by saying "Before that bill was passed children with cancer and other fatal diseases couldn't get insurance or were having their insurance cancelled so they just died. Now insurance companies are required by law to insure them and they can get treatment. I'd like my opponent to explain why he thinks insurance company profits are more important than childrens' lives." If the Democrats can change the frame from "socialism" to "saving children's lives" they can probably limit their losses in November (the "out" party always wins the midterms, as we discussed here last week.

Passage of the Bill Probably Helps Palin in 2012     Permalink

In a peculiar way, passage of the bill probably helps Sarah Palin get the Republican nomination in 2012 because it hurts the current front runner, Mitt Romney. If the Republicans dig in their heels and make repeal their heart of their strategy for the next 2 years, it will be more than a bit awkward for Mitt Romney to explain how Romneycare, which he signed into law as governor of Massachusetts on April 12, 2006, and which he has repeatedly cited as a great achievement, differs from Obamacare, which the Republicans are going to spend two years violently attacking. Romneycare also has an individual mandate, the most-hated feature of Obamacare. How is Romney going to convince people that a mandate to buy insurance is a good thing if it is in state law but a bad thing if it is in federal law? This is a subtle point that is going to be lost on most voters. On the other hand, Palin will be free to attack Obamacare as a horrible thing without being accused of being a flip-flopper and a hypocrite.

Romney is not the only person who will find the passage of Obamacare embarrassing. Sen. Scott Brown (R-MA), is up for reelection in 2012. It will be interesting to see whether he campaigns then on repealing it. If he does, surely his opponent will mention a few times that as a state senator in 2006, he voted for Romneycare. He had better have a good explanation.

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