As our staff report below indicates, it’s looking very good for a favorable Senate Finance Committee report of the health care reform legislation this week. The Senate floor vote later on is more of a concern. The central question pre-occupying Senate-watchers and progressive health reform advocates alike is, what kind of public option, if any, is taking shape?
The answer to that question depends on the consensus-building skills of the white house and the willingness of a half-dozen or so key Senators, who have put their concerns out there, loud and clear, and who can not be expected to roll over without some face-saving concessions. They include:
Senator Ron Wyden (OR) wants much broader access to a ‘health exchange’ marketplace;
Senator Blanche Lincoln (AR) wants stronger cost-cutting measures so she can convince her middle-class constituents that they are not going to get saddled with tax hikes.
Republican Senator Olympia Snowe won’t vote for anything that even smells like a ‘public option’ without a ‘trigger’ mechanism of some kind;
Senator Maria Cantwell (WA) and Sen. Tom Carper (DE) want to localize the ‘public option’ by making it a state elective;
Senator Bill Nelson is mostly concerned about seniors, who are a large component of his FL constituency, and who are nervous about changes in the popular ‘Medicare Advantage’ programs.
It’s not hard to imagine a range of deals to make these six adequately happy. They have to be able to go back to their constituents and say in effect, “See, all that fussing I was doing has helped get changes in the reform package that address your concerns.” President Obama and his staff are working overtime to help make this doable.
Cantwell and Carper have already gotten an amendment supporting a public-private hybrid state approach passed in the Senate Finance Committee. Some form of it will have to survive the floor votes and reconciliation stages to keep them on board.
Wyden’s main concern is that access to health exchanges ought not be limited to those who can’t get employer-based coverage. He feels strongly that it is a critical element of cost-cutting, and forcing private providers to be competitve. Sounds about right to me.
As for Snowe, perhaps a ‘hair trigger’ that will enable her to say to her constituents, “This will protect the private insurers from cut-throat government insurance,” will be enough to make her comfortable with the package and still be acceptable to ‘robust’ public option advocates like WV Sen. Jay Rockefeller.
My guess is that Sen. Lincoln is the hardest to please, since she is the only Dem who voted against the Cantwell amendment in the Finance Committee. She has been hanging tough about cost-cutting and opposing tax hikes, and she is not alone, backed by several other moderate Democrats who share her views in varying extent, including Mary Landrieu, Ben Nelson, Debby Stabenow, Joseph Lieberman and Claire McCaskill, among others. Convincing moderate-conservative constituents that major government reforms are not going to jack up their taxes has always been a very tough sell. Satisfying Lincoln and like-minded Senators is the white house’s most difficult challenge.
All of these Senators are aware that nation-wide public opinion favors some kind of a public option. In September, The Kaiser Family Foundation’s health care poll found that 57% of Americans want “public health insurance option similar to Medicare.” As Democratic strategist Paul Begala said, quoted in an article in today’s L.A. Times by Noam Levy and Janet Hook, “One of the most consistently popular ideas in the healthcare debate is the public option, more popular than health reform generally…”It’s good politics.”
The Administration’s best hole card, however, is that no one Senator wants to be the spoiler who gets lambasted for killing reform prospects that could save the lives of countless thousands during the next few years. Yet, understandably, none are willing to go back to their constituents empty-handed. In between these two fears there is an array of possible compromises, concessions and deals that everyone can live with. The great hope is that Team Obama can find the balances that can get to 60.