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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

The Senate Health Care “Deal”

Word is the so-called “Team of Ten”–a group of Democratic senators that includes five perpetually shaky “centrist” votes on health care reform–has come up with a compromise that could hold the 60 Democrats more or less together going into the next savage phase of floor debate.
Details on the deal are skimpy; its authors want the Congressional Budget Office to “score” the proposal’s budget impact before releasing a plan description. But here’s what Ezra Klein is reporting:

The deal looks pretty much like it’s looked for the past few days: The Office of Personnel Management will shepherd national, non-profit plans into existence. Medicare will open to folks between 55 and 64 who are eligible for the exchange. If the national non-profit plans don’t materialize, then there appears to be a trigger that will call a public plan into the market, but that seems pretty unlikely. All of this, of course, is contingent on CBO giving it a good score.
The details will be important here. What are the conditions for the non-profit plans? How many plans do there need to be? What does the regulation look like? When does the Medicare buy-in start? But assuming those pieces don’t come in much worse than expected, the combination of national non-profits and a Medicare buy-in seems like a pretty good deal. Better by far than what Democrats looked likely to get a week ago. And more likely, by far, to seed health-care reform with scalable experiments.

Two particular notes here: if the deal is as reported, it represents a break with past Senate reliance on a state-by-state method for adjudicating differences of opinion on the public option. National non-profit plans could achieve economies of scale that could make them as effective as a negotiated-rate publicly run plan. The approach also coopts the conservative hobby-horse of insurance sales across state lines, with the crucial difference that these national non-profit plans would be federallly regulated.
The inclusion of a Medicare buy-in was a crucial concession to Senate (and indirectly, House) progressives who have for ages longed for an expansion of Medicare beyond the population eligible for Social Security. Letting near-seniors “buy in” has been discussed off and on for at least a decade, and has been a particular focus for Sen. Jay Rockefeller (a member of the Team of Ten), who had been threatening to blow up any deal that deep-sixed the public option.
It’s worth noting that the Democratic senator considered most likely to join a Republican filibuster of health care reform, Ben Nelson of Nebraska, is a member of the Team of Ten. He will certainly need to make up his mind soon, since the Senate voted down his amendment yesterday seeking to impose the same sorts of restrictions on abortion funding that the House adopted in the Stupak Amendment. Nelson had been threatening to join a filibuster if his amendment failed; now we’ll see where he really is.
We’ll also see how the public and key stakeholders–and House members–react to the Team of Ten’s work. Will public option advocates react as sunnily as Jay Rockefeller seems to have done? Is Olympia Snowe interested in any “trigger” approach other than her own? Will Joe Lieberman–who was initially appointed to the Team of Ten by Harry Reid, and failed to show up–try to blow up the deal? Or will CBO blow it up with “bad” numbers? All these things are currently up in the air.

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