So, it’s finally out there: the “President’s Proposal” for health care reform which Obama will explain and defend in the “summit” with bipartisan congressional leaders on Thursday.
It’s unclear to what extent this plan reflects completed House-Senate negotiations on various sticking points between the bills each chamber has already passed. But it certainly addresses many of them. Think Progress has a useful chart comparing House, Senate, and Obama provisions. The biggies in terms of “improvements” to the Senate bill that would be enacted via reconciliation include a significant watering-down of the excise tax on high-cost insurance plans; bigger subsidies for insurance purchases; a sizeable increase in the federal share of costs associated with Medicaid expansion (accompanied by elimination of the special deal for Nebraska that the Senate included to get Ben Nelson on board); and the closing of the so-called “donut hole” in Medicare prescription drug coverage. These do represent the most often cited problems House Democrats have cited in the Senate bill, aside from the more fundamental failure to include a public option.
The two “surprises” in the proposals were that it did not authorize national health insurance exchanges (probably because of fears that such a step could trigger an adverse parliamentary ruling as non-germane to a reconciliation bill), which could be a serious issue for some House members; and a new provision that would enable federal regulators to stop large health insurance premium increases, which was almost certainly motivated by the recent big Anthem premium increases in California.
Republicans, of course, have immediately denounced the proposal as “partisan,” and appear ready for total war at the summit. Interestingly, the only spurned Republican “ideas” specifically mentioned in House Minority Leader John Boehner’s official response to the Obama proposal were interstate insurance sales and a total ban on private abortion coverage for people receiving federal subsidies (the Obama proposal tracks the Senate bill on abortion, which requires separate accounts for supplemental abortion insurance, but doesn’t try to outlaw it outright like the House bill’s Stupak Amendment does).
For those readers most concerned with a late revival of the public option, it should be noted that this possibility remains strictly contingent on progress towards getting 50 Democratic senators signed on. At this point, including it in the Obama proposal would have probably been counter-productive, even among Senate Democrats, while creating a new distraction going into the summit.
So we’re now ready for some serious Kabuki theater on Thursday. Obama’s objective will be three-fold: to rekindle some momentum for final action on health reform; to explode some of the Republican “ideas” like interstate sales; and to force Republicans to show the back of their hands while identifying them with potentially very unpopular proposals like voucherizing Medicare.