At today’s House Republican retreat, President Obama emphasized the Republican ideas in the House and Senate health care bills and called on the party to abandon their harsh rhetoric and work on reform in a bipartisan manner. “[F]rom the start I sought out and supported ideas from Republicans, I even talked about an issue that has been a holy grail from a lot of you and said I would be willing to work together as part of a comprehensive package to deal with it. I just didn’t get a lot of nibbles,” Obama said before listing 3 or 4 Republican policies that are part of both health care reform bills.

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During the question and answer session, however, the GOP still insisted that all of their ideas had been ignored. Rep. Tom Price (R-GA) — who just this summer engaged in a misleading campaign to trick physicians into opposing health care reform– accused Obama of “repeatedly” saying “that Republicans have offered no ideas and no solutions” and touted the health care solutions offered at GOP.gov. House Minority Leader John Boehner (R-OH) even provided the President with a book of GOP solutions.

So what do these ideas entail? Like Democrat proposals, Republicans solutions would prohibit health plans from setting arbitrary annual or lifetime spending caps, eliminates rescissions, allow insurers to sell policies across state lines, and require insurance plans to cover dependents up through their 25th birthday. The Democratic health care bills incorporate some of these ideas in modified form. As Obama explained of the “across-state-lines” idea, “we include that as part of our approach. But the caveat is, we’ve got to do so with some minimum standards, because otherwise what happens is that you could have insurance companies circumvent a whole bunch of state regulations about basic benefits or what have you, making sure that a woman is able to get mammograms as part of preventive care, for example.”

Republican solutions promise to “take meaningful steps to lower health care costs and increase access to health insurance coverage” “without (1) raising taxes; (2) cutting Medicare benefits for seniors; (3) adding to the national deficit; (4) intervening in the doctor-patient relationship; or (5) instituting a government takeover of health care.” In short, Republican solutions take small steps towards regulating insurers, but do very little to lower health care costs for sicker Americans or control overall health care costs. In practice, their policies simply shift the costs and risks of insurance onto individuals and fragment the insurance market into low-cost plans for the healthy and high-cost insurance for the sick. Below is a summary of the plan House Republicans introduced in the House: Read more

This afternoon, during a conciliatory visit with the House Republicans, President Obama suggested that the party’s bitter political attacks prevented any possibility of negotiation or compromise on health care reform. “If you were to listen to the debate, and frankly how some of you went after this bill, you’d think that this was some Bolshevik plot,” Obama said:

If the way these issues are being presented by the Republicans is that this is some wild-eyed plot to impose huge government in every aspect of our lives, what happens is you guys then don’t have a lot of room to negotiate with me. I mean, the fact of the matter is that many of you — if you voted with the administration on something — are politically vulnerable in your own base, in your own Party. You’ve given yourselves very little room to work in a bipartisan fashion. Because, what you’ve been telling your constituents is: this guy’s doing all kinds of crazy stuff that is going to destroy America.

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Obama described the health reform legislation as “a plan that is pretty centrist” and pointed out that it already incorporated modified versions of Republican proposals. He said that the legislation reflected the basic elements of a plan introduced in June of last year by a bipartisan group of former Senate majority leaders and reminded Republicans that they would have to negotiate with Democrats to add their ideas to the final legislation. “Most independent observers would say” it is “similar to what many Republicans proposed to Bill Clinton,” Obama added. In 1994 then Senate Majority Leader Bob Dole proposed alternatives that included an individual mandate, subsidies for lower income Americans and benefit standards “at least equal to those offered federal employees.”

Throughout the health care debate, House Republicans have resorted to sensational rhetoric and deceitful attacks. In July, Rep. Ginny Brown-Waite (R-FL) said that “last week Democrats released a health care bill which essentially said to America’s seniors: Drop dead.” Rep. Steve King (R-IA) predicted that “People die when they’re in line [for health care services]” and Rep. Virginia Foxx (R-NC) famously said that the Democrats health care reform would “put seniors in a position of being put to death by their government.”

Inside Health Policy is reporting that Senate Finance health subcommittee Chair Jay Rockefeller (D-WV) is considering “using the jobs bill under discussion in the Senate to extend enhanced federal Medicaid matching funds, the first provision to be carved out of the health reform effort even as Democrats vowed to continue fighting for a comprehensive reform bill.” The additional federal dollars would help struggling states meet the demands of increasing enrollment and reduce the need for tax increases or cuts to other essential state services.

In 2008, states reduced Medicaid payments to hospitals and other health care providers to compensate for budget shortfalls even as enrollment in Medicaid grew 2.6%, up significantly from 0.7 percent in 2007. The Recovery Act increased the federal government’s Medicaid contribution to help states maintain their health programs during the recession, but that extension expires on December 31, 2010 “in the middle of most states’ fiscal years.” Many states are already struggling to keep up with the exploding growth in safety net programs, due to rising unemployment and increasing health care costs.

In Kentucky, Gov. Steve Beshear’s proposed budget “calls for spending an additional $782 million on Medicaid over the next two years.” However, Beshear is also calling for $108 million in cuts to the program over two years, and 2-percent nearly-across the board cuts to Cabinet for Health and Family Services program.” Vermont would have to invest $53 million “to close the gap between available revenues and expenditures next year” in its human service programs and New York is contemplating cutting Medicaid reimbursements to hospitals and nursing homes to reduce Medicaid spending by a $1 billion.

It’s not clear that Rockefeller’s proposal will garner significant Congressional support. The Hill reports that “some of his colleagues are skeptical of his proposal, arguing the funds would not be used directly to create jobs.”

Responding to President Obama’s call to “not walk away from reform,” House Speaker Nancy Pelosi (D-CA) today reaffirmed her commitment to comprehensive health care reform and pledged to “take whatever time it takes to do it.” Pelosi said that the House could pass additional measures that “may not fit into the bigger plan,” stressing that these sidebar issues can be done quickly but wouldn’t “substitute for doing comprehensive.” “It means we will move on many fronts. Any front we can”:

As I said to some friends yesterday in the press, we will go through the gate. If the gate is closed, we will go over the fence. If the fence is too high, we will pole vault in. If that doesn’t work, we will parachute in. But we are going to get health care reform passed for the American people for their own personal health and economic security and for the important role that it will play in reducing the deficit.

Watch it:

Pelosi said that the House and Senate bills are “about 75 percent the same” but refuted the notion that negotiations only had to make “minor tweaks” before merging the two bills. “I would not call them them minor tweaks because that would infer, would imply, that there was something there that we could easily accept, except for some minor tweaks. No, it’s more serious than that,” she said, suggesting that the ball was now in the Senate’s court.

Pelsoi didn’t specify which sidebar issues the House would take up, but House aides told TPMDC’s Brian Beutler that “[o]ne of the issues said to be under consideration was a repeal of the health insurance industry’s anti-trust exemptions.” The House could also potentially create a temporary reinsurance coverage to retirees over age 55 who are not eligible for Medicare, allow young adults to stay on their parents’ insurance coverage, reduce the price of COBRA coverage, and begin closing the Medicare Part D doughnut hole.

Meanwhile, Senate Majority Leader Harry Reid (D-NV), who is holding a meeting on how to move forward on health care reform, also committed to passing health care reform “this year.” “This is not a one-year Congress, this is a two-year Congress and we have had a number of extensive meetings of trying to come up with a path forward,” Reid said. “We are going to move forward on health care. We’re going to do health care reform this year. The question at this stage is procedurally how do we need to get where we need to go.” “The President said that jobs was the number one issue before us in 2010 and we couldn’t agree more,” Sen. Chuck Schumer (D-NY) added. “In fact, the three top issues on our agenda this year are jobs, jobs, and jobs.”

Matt Yglesias responds to those of us who thought that the health care section of President Obama’s State of the Union address should have laid out a specific way forward, reclaimed the sense of urgency in previous speeches, or at least committed Congress to passing health care reform before the end of the year:

I think he made the right call. The speech is a speech to the American people, especially to people who follow politics pretty casually, and regular people don’t want to hear about congressional process. The reality is that this is going to have to be worked out behind the scenes, behind the dread closed doors. But one of the main points of the speech was to get the focus on Obama and Obama’s themes and off closed door dealmaking. So he emphasized the need for action and correctly situated the call for health reform in a broader context of economics reform.

There is certainly some sense in shifting health care reform from public view. The legislation has become a symbol of Washington corruption and drawing more attention to the process could have fed the winds of popular discontent and buried the entire effort. The Massachusetts election and the administration’s reluctance to set a specific course of action in the hours after, has complicated reform, stripped it of its inevitability and generally provided reluctant Democrats with a reason to oppose the effort.

If Obama had laid out a roadmap for how to pass the legislation, he may have very well killed it. But by moving reform to the back burner — by failing to build on any momentum in Congress — he runs a greater chance of seeing any remaining possibility of comprehensive reform evaporate. And many in Congress were looking to him for direction.

Today, Sen. Mary Landrieu (D-LA) said health care reform was now “on life support” and said that the President should have been more specific with how Democrats should move forward. “He should have been more clear, and I am hoping that in the next week or two he will because that is what it is going to take if it is at all possible to get it done,” Landrieu said. Hours before the President delivered his address, House Speaker Nancy Pelosi (D-CA) hinted that the House may be able to pass the Senate health care bill and on Monday, House majority whip James Clyburn (D-SC) told The Plum Line’s Greg Sargent that Obama should “throw his weight behind this approach during tomorrow’s State of the Union Address.” “I think that would be helpful,” Clyburn said. “I would like for him to say that we ought to do the fixes…and pass the rest of the Senate bill. I think it would be good for him to let everybody know.”

The State of the Union provided Obama with an opportunity to overcome the popular divisiveness surrounding reform and mobilize Congress into action. The emphasis on the deficit, jobs and the economy allowed the president to make the economic case for health care reform. As he said in September, “Put simply, our health care problem is our deficit problem. Nothing else even comes close. Nothing else.” These remarks would have been unpopular, but they would have been true. And as Obama said last night, “Those of us in public office can respond to this reality by playing it safe and avoid telling hard truths and pointing fingers. We can do what’s necessary to keep our poll numbers high, and get through the next election instead of doing what’s best for the next generation.

Obama said, “when I ran for President, I promised I wouldn’t just do what was popular -– I would do what was necessary.” But on health care, he didn’t live up to his own expectation.

For those who hoped that President Obama would bring more clarity to how Congress can pass health care reform, the State of the Union address fell far short of expectations. Instead of laying a path to final passage, Obama briefly described the health care bills, urged Republicans to contribute to the process, and simply “asked” (rather than demanded) Congress to “not walk away from reform.”

Gone was his sense of urgency or commitment to passing health care reform before the end of the year. Obama spent just 6% or 5 minutes of his speech on health care (452 out of 7,077 words) and failed to connect health care reform to the economic recovery or job creation. Below is an excerpt:

But I also know this problem is not going away. By the time I’m finished speaking tonight, more Americans will have lost their health insurance. Millions will lose it this year. Our deficit will grow. Premiums will go up. Patients will be denied the care they need. Small business owners will continue to drop coverage altogether. I will not walk away from these Americans, and neither should the people in this chamber.

As temperatures cool, I want everyone to take another look at the plan we’ve proposed. There’s a reason why many doctors, nurses, and health care experts who know our system best consider this approach a vast improvement over the status quo. But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know. Here’s what I ask of Congress, though: Do not walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people.

The tone was a marked departure from how Obama described reform just five months ago. Standing in that same spot in September, Obama declared that “the time for bickering is over. The time for games has passed. Now is the season for action….Now is the time to deliver on health care. Now is the time to deliver on health care.” In December, Obama even connected health care reform to the economy. “Those who’ve been accusing me of ignoring the unemployment problem haven’t been paying attention.” “Health care reform will create thousands of jobs.”

While House Speaker Nancy Pelosi (D-CA) says that the House has the votes to pass the Senate health care bill if the Senate first approves a package of changes through the reconciliation process, the White House is suggesting that the President will refrain from calling Congress into action during tonight’s State of the Union address. According to reports, Obama will reaffirm his commitment to a comprehensive bill without laying out a roadmap for how to pass the legislation.

But since Congress is so close to passing reform, Obama’s endorsement of the effort is a step backward. As the process of reform has moved forward, Obama’s rhetoric has remained in campaign mode, without a clear path forward. In tonight’s address, Obama must call on Congress to pass the Senate bill, alongside a reconciliation package of fixes, and reclaim the urgency that characterized his address in September. During that speech, Obama said, “I am not the first President to take up this cause, but I am determined to be the last” and reminded lawmakers that it is “[o]ur collective failure to meet this challenge — year after year, decade after decade — has led us to the breaking point“:

Well, the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care. Now is the time to deliver on health care. [...]

But know this: I will not waste time with those who have made the calculation that it’s better politics to kill this plan than to improve it. (Applause.) I won’t stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what’s in this plan, we will call you out. (Applause.) And I will not — and I will not accept the status quo as a solution. Not this time. Not now.

Everyone in this room knows what will happen if we do nothing. Our deficit will grow. More families will go bankrupt. More businesses will close. More Americans will lose their coverage when they are sick and need it the most. And more will die as a result. We know these things to be true. That is why we cannot fail. Because there are too many Americans counting on us to succeed — the ones who suffer silently, and the ones who shared their stories with us at town halls, in e-mails, and in letters.

Congressional leaders, health policy experts and progressive advocates have called on Democrats to quickly pass a comprehensive health care reform bill. Tonight, it’s the President’s turn to rush our lawmakers into action.

Today, Rep. Paul Ryan (R-WI), the ranking members on the Budget Committee, is re-releasing his ‘Roadmap For America’s Future‘, a Republican guide to “tackle our nation’s most pressing domestic challenges — updated to reflect the dramatic decline in our economic and fiscal condition.” The document closely resembles the GOP’s April Fools budget or a McCain-Palin 2008 press release. It relies on the traditional partisan prescription of tax credits, spending cuts and privatization of public services.

The Roadmap’s health care plan “provides a refundable tax credit—$2,300 for individuals and $5,700 for families—to purchase coverage” and establishes “state-based high risk pools will make affordable care available to those with pre-existing conditions.” Rather than strengthening the existing Medicare program, Ryan moves “those under 55″ into a private “Medicare certified plan” outside of the current Medicare system.

These polices are bad, but the overall ideology is even worse. As Ryan explains in an editorial in today’s Wall Street Journal:

The plan ensures universal access to affordable health insurance by restructuring the tax code, allowing all Americans to secure an affordable health plan that best suits their needs, and shifting the control and ownership of health coverage away from the government and employers to individuals.

It’s what Jacob Hacker calls The Great Risk Shift. Republicans are slowly dismantling the New-Deal era institutions that spread economic risks “across rich, and poor, healthy and sick, able-bodied and disabled, young and old” and shifting all of the economic costs and risks onto individuals (or as Ryan calls it, freeing Americans from the “relentless expansion of government and a new culture of dependence“).

In the wake of the Great Depression, “political and business leaders put in place new institutions designed to spread broadly the burden of key economic risks, including the risk of poverty in retirement, the risk of unemployment and disability.” “These public and private institutions did not let the individuals off the hook they required contributions and work and proof of eligibility” and they provided all Americans with a guarantee that if they paid into the system, they would later benefit from it.

But under Ryan’s alternative, the economic costs and risks of insurance are spread across a party of one — the individual. If that individual falls sick or a family loses its breadwinner, she is only empowered to lose. As Hacker explains, “The next frontier in the Great Risk Shift is the transformation of existing programs — Medicare and Social Security chief among them — from guaranteed benefits defined by law to individualized private accounts that leave workers and families shouldering more and more of the risks that these programs once covered.”

This Republicans message about personal responsibility and individual liberty resonates with the American experience and forms a powerful and convincing political narrative. But rather than creating “a nirvana of empowered owner” as Republicans would like, the Great Risk Shift leaves many Americans to face economic risks and insecurities on their own.

During last year’s health care debate, Sen. Ben Nelson (D-NE) insisted on inserting specific language into the Senate health care bill that prevented public dollars from funding abortion services and asked leadership to adopt the restrictive abortion language “that might be compatible with the Stupak language in the House.” Majority Leader Harry Reid (D-NV) refused to incorporate the House bill’s Stupak restrictions and Nelson, along with Sens. Orrin Hatch (R-UT) and Bob Casey (D-PA), introduced a similar amendment that withheld affordability credits from women enrolled in plans that offered abortion services. Once the Senate tabled the measure, Nelson held out his 60th vote until negotiators implemented a compromise that required women to write a separate check for abortion services.

But yesterday, in an interview with LifeSiteNews.com Nelson said that he agreed to the compromise to “get” the final bill into conference and planned to use his leverage as the 60th vote, to insert his original amendment into in the final conference report:

LSN: OK, so you were planning on coming back…
NELSON: Absolutely. That is what I was just trying to tell the gentleman who was arguing about the 60th vote.
LSN: What made you think that it had a shot, after conference?
NELSON: Because they needed 60 votes again.
LSN: Right, but before, you voted for it even without it –
NELSON: To get it there….But, once it went to conference, as part of the conference, there was still another 60 vote threshold, and that is when I would have insisted and that is what Christy was talking about when I mentioned this on the phone – how we would approach this in conference to say, for my last 60th vote, it has to have Nelson/Hatch/Casey.
LSN: Why didn’t you stop it right then and there and say, “No Nelson/Hatch – nothing.”
NELSON: Because, at that point and time, the leverage wasn’t as strong – you have to play it [...]
LSN: So, if we got to conference and it was just the Nelson not the Nelson/Hatch/Casey – you would say ‘yes’ because you think it was good enough.
NELSON: I could have but I was going to say – and this was all the plan – that I would insist that it be Nelson/Hatch/Casey.

Nelson also said that federal law — the so–called Hyde restrictions — already prevented federal money from funding abortions that did not result from pregnancies that threaten the life of the woman, rape or incest, and admitted that his amendment was a redundancy. “I think it was probably necessary to clear up any question about it that somebody might have – but if Hyde truly applies…It was a belt and suspenders approach … to make sure that it was clear that it didn’t… This was just to make it clear,” he said.

During yesterday’s interview with ABC News, President Obama admitted that the process of passing health care reform had not been as transparent as he would have liked. “Part of what I had campaigned on was changing how Washington works, opening up transparency and I think it is — I think the health care debate as it unfolded legitimately raised concerns not just among my opponents, but also amongst supporters that we just don’t know what’s going on,” Obama said. “And it’s an ugly process and it looks like there are a bunch of back room deals”:

OBAMA: Now I think it’s my responsibility and I’ll be speaking to this at the State of the Union, to own up to the fact that the process didn’t run the way I ideally would like it to and that we have to move forward in a way that recaptures that sense of opening things up more.
SAWYER: A lot of people think you must say at the end of the day, this is not who I was in 2008, these deals with Nebraska, with Florida…
OBAMA: Let’s hold on a second, Diane. I mean, I think that this gets into a big mush. So let’s just clarify. I didn’t make a bunch of deals. There is a legislative process that is taking place in Congress and I am happy to own up to the fact that I have not changed Congress and how it operates the way I would have liked. So that’s point number one.

Obama is right to recognize that the process of forcing 60 Democrats to support something as ambitious as comprehensive health care reform required some serious arm twisting. But Washington deal-making isn’t the only factor behind the popular dissatisfaction with the “process”; Republican obstructionism and repeated Democratic concessions deserve at least some of the credit.

In the Senate, Democrats wasted a lot of time reaching out to the GOP and conservative Democrats. They watered down their legislation — removed the most popular elements of reform — and when Republican support still failed to materialize, they found themselves at the mercy of the Democratic hold-outs. Members like Ben Nelson, could not be convinced to vote for reform for reform’s sake and were brought on board with extra Medicaid funding. This drawn out process of missed deadlines and back room negotiations in the majority leader’s office tugged on the public’s patience and did more to dilute reform than improve it.

The process wasn’t pretty, but it was a far cry from the kind of arm twisting the GOP engaged in during their push to pass Medicare Part D in 2003. Democrats held months of committee mark-ups and debate. They provided Republicans with ample opportunity to contribute to the legislation, allowed Max Baucus to hold nine months of bipartisan negotiations and included Republican-friendly provisions in their bills. But Republicans undermined this process. House Republicans shouted down Democrats as they tried to introduce the measure for debate, Republican Senators tried to prevent health care reform from reaching the Senate floor, forced the clerk to read thousands of pages of legislative language, routinely lied about the bills, and introduced a stream of message amendments designed to derail reform.

On the whole, the process produced a fairly conservative piece of legislation in a moderately transparent manner. The GOP’s success in painting the bill and the debate as a left-wing power grab while they got away with talking about ‘death panels’ and successfully obstructing “the legislative process” every step of the way, says more about the GOP’s communication efforts than it does about Ben Nelson’s Cornhusker kickback.

Earlier today, The Plum Line’s Greg Sargent reported that “[t]he GOP Senate leadership has privately settled on a strategy to derail health reform if Dems try to pass the Senate bill with a fix through reconciliation.” Republicans are promising to “[u]nleash an endless stream of amendments designed to stall for time and to force Dems to take untenable votes.” “There is no way to limit the number of amendments that are voted on. You can’t close debate. Democrats will have to vote on every politically perilous amendment that you can possibly think of,” the aid said.

But at least one former Senate parliamentarian is calling the strategy “patently absurd.” According to Robert Dove, who served as Senate parliamentarian until 2001, “In the Senate, the motion to go to that [reconciliation] bill is not debatable, and the bill itself is only debatable for 20 hours. All amendments must be germane.” “If there are differences between the two houses in their reconciliation bills, then you would either work out those differences through a conference, or through amendments as they bounce back and forth,” Dove told Lester Feder, who has been covering health care policy for The Nation and the O’Neill institute’s health law blog.

Dove also revealed that Vice President Joe Biden, not the Senate parliamentarian, is “the ultimate decider” of “what can stay in under the rules“:

But no vice president has tried to play that role in reconciliation. We haven’t had vice presidents that have tried to play important procedural roles for a very long time. The last one was Nelson Rockefeller, in 1975, and before him Hubert Humphrey, in the 1960’s. But no vice president has ever tried to play a role in reconciliation. Basically, since Walter Mondale was vice president, they have kind of been co-opted by the president and given an office down in the West Wing. Their interest in playing Senate politics has become attenuated. That has left the Senate parliamentarian in an extremely powerful position.

Dove stressed that “reconciliation was never designed for something like health care” and pointed out that “It’s designed for deficit reduction, and therefore everything in a reconciliation bill must contribute to deficit reduction.” Of course, in 2001, Republicans broke from tradition and used the reconciliation process to pass President Bush’s budget busting tax cuts for the rich. As a new report from the Center on Budget and Policy Priorities points out, reconciliation has been used to pass major pieces of legislation in the past and, “[s]ince rising health costs are the single largest reason for projected long-run deficits, it is appropriate that health reform be considered through the reconciliation process.”

Reports are suggesting that Senate and House negotiators are rallying behind a strategy that would require the House to pass the Senate health care bill alongside a reconciliation package of fixes that would improve the bill and satisfy progressive lawmakers. The reconciliation package would originate in the House and require just 51 votes to pass the Senate. Congressional aides are hoping to use the measure as a vehicle to remove the “Cornhusker Kickback” from the Senate bill, close the Medicare Part D doughnut hole, include higher subsidies, cut deeper into Medicare Advantage, and preserve the deal with labor unions to delay a tax on expensive insurance plans and increase the thresholds for the tax.

But speaking at the National Press Club today, House Majority Leader Steny Hoyer (D-MD) reiterated that Congress has not settled on a course of action and said that it would be possible to pass a scaled-down health care reform bill. Hoyer suggested that Congress could offer a “more limited exchange,” encourage small businesses to pool risk, enact insurance reform, eliminate the insurer exemption from anti-trust laws and institute “smaller” affordability measures:

Much of the bill is an integrated whole. That is to say, to accomplish the objectives you need to both include many more people in coverage under insurance, spread the risk, bring costs down for individuals. At the same time that you affect reforms…That is an integrated whole that works as a whole. It’s more difficult when you take out individual items. However clearly an exchange could be created, a more limited exchange. There is I think broad based belief that we need to empower small businesses to come together to create larger markets, not small groups but large groups so they’ll get better prices and bring them down…There are obviously within affordability smaller things you can do, but I think there are somethings we can work together on…It is difficult to take small pieces and accomplish the objective that you want to accomplish. But it is not impossible and insurance reforms are popular…

Watch it:

Meanwhile, TPMDC is reporting that “House and Senate leaders will huddle today at 4 p.m., House Democratic leadership will meet at 5 p.m. and then House leadership will hold a caucus meeting with rank-and-file members at 7 p.m.” to “get a sense of where members stand after spending three days sounding out constituents.” “Nothing is certain; rank-and-file Democrats are all over the map with some members opposing comprehensive reform outright, and others resistant to passing the Senate bill and having lost faith that the Senate will be able to pass a separate bill. A House leadership aide tells TPMDC that members will be presented with “three ways forward and that’s it. And none of them are really that good.”

“The overwhelming majority of our caucus wants to pass a health care bill,” the aide told TPMDC. “They can’t make a decision yet because they are still trying to work through the parliamentary procedures that are at our disposal.”

This morning, Sen. Evan Bayh (D-IN) appeared on MSNBC’s Morning Joe to endorse President Obama’s new proposal to institute a discretionary spending freeze for two years. “The freeze would affect $447 billion in spending, or 17% of the total federal budget,” but it would “exempt security-related budgets for the Pentagon, foreign aid, the Veterans Administration and homeland security, as well as the entitlement programs that make up the biggest and fastest-growing part of the federal budget: Medicare, Medicaid and Social Security.”

Bayh supported Obama’s new approach but criticized him for spending too much time on health care reform. “We can have progressive government in this country, but you’ve got to take it a step at a time. You’ve got to be in touch with the times you’re in,” he said:

And going with the large bill in the middle of the worst recession since the 1930s and a major new expenditure at a time we were running a $30 trillion deficit just didn’t resonate real well. Monday morning quarterbacking is not something I’m into, but you’ve gt to learn from these sorts of things, and going forward let’s do what we can in a common sense way.

Watch it:

Bayh is wrong to suggest that health care reform is antithetical to reducing the nation’s $1.4 trillion deficit. After all, according to the Congressional Budget Office (CBO) the Senate health care bill would reduce the deficit by $132 billion over 10 years (or up to $409 billion over 10 years according to a Commonwealth study) and lower Medicare spending per beneficiary from 8% growth rate to 6% growth rate. As Christina Romer, chairwoman of the Council of Economic Advisers, explained in December, reform would slow the growth rate of cost by 1 percentage point per year” and have “a dramatic impact on where we are relative to otherwise we would have been.”

Health care reform would compliment the administration’s new focus on deficit reduction by slowing the fastest growing part of the deficit. In yesterday’s interview with Diane Sawyer, Obama reiterated his commitment to “keep on pushing” “on the big issues” and said, “We are going to have to be serious about the deficit in ways that we haven’t been before.” Obama didn’t say if he would urge Congress to pass comprehensive health care reform as party of his effort “to be serious about the deficit,” but taking a strong position on reform certainly demonstrate that he is “not backing off the need for us to tackle these big problems in a serious way.” As he told Congress during his address in February, “Put simply, our health care problem is our deficit problem. Nothing else even comes close. Nothing else.”

While Senator-elect Scott Brown (R-MA) now says that Massachusetts shouldn’t subsidize federal health care reform, in October of 2009 the then-mostly unknown candidate Brown bragged that his state “took money that was coming from the federal government” rather than raise taxes to pay for its 2006 health care overhaul. During the radio interview with WRKO, Brown also defended the individual and employer health care mandates and admitted that the public option “may be good for other parts of the country“:

BROWN: It’s not good for Massachusetts because any time government is trying to put a government option there with directly competing with what we’ve done already here, it may be good for other parts of the country, but for us where we have 98% of the people insured already, government should not be in the business of running health care…We took actually money that was coming from the Federal government and also from the uncompensated health care pool, things we were giving hospitals were in fact to pay for this. And obviously there’s an employer contribution and a purchaser contribution. We gave through the Connector and various types of plans, Commonwealth Care, we provided pretty good plans for a lot of folks that wanted that type of care.

Listen:

Brown implied that the federal government needs to play a role in reforming the health care system and stressed that the federal dollars have helped insure residents who “don’t have any care whatsoever.” “Until they change the federal rules regarding health care and health care coverage for all, and we have to continue to support the folks hare in Massachusetts to keep them healthy,” he said.

The absence of election-night exit polls allowed commentators to argue that the Massachusetts election was a referendum on Democrats’ health care reform bills, but a new Washington Post/Kaiser/Harvard poll undermines this conventional wisdom. Voters elected Senator-elect Scott Brown (R-MA) to protest the Washington process and hoped that their new Senator would work with Democrats on a health care bill. The electorate rejected the process of securing a large health care package, not the policy of reform. Voters asked for more cooperation between the parties; they did not vote to abandon progressive prescriptions for the Republican alternative or ask the Democrats to separate their comprehensive health care bills into a thousand little pieces.

Only 11% of voters, including 19% of Brown voters, want Brown to “stop the Democratic agenda“:

- 70% of voters think Brown should work with Democrats on health care reform, including 48% of Brown voters.

- 52% of voters were enthusiastic/satisfied with Obama administration policies.

- 44% of voters believe “the country as a whole” would be better off with health care reform, but 23% believe Massachusetts would be better off.

- 68% of voters, including 51% of Brown voters approve of Massachusetts’ health care reform.

Fifty-eight percent of all voters, including 37% of Brown voters, felt “dissatisfied/angry” with “the policies offered by the Republicans in Congress,” while opposition to progressive health care policies had a low impact on the electorate:

Some Democrats have always questioned the President’s health care reform agenda and many are now using the Massachusetts result to argue that pursuing the effort would result in a popular backlash and electoral catastrophe. But this poll suggests that voters would be more frustrated if Congress simply abandoned the effort. After all, frustration with the politics of reform is not an endorsement of inaction and the status quo.

Our guest blogger is Ellen-Marie Whelan, Associate Director of Health Policy and Senior Health Policy Analyst at the Center for American Progress Action Fund.

As a primary care nurse practitioner who has worked as one of those rare Medicaid providers in inner-city neighborhoods and in community health centers, I want to offer yet another view of why an incremental approach to health care reform won’t work.

One of the provisions that would likely be included in a pared down bill is some form of Medicaid expansion. But simply increasing the number of people eligible for Medicaid would not necessarily expand access to care. Why? Mostly because there aren’t enough Medicaid providers to service the current beneficiaries and expanding the program would only exacerbate provider shortages. Congress’ comprehensive approach to reform addressed this problem in several ways:

- Increased funding for Community Health Centers: These community clinics are already established in neighborhoods that serve Medicaid patients. The reform bills would expand and enhance these centers by allowing them to see an additional 35-45 million patients and ultimately save up to $23 billion through the provision of preventive services and better coordinated care.

- Increased funding for National Health Service Corps: The NHSC provides scholarships and loan repayment to health professionals who agree to work in areas with health professional shortages. The House and Senate health care bills provide funding for over 8,000 clinicians allowing them to serve millions of newly covered Americans.

- Boosting Medicaid primary care payments to Medicare rates: Medicaid typically pays significantly less than Medicare, which in turn tends to pay less than private insurance. As a result, it’s often hard to find providers to participate in the Medicaid program. The House bill would increase Medicaid payments to primary care doctors to same rates that Medicare pays. This would not only help Medicaid beneficiaries get access to care, it would also give an extra financial boost to primary care clinicians, who desperately need it.

- Increasing Medicare primary care payments: There is near universal agreement that we must increase reimbursement rates for services provided by primary care specialties. This would not only reward those currently delivering primary care but also help make the field of primary care more attractive by sending a message to medical students about what we think is important in the health care system. Many acknowledge this won’t completely solve the current primary care physician shortage but we are seeing some early indicators that it may be helping. Just this week, I learned that the University of New Mexico, Department of Family and Community Medicine has seen an uncharacteristically large increase in applicants into their family medicine residency programs – presumably because of the increased emphasis on primary care in the developing bill. Though this only directly affects Medicare beneficiaries, other payers undoubtedly follow Medicare’s lead.

So this is the puzzle of health care reform where Senator Rockefeller notes, “…Everything fits together.” “It’s very hard to say ‘We could just cut this out’ and do that.” Though I’d like to say the health care reform bill is a finely woven safety net, I don’t think it’s quite that secure. It is more like a quilt knitted together over this past year by many thoughtful individuals. Collectively it works but a few strands of yarn here and there just won’t offer the protection the nation desperately needs.

The White House hasn’t ruled out paring down the health care bill into smaller pieces, but during his jobs even in Ohio today, President Obama emphasized that the health care reform provisions are interconnected and suggested that they could not effectively reduce costs or increase access as separate pieces of legislation. “A lot of these insurance reforms are connected to some other things we have to do to make sure everyone has some access to coverage,” he said.

Obama admitted that “the process” of passing health care reform “has been less than pretty” but stressed that “when you deal with 535 members of Congress, it’s gonna be a somewhat ugly process.” “When you put it all together it just starts looking like this monstrosity and it makes people fearful and it makes people afraid,” he said:

There are things that have to get done. This is our best chance to do it. We can’t keep on putting this off….The point is this, none of the big issues that we face in this country are simple. Everybody wants to act like they’re simple. Everyone wants to say that they can be done easily, but they’re complicated, they’re tough. The health care system is a big, complicated system and doing it right is hard…We can’t sort of start saying to ourselves America or Congress can’t do big things, that we should only do the things that are noncontroversial. We should only do the stuff that’s safe. Because if that’s what happens then we’re not going to meet the challenges of the 21st century. And that’s not who we are. That’s not how we used to operate and that’s not how I intend us to operate going forward.

Watch it:

“Nearly four dozen health care experts” have sent a letter to Congress urging the House to adopt the Senate bill and a separate reconciliation package. The experts criticized proposals to slim down reform. “From the perspective of both politics and policy, we do not believe that this is a feasible option,” they wrote. “Indeed we doubt that any bill would reach the President’s desk should congressional leaders pursue this misguided course.”

In the Battle of Waterloo, Democrats are prepared to surrender. After Sen. Jim DeMint (R-SC) issued his battle cry to the Democrats in August, President Obama aptly responded by noting “this isn’t about me,” but rather, it’s about “a health care system that is breaking America’s families.” “We can’t afford the politics of delay and defeat when it comes to health care — not this time, not now,” Obama added. But today, Democrats — just inches from the goal-line — are indeed prepared to take a knee, run out the clock, and renege on their promise of seeing health care reform through completion.

Learning the wrong lessons from a Massachusetts election, Democrats are finding difficulty motivating their solid majorities in the House and Senate to finish what they started. The outcome in Massachusetts didn’t change the basic fundamental questions: Can we afford the status quo, and is the current reform bill better than doing nothing at all?

Last year, Senate and House Democrats pledged to fix the broken health care system and put the nation on a sustainable economic path by repeatedly voting for change. If they’re still committed to that goal, then passing the Senate health care bill alongside a reconciliation package to improve the underlining legislation and address popular concerns is the only way to achieve the change voters demanded in 2008.

Trying to pass a scaled-back version of reform would drag out the process, fail to substantially lower costs or improve access, and do so without any assurance that it will be any more popular in Congress. Democrats therefore have two choices: pass an improved version of the Senate health care bill or abandon the effort altogether. If Democrats chose the latter, millions more Americans would go without health care and health care costs would continue to skyrocket. Politically, the Democratic Party will be ridiculed for talking a big game but delivering no results. They will lose their progressive base and outsource their agenda to the Republican minority — all simply because their supermajority of 60 shrank to 59.

Democrats are hesitant to vote again for an unpopular health care bill. They fear that the Massachusetts elections are a bellwether of the upcoming midterms. Change of the magnitude envisioned by health care reformers certainly does not come easily. As President Obama said in March, “To kick these problems down the road for another four years or another eight years would be to continue the same irresponsibility that led us to this point. That’s not why I ran for this office. I didn’t come here to pass on our problems to the next President or the next generation — I came here to solve them.”

The Democrats have an opportunity to improve health care for millions of Americans. They will regret squandering this moment if they cannot regroup now.

A new poll finds that when Americans shift through the misinformation and politics of health care reform, they actually like what they see. According to January’s Kaiser Health Tracking Poll, conducted before the Massachusetts Senate vote, 42% support health care reform, while 41% oppose it. “However, a different and more positive picture emerged when we examined the public’s awareness of, and reactions to, major provisions included in the bills. Majorities reported feeling more favorable toward the proposed legislation after learning about many of the key elements, with the notable exceptions of the individual mandate and the overall price tag.” Some elements of the legislation “were popular enough to prompt a majority of skeptics to soften their opposition“:

- 62% of current opponents said including the tax credits for small businesses made them supportive of reform.

- 59% of current opponents said the fact that most people’s existing insurance arrangements would not change made them more supportive of reform.

- 55% of current opponents said if there was a stipulation that no federal money would go to abortion they would be more supportive of reform.

The poll also found that 17 of 27 different provisions made respondents feel more positively about the bills, including the exchanges, the new insurance regulations, and closing the Medicare “doughnut hole.” All this suggests that the public is fed up with the process and politics of health care reform, but they’re supportive of what Democrats are actually trying to accomplish. Which brings us back to the argument that Democrats are seriously misreading the Massachusetts election results.

On Tuesday, Massachusetts voters elected a Republican candidate who defended a reform bill that’s very similar to what the House and Senate Democrats have supported. Far from suggesting that health care reform would lose elections, the Massachusetts results actually suggest that when Americans see the benefit of health care reform, they tend to politically reward the candidate who vows to protect it.

Senator-elect Scott Brown (R-MA) supports Massachusetts’ 2006 health care reform but opposes the near-identical Senate health care bill. During the campaign, Brown promised to provide the 41st vote for any national reform effort that required states like Massachusetts to finance reform elsewhere:

Thank you for the question, the health care plan is not good for Bay State Health Center here in Springfield, I worked on that health care bill, the problem with it is that we have 98% of our people insured and we have to look at pricing it’s getting out of control – but the Federal plan, taking a half trillion from Medicare, why would we go and subsidize the failure of other states – not only would we be paying for our plan, we’d be paying for everyone else – and look at the back door deals – I think people have lost confidence – and I think that we need to go back – I’d work on it – why do we need a one size fits all government approach we already did it.

Watch it:

But if Brown believes that Americans should not have to finance other states’ reform efforts, he should return the federal dollars that subsidize Massachusetts’ Medicaid expansion. After all, the state’s 2006 health care reform legislation included an expansion of Medicaid for children up to 300% of the federal poverty level and increased enrollment caps on existing Medicaid programs for adults. Massachusetts relied “very heavily on federal Medicaid funds to finance the plan, including $385 million in annual federal Medicaid payments that would have been lost in the absence of a plan to reduce the number of uninsured.”

Massachusetts used federal funds because, like all states, it lacked the economic capacity to invest in something as big as health care reform. Only the federal government can fix the systematic problems plaguing the health care system and improve the system in an equitable manner. Brown’s insistence that states can do reform on their own, is just a back door way for preserving the status quo that denies millions of Americans the kind of reforms that they’re financing in Massachusetts.