The clearest path forward for health reform is for House Democrats to (a) pass the Senate bill, and (b) pass a “sidecar” of amendments that deal with reconciliation-eligible topics, allowing House leaders to improve the bill by modifying the “cadillac” tax and replacing the Senate’s state-based exchanges with a nationwide exchange. But Carrie Budoff Brown reports that not every Senator likes this idea:
Sen. Ben Nelson (D-Neb.) said Monday that he would oppose any health care reform bill with a national insurance exchange, which he described as a dealbreaker.
“The national exchange is unnecessary and I wouldn’t support something that would start us down the road of federal regulation of insurance and a single-payer plan,” Nelson told reporters Monday.
If Senate Democrats still had 60 votes, this would matter a lot.
Note that Nelson’s statement is ridiculous. A nationwide exchange on which people can buy health insurance plans from private, for-profit health insurance companies starts us down the road to a single-payer plan in the same sense that the road from the Capitol to National Airport starts us down the road to Santiago, Chile.
The real point, however, is that Nelson’s views are irrelevant. The exchange set-up will either be determined by reconciliation or else nothing will be done. Either way, he doesn’t matter. And this, incidentally, is the reason why the Democrats are so reluctant to do things with reconciliation or to curb the filibuster. Each of them is more important under a supermajority rule than they would be under a majority rule, even if it renders them collectively impotent.
It’s worth emphasizing that even the so-called “national exchange” isn’t all that national.