The White House is paring down health care reform ahead of the President’s prime time address on Wednesday. The overhaul would still include insurance regulations, “a requirement for most individuals to buy insurance; a federally operated exchange where individuals and small businesses could buy insurance; and tax credits to help people buy plans.” But the President’s new vision of reform would lower the price tag of reform by undercutting certain reform provisions.
White House sources are telling reporters that the administration will try to win-over conservative Democrats and some moderate Republicans by lowering subsidy levels, compromising on the public option, and taking out some of the more ‘politically controversial’ elements of reform. “It’s so important to get a deal,” a White House official told the New York Times, speaking on the condition of anonymity in order to be candid about strategy. “He will do almost anything it takes to get one”:
– To avoid some of the most heated criticism voiced in recent weeks, White House officials said they would have no objection if Congress scrapped proposals to have Medicare pay for counseling on end-of-life care.
– White House officials said Congress could also drop proposals requiring the government to create school-based health clinics and collect nationwide data on health and health care by race, sex, sexual orientation and “gender identity.”
– Another option, lawmakers said, is to attempt to make any package that comes to the Senate floor more attractive to Republicans by including tighter cost controls and slowing the pace of providing coverage to the 47 million Americans who have no insurance
– But comments from senior White House aides to POLITICO that the president does not plan to insist on a public option.
Meanwhile, Jonathan Cohn explains that extending affordable coverage to all Americans would cost somewhere in the neighborhood of $1.5 trillion “if done properly.” “Anything less and you have to start cutting back. You offer lower subsidies. You provide people with weaker, less protective insurance. You roll out changes over time.” Cohn believes that the administration is trying to lower the cost of the reform to around $700 billion, a number that would require very serious cut backs in subsidies and could potentially endanger the effectiveness of an individual mandate. “[Y]]ou’ll end up reducing them down to levels where large numbers of people still couldn’t afford insurance. And if people can’t afford insurance, you can’t make them buy it,” Cohn concludes.
In other words, at $700 billion, health reform becomes somewhat ineffectual or at best, incremental; it’s certainly not universal. At $700 billion, the final bill would likely include “the structural and regulatory changes around which universal coverage could eventually be built,” but it would further put off “the dream” of universal coverage and would likely do very little to lower long-term health care spending.
Ultimately, the President has a choice to make. He can either scale down reform — in an effort to please conservative Democrats and Olympia Snowe — and abandon good policy and his liberal base, or he can throw his support behind a robust reform plan and stake his entire presidency on seeing it pass.
Sen. Ben Nelson (D-NE) supports a trigger public option:
“A public option as a fallback position is a concept I think that could be acceptable,” Nelson said. “If it’s a cooperative under certain circumstances that might be acceptable.”