LAY OF THE LAND, PART II…. OK, so we talked about how things are going for health care reform in the Senate. Now, let’s tackle the House, where there’s more movement afoot.
Late yesterday, the Congressional Budget Office delivered some tentatively good news to reformers: the House Democratic plan, which includes a “robust” public option (reimbursing physicians at Medicare rates plus 5%), would cost $871 billion over the next decade — well below the $900 billion ceiling proposed by the White House. Just as important, the CBO report, which is preliminary and subject to change, also found that the House Democrats’ plan reduces the budget deficit.
And with those encouraging preliminary numbers in her pocket, House Speaker Nancy Pelosi reportedly decided last night to move forward on the caucus’ ambitious reform plan, whether the Blue Dogs and/or the Senate like it or not.
As Jonathan Cohn explained this morning, it’s a strategy with some risks.
Yes, a strong public plan remains a tough sell, particularly with centrists in the Senate. But precisely because the Senate will pull the bill to the right, it’s critical that Pelosi pull it to the left while she can. The public option is gaining momentum right now, thanks to strong polling numbers and a realization, among members, that requiring people to get insurance is a bad idea if the available insurance options aren’t very good.
It helps, too, that CBO has apparently determined the strong public option — which would pay at rates pegged to five percent above Medicare — could save somewhere in the neighborhood of $100 billion. Given what happened during the stimulus debate, when centrists in the Senate successfully pushed to scale back the bill, it’d be foolish of Pelosi not to anticipate that move.
What’s more, this way Pelosi can force the Blue Dogs, many of whom oppose the public option, to confront the trade-offs as they exist. If they don’t want the public option, she can say, how else will they find the money the public option might save
The fear comes from people who think this move will backfire — by alienating the Blue Dogs, centrists in the Senate, or both. These people note that we’re still not all that far removed from August, a time when reform’s very survival seemed very much in doubt.
Things look good now, the argument goes, because of united Democratic consensus around the basic principles of reform. But the consensus is fragile. Senators Kent Conrad and Ben Nelson have offered hints they’re open to some sort of compromise, but Pelosi’s proposal surely goes too far. And precisely because centrists in the Senate will never go for such a bold public option, the House’s Blue Dogs will scream.
During a House Democratic caucus meeting last night, the Speaker conceded that she has not yet lined up the 218 votes she’ll need to get the bill passed, though, according to a senior Democratic staffer, Pelosi said, “We are very close and I count tough.”
As part of this tough count, the Speaker instructed House Democratic Whip Jim Clyburn (D-S.C.) to start canvassing the caucus, getting firm answers from every member on whether they’re prepared to vote for the bill. Going into this week, there are dozens of House Dems who’ve noncommittal. Today, the leadership expects every Dem in the chamber to get off the fence and pick a side.
The caucus is scheduled to meet again today to see where the party stands.