Tuesday, March 23, 2010

My probable last post on health care reform

As you know, health care reform was signed into law today. This will probably be my last post about health care reform, so those of you who didn't like that aspect of my blog can celebrate as well.

I was trying to think of what sort of post I should make. A retrospective explaining what happened? How we got here? A post on what in contained in the bill?
Well, if anyone wants that, they can ask for them. Otherwise, I am going to make a post about what is to come.

But before I do, I want to address the concern that has come up by a few people that at the last minute women were thrown under the bus to get health care passed. I'm not happy by what happened, but that is certainly not what happened. So, to recap: When the original House health care bill passed, it passed with severe restrictions on women being able to get insurance that would support abortions. The senate passed a health care bill, and it contained language that restricted federal money going to pay for such insurance products, but did not limit the ability to get those insurance products through the exchanges. This senate bill, in effect, maintained the status quo on abortion. For those of us who believe the status quo is too restrictive on a woman's ability to get an abortion, that is obviously a disappointment. However, we should clearly admit that what was being maintained was the status quo, not some sort of regressive restrictions. Well, then we ended up in the situation where the House had to pass the senate bill, with restrictions on what changes could be made to the senate bill. That was pretty good in this case, because from a pro-choice standpoint the senate bill was easily superior than the house bill. The problem was, the house was having trouble assembling the votes for passage. The pro-life group, led by Stupak, were originally leveraging to get some level of increased restrictions on abortion in exchange for there votes. After some going back and forth, someone (Pelosi, at the very least, maybe aided in this move by Obama, it is unclear) laid down the law. No way were abortion restrictions going to be added. Then Stupak et al's best option was that Pelosi was going to be able to find the votes elsewhere. Which she was unable to do. So, Stupak and his gang were in an awkward position. They clearly wanted health care to pass, but had made public statements taht would make it hard to support. So, Obama agreed to pass an executive order that basically says, we will enforce the senate bill's stance on abortion. That gave Stupak the political cover to vote, and the rest is quite literally history.
Now, I don't like the optics of Obama seeming to give his stamp of approval on the status quo, but that is all that happened. And moreover, no new restrictions were added that were not already in the senate bill. Part of the outrage comes from the over the top response from NOW. I don't understand what inspired that statement, and I have both sympathetic and unsympathetic ideas. Anyway, if you read the statements released by both NARAL and Planned Parenthood, I think you get a better idea of what happened (you can read all three statements here).

So, now to what comes next. The senate has to pass the reconciliation package, but that seems very likely. Also included in that reconciliation package is a overhaul of the student loan system, another failed initiative from the Clinton years. It hasn't been getting as much attention, for the obvious, but is still important. Republicans are talking about repealing it, but the electoral math just isn't there. This bill will have to be very unpopular (more than it even is right now), and stay that way for a while in order for the republicans to really be able to repeal it. I obviously don't think that will happen. The lawsuits are already beginning. They seem unlikely to go anywhere. The objections of telling the states what to do seem unlikely to move the supreme court (if no other reason they don't want to give up their ability to tell state courts what to do), and the individual mandate is covered well by existing law (not only the interstate commerce clause, but more particularly Congress's ability to control tax law). For the supreme court to repeal this, would require a level of absurdity far beyond the Bush v Gore fiasco. I guess what I am trying to say is that we will have far bigger problems than health care reform it the Court repeals it.

The things that can improve the reform the most are better subsidies, better caps on out of pocket expenses or controls to lower deductibles even more, and federal regulation of the exchanges. Sadly those cannot go through reconciliation. What can go through reconciliation is a public option. A strong public option never had the majority votes in the house, or majority votes in the senate. But a weak (level playing field) public option just might, assuming the dems still control the house after midterms.

Outside of health care, there are some legislative goals that seem possible in the nearish future. A national broadband plan is possible (see this and this), some sort of movement on carbon pricing is still possible, but it always seems unlikely, tax reform, and Chris Dodd's financial regulation bill has made it out of committee and will be proceeding to the floor after senate takes up health care, but that seems like a long shot of passing. Harry Reid has also promised to work on filibuster reform (assuming he is still part of the senate) at the beginning of next congress, which will probably be necessary to get any of these through.

And that is kinda that.