Health Care Reform Passes, Pigs Fly
So, the health care reform was passed last night owing to a bizarre compromise is which Bart Stupak persuaded President Obama to issue a meaningless executive order proclaiming that the law passed by both Houses of Congress says what Stupak has spent months pointing out it doesn’t say.
The basic facts, from NYT:
With the 219-to-212 vote, the House gave final approval to legislation passed by the Senate on Christmas Eve. Thirty-four Democrats joined Republicans in voting against the bill. The vote sent the measure to President Obama, whose yearlong push for the legislation has been the centerpiece of his agenda and a test of his political power.
After approving the bill, the House adopted a package of changes to it by a vote of 220 to 211. That package — agreed to in negotiations among House and Senate Democrats and the White House — now goes to the Senate for action as soon as this week. It would be the final step in a bitter legislative fight that has highlighted the nation’s deep partisan and ideological divisions.
After a year of combat and weeks of legislative brinksmanship, House Democrats and the White House clinched their victory only hours before the voting started on Sunday. They agreed to a deal with opponents of abortion rights within their party to reiterate in an executive order that federal money provided by the bill could not be used for abortions, securing for Democrats the final handful of votes they needed to assure passage.
The health care bill would require most Americans to have health insurance, would add 16 million people to the Medicaid rolls and would subsidize private coverage for low- and middle-income people, at a cost to the government of $938 billion over 10 years, the Congressional Budget Office said.
The bill would require many employers to offer coverage to employees or pay a penalty. Each state would set up a marketplace, or exchange, where consumers without such coverage could shop for insurance meeting federal standards.
The budget office estimates that the bill would provide coverage to 32 million uninsured people, but still leave 23 million uninsured in 2019. One-third of those remaining uninsured would be illegal immigrants.
The new costs, according to the budget office, would be more than offset by savings in Medicare and by new taxes and fees, including a tax on high-cost employer-sponsored health plans and a tax on the investment income of the most affluent Americans.
Actually, most of those savings depend on the kindness of future Congresses, a rather neat trick.
Politico summarizes the Stupak deal:
House Democrats moved toward a decisive series of votes on health reform Sunday night after a cadre of anti-abortion Democrats signed onto an agreement with the White House — finally putting the Democrats over the 216-vote threshold to pass President Barack Obama’s top legislative priority.
The announcement by Rep. Bart Stupak (D-Mich.) and a half-dozen colleagues came just after Obama said he will sign an executive order reaffirming a ban on federal funding of abortions.
Earlier in the day, Stupak (D-Mich.) told Democratic leaders that he would vote for the bill after receiving assurances that Obama will issue the order and that he would be able to state his concerns about abortion funding in the bill in a colloquy on the House floor before the vote. Later, Stupak and Waxman took to the floor to put into the record that the bill is meant to completely prevent the use of any federal dollars to pay for abortion.
Except, of course, that it isn’t.
At any rate, the immediate fallout of all this is that, for a day at least, pigs are flying :
- The Obama Executive order (see Mark Ambinder for the text) amounts to a signing statement — yet another case of Obama adopting a practice he roundly criticized his predecessor for using. It’s an Alice in Wonderland document stating that the law says what it doesn’t say.
- Bart Stupak has gone from Pro Life hero to Public Enemy Number One.
- NOW has issued a statement titled “President Obama Breaks Faith with Women.”
The National Organization for Women is incensed that President Barack Obama agreed today to issue an executive order designed to appease a handful of anti-choice Democrats who have held up health care reform in an effort to restrict women’s access to abortion. Through this order, the president has announced he will lend the weight of his office and the entire executive branch to the anti-abortion measures included in the Senate bill, which the House is now prepared to pass.
President Obama campaigned as a pro-choice president, but his actions today suggest that his commitment to reproductive health care is shaky at best. Contrary to language in the draft of the executive order and repeated assertions in the news, the Hyde Amendment is not settled law — it is an illegitimate tack-on to an annual must-pass appropriations bill.
- Mark Steyn and Matt Yglesias agree, using almost precisely the same language, that, “If Barack Obama does nothing else in his term in office, this will make him one of the most consequential presidents in history. ” (They differ substantially in how they interpret said legacy.)
Normally calm commentators are having uncharacteristically heated reactions to the proceedings.
Megan McArdle, who supported Obama’s election but opposed most of his campaign promises, thinks the chicanery used to get this bill past will be the norm from now on.
Regardless of what you think about health care, tomorrow we wake up in a different political world.
Parties have passed legislation before that wasn’t broadly publicly supported. But the only substantial instances I can think of in America are budget bills and TARP–bills that the congressmen were basically forced to by emergencies in the markets.
One cannot help but admire Nancy Pelosi’s skill as a legislator. But it’s also pretty worrying. Are we now in a world where there is absolutely no recourse to the tyranny of the majority? Republicans and other opponents of the bill did their job on this; they persuaded the country that they didn’t want this bill. And that mattered basically not at all.
What I hope is that the Democrats take a beating at the ballot box and rethink their contempt for those mouth-breathing illiterates in the electorate. I hope Obama gets his wish to be a one-term president who passed health care. Not because I think I will like his opponent–I very much doubt that I will support much of anything Obama’s opponent says. But because politicians shouldn’t feel that the best route to electoral success is to lie to the voters, and then ignore them.
As someone who opposed Obama, it’s hard for me to blame him. He campaigned on a massive overhaul of the health care system and got as much of it passed as he could. From my perspective, this bill is far less damaging than one Obama would have wished for. One could take him to task for the cynicism of the executive order — and, indeed, I do — but it’s hard to blame him for it after more than a year of fighting.
David Frum, in a post titled “Waterloo,” writes that “Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s.”
It’s hard to exaggerate the magnitude of the disaster. Conservatives may cheer themselves that they’ll compensate for today’s expected vote with a big win in the November 2010 elections. But:
(1) It’s a good bet that conservatives are over-optimistic about November — by then the economy will have improved and the immediate goodies in the healthcare bill will be reaching key voting blocs.
(2) So what? Legislative majorities come and go. This healthcare bill is forever. A win in November is very poor compensation for this debacle now.
Frum’s partly right on the first point — I don’t see a 1994 style turnover, although I do see major GOP gains and most of the bill’s provisions don’t kick in until 2014 — but he’s almost certainly right on the second. The bill’s unpopular on the whole but almost all of the parts Republicans object to will be hard to undo unless, as Megan suggests, they’re willing to go kamikaze to do it.
Still, Frum, NPR’s Mara Liason, and others who are comparing this to 1994 seem to miss one major fact: Clinton was going for something much more fundamental than this — a single payer system. Obama wanted that outcome as well but didn’t fight for it, knowing it was impossible.
That said, there’s a reason this fight took this long.
Passage of the bill represents the biggest change in domestic policy since the enactment of Medicare and Medicaid in 1965, says Sara Rosenbaum, who chairs the department of health policy at George Washington University. “We have now fundamentally transformed American society,” she says. “We have gone from assuming many people will not have insurance to expecting that people will have insurance.”
The $940 billion bill seeks to extend health coverage to most Americans. Medicaid, the federal-state program that provides health insurance to the poor and disabled, will be expanded to cover all adults earning less than 133 percent of the federal poverty level.
Private health insurance will be made available to individuals and small companies through exchanges that will be run by the states. Individuals who do not buy insurance face fines, as do most employers who do not offer coverage to workers.
Bill sponsors predict that all but about 5 percent of non-elderly Americans will ultimately be covered. Half of those currently uninsured will receive coverage through the expansion of Medicaid and half through private insurance through the exchanges — often with subsidies that make up the bulk of the legislation’s projected costs.
It’s massively expensive and the funding mechanisms are promises, not law. Nor does it do much to address the most fundamental problem of our current system: the ticking time bomb of exploding costs colliding with an aging population. But it’s a massive change in our system.