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NRO’s health-care blog.

The Democrats’ Contorted and Implausible End-Game



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Over the past year, many commentators have noted that the Democratic party has invested so much in the health-care effort that Team Obama would do just about anything to get a bill to the president’s desk. We are now witnessing the depths to which the administration is willing to sink to do just that.

What would appear to be the final episode in this long-running saga apparently commences tomorrow. We are told that the president will unveil yet another health-care plan while delivering yet another health-care speech in Washington. This latest presidential offering is being advertised by House Speaker Nancy Pelosi as “much smaller” than the bill the House approved last November.

But how will it be “smaller”?

Here, it is crucial to understand the process Democrats have now apparently settled on for the end-game.

For a time, House Democrats, including the Speaker, were arguing that the House could hold off approving the Senate-passed bill until after both chambers approved a series of “fixes” using the budget-reconciliation process. Once the reconciliation bill was cleared by Congress, the House would then approve the Senate-passed health-care bill, and both bills would then go together to the president for his signature. The final plan would then be a combination of the Senate-passed version of health-care reform as amended by the reconciliation bill, with both becoming law at the same time (the Senate’s health-care bill would presumably get signed first).

But this scheme was always built on the flawed assumption that the reconciliation process could carry a bill through to passage that is essentially a series of amendments to something that is not yet in law — namely the Senate-passed health-care bill, now being held in the House. The problems such contortions would raise are so numerous that it was always implausible Congress would head down this path.

For starters, the Congressional Budget Office (CBO) assesses the budgetary impact of bills by comparing them to current law. To buy off House liberals, the president’s proposal from last week called for upping the premium subsidies provided in the Senate bill. It might be possible to draft a sensible rewrite of the Senate bill’s subsidy sections and put it into a separate piece of legislation. If such a provision were in fact signed by the president after he signed the Senate health-care bill, then it would take precedence and override what’s in the Senate bill. But how in the world could CBO score such a provision for purposes of consideration in Congress? Current law has none of the Obamacare architecture that would make the subsidy program operational. Most especially, there’s no government-run insurance exchanges to even administer the subsidies. Nor is there a government-determined benefit package to set the boundaries for calculating the value of the premium assistance. In such a context, it would be all but impossible for CBO to produce a sensible cost estimate.

Senate Budget Committee chairman Kent Conrad apparently saw the unholy mess that would unfold if this gambit were actually tried and decided to head it off at the pass. Last week he announced, rather definitively, that for the whole reconciliation-to-fix-the-Senate-bill scheme to work, the House would first have to approve the Senate bill and send it to the president for his signature. In other words, the Senate’s health-care plan must become law before any next steps are taken.

And that puts us back to where we were when Scott Brown stunned the political world with his election victory on January 19. If the Democrats are determined to press ahead with a government-takeover of American health care in spite of widespread public opposition, then House Democrats will have no choice but to approve the Senate-passed bill before doing anything else. Period.

Then, and only then, could the House and Senate take up a reconciliation bill to amend it. Democrats are apparently looking at a timeline that would have the House pass the Senate bill by mid-March, followed by two weeks of pushing a reconciliation bill through both chambers.

Is this scenario at all plausible?

Start with the prospects of House passage of the Senate health-care bill. The Speaker’s description of what the president will propose tomorrow as being “smaller” than what Congress has been considering to date is all spin aimed at generating some renewed interest among those moderates and conservatives in her caucus who voted no the first time around. She almost certainly needs several of them to switch their votes if she is to have any hope of passing something, and they have all expressed the desire to proceed with a “smaller” measure.

But what she will be asking them to approve is anything but small. As everyone who watched the Blair House meeting now knows, the Senate-passed bill is very lengthy, clocking in at 2,400 pages. That’s because it reflects the liberal ambition to rewrite American health care from top to bottom. It stands up another runaway entitlement program, which CBO says will reach $200 billion by 2019 and grow 8 percent every year thereafter. It would impose massive tax increases and job-killing mandates on employers. It would apply arbitrary, across-the-board cuts in Medicare’s provider-payment rates that the chief actuary of the program says will push many institutions into financial distress. It would, for the first time, ask federal taxpayers to pay for elective abortions, including through Community Health Centers.

And to top it off, the bill the House would have to approve first would still include all of the egregious deals struck with individual Senators to buy their votes for passage in December. The special Medicaid arrangement for Nebraska. The exemption of Florida seniors from the Medicare Advantage cuts. The $300 million for Louisiana. Those, and many others, are all in the Senate-passed bill that Speaker Pelosi will be trying to sell in coming days.

Of course, the Speaker will tell these members, don’t worry, the reconciliation bill will fix all these problems. But will it?

If anything, what the president is now pushing, and will presumably push again tomorrow, would make the Senate bill even more expensive, by upping the premium subsidies, closing the Medicare “donut hole,” and giving all states the same deal as Nebraska. These added costs would be paid for with an entirely new Medicare payroll tax, applied to investment earnings. In other words, just days after voting for a highly controversial, trillion-dollar health-care bill, House Democrats would be asked to vote for a reconciliation bill that taxes and spends even more. And then that measure would go to the Senate, where there are never any guarantees that something will emerge unscathed.

It’s hard to see how any of this would be reassuring to House Democratic moderates or conservatives. If they switch their votes to “yes,” they will rightly be seen by voters as putting a risky government takeover of American health care over the top. Plain and simple.

And there are alternatives. President Obama himself has drafted a scaled-back “Plan B.” If sensible House Democrats stand their ground and refuse to go along with the contorted and implausible partisan scheming of their leaders, it will lead to a much better outcome for the country.



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