Forcing the Senate health insurance bill as is through the House, the option that seems to be building steam among Dem leaders, is going to be fraught with difficulties. There's the right:
In an interview on Monday, Representative Bart Stupak, a Michigan Democrat who opposes the Senate bill in part because of provisions related to insurance coverage of abortions, said: "House members will not vote for the Senate bill. There’s no interest in that."
When the idea was suggested at a Democratic caucus meeting last week, Mr. Stupak said, "It went over like a lead balloon."
And then there's the left, who for reasons from the lack of a public option to the inclusion of the Coathanger amendment to the affordability issues to the maintentance of the anti-trust exemption, have serious policy concerns about making this flawed bill actual law. Add a national exchange, as opposed to state exchanges, to that mix, and here the House has some back-up.
A coalition of labor and progressive consumer and health groups sent a letter [pdf] today to Reid and Pelosi, demanding that the compromise still being negotiated included a national exchange. Greg Sargent reports:
The letter argues that a state-based approach risks undermining reform from the start, and that a national exchange is the only way to ensure real reform that prevents insurers from gaming the system:
In sum, we urge you to adopt the House approach of a national exchange, with the option for states to establish an exchange if they have the capacity to meet or exceed national standards. We also urge you to adopt the House provisions which prohibit the sale of individual converage outside the exchange, the Senate provisions which pool risk of the small group market outside and inside the exchange, and to prohibit insurers from selling only outside the exchange. A national exchange and strong rules to prevent insurer manipulation will lay the foundation to help millions of Americans secure affordable, good-quality coverage starting the first day the exchange opens.
Labor and the White House already reached a deal on the "Cadillac" tax, and this opens another front for negotiations and possible differences. If Brown wins, there will be heavy pressure on the House — as well as unions and other liberal groups — to accept the inevitable and back the Senate bill as is.
The question is whether these groups will acquiesce, or whether they’ll draw a line over issues like the exchange and insist on another way forward other than merely swallowing the Senate bill, such as reconciliation.
Here's the problem for the "shove the Senate bill through" argument--in order to do that, you need to have labor on board. They've negotiated the excise tax compromise that would have to be passed through a subsequent (if not simultaneous) reconciliation bill. The exchanges are another matter, one that really couldn't be addressed in reconcilation, which is essentially limited to the revenue side of the bill. The national exchange has been one of the primary sticking points for the House, for the good reason. In the absence of a public option, a national exchange is one of the very few mechanisms that could provide a means of keeping insurance companies at least relatively honest.
Here's a trade the House could make, though: a robust public option, which could be passed through reconciliation and which could provide the additional cost control lost through the adjusted excise tax, for a national exchange.