The dual-track reform approach--pass the Senate bill in the House in conjunction with the necessary fixes in a reconciliation package--continues to gain some steam, with even Finance Chair Max Baucus saying that "Reconciliation, I’m guessing at this point, will be part of the solution," [sub req]. It's a potentially complicated approach, but apparently the White House, House, and Senate are still assessing the way forward.
Add to the mix the bomb throwing Stupak, who has by no means gone away.
Stupak & Co. can refuse to go with the White House–supported option of the House approving the Senate bill, which has weaker abortion restrictions. There is a second option that would allow for more bargaining: the House passes the Senate bill with the assurance that budget reconciliation (which would only require 51 votes in the Senate) would follow. As Jon Alter wrote today earlier on The Gaggle, it’s "a messy approach but doable." But since haggling in budget reconciliation would be limited to the budgetary issues, there would likely be little room to change abortion language.
Stupak has said many, many times before that he won’t support a bill without his amendment. If that would mean the downfall of health-care reform, then so be it. "It's not the end of the world if [the bill] goes down," he told The New York Times a few weeks ago. And this isn’t a Ben Nelson situation, where he’s a lone politician throwing down the gauntlet. Stupak claims—and so far, I haven’t heard any dispute to this—that he has 10 or 11 Democrats committed to opposing the Senate bill’s less restrictive language. Given that the House health-care bill passed with a five-vote margin, this is not a threat to take lightly.
At this moment, we really have no idea if he has that many behind him or if they would be able to attract enough Blue Dogs to scuttle reform. So that's where those smart people getting paid the big bucks to make legislation might have to think of some other options to try to salvage as much as possible from this reform.
In some ways, it makes the Grijalva pass-it-in-pieces approach more attractive. Let Stupak put his amendment on the floor as a stand-alone and see if it passes. There's a great deal that's politically attractive to this approach--forcing the Blue Dogs, ConservaDems, and even so-called moderate Republicans to actually have to vote on stand alone insurance reforms. Want to continue to work for Aetna, Lieberman? Than vote to allow them to continue to deny insurance people because of bogus claims of pre-existing conditions.
That's one possible approach, another, that I don't like as much, is the Ezra Klein/Howard Dean "scale-it-down" alternative--one that I don't think either of them would argue is the best approach, but that is one alternative. Here's Ezra, who's first choice is still a full package:
So you make it real simple: Medicare buy-in between 50 and 65. Medicaid expands up to 200 percent of poverty with the federal government funding the whole of the expansion. Revenue comes from a surtax on the wealthy.
And that's it. No cost controls. No delivery-system reforms. Nothing that makes the bill long or complex or unfamiliar. Medicare buy-in had more than 51 votes as recently as a month ago. The Medicaid change is simply a larger version of what's already passed both chambers. This bill would be shorter than a Danielle Steel novel. It could take effect before the 2012 election.
Dean, uncharacteristically, sees little hope for comprehensive reform, and says
"So pass something through reconciliation. It doesn't have to be big and complicated. And it shouldn't be. We're not going to get the comprehensive health care bill that we had hoped we were gonna get."
So what can Democrats get? Expansion of Medicaid, a Medicare add-on and a "good, steady down payment" on a health care system that "everyone understands," Dean said.
If reform efforts have to be scaled back this drastically, it's probably more likely to be Stupak, the Blue Dogs, and the ConservaDems forced it--they're the ones that don't give a damn if anything passes. The rest of the Dem caucus, in both chambers, is likely to want to do as much as they can to advance reform, or could at least be shamed into it.