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We like that Allyson Schwartz isn't backing down from Obamacare just because of the rocky roll-out like some other Democrats are, but many of the national and local media outlets are weirdly silent on how much of an Obamacare frenemy Congresswoman Schwartz has been.

Health care policy is really where the Third Way/New Democrat rubber meets the road for the Congresswoman. And though she recently dissolved her affiliations with Third Way and the New Democrat coalition during the Democratic primary for Pennsylvania Governor, there is a reason she once supported those groups.

Typically how a New Democrat differs from a good Democrat is that, while both generally vote the same way on the biggest, most visible issues, a New Democrat will look for ways to sell out progressives on less visible issues, taking positions that appeal to special interests and donors when the base isn't looking.

So for instance, there are a lot of medical device makers in southeastern Pennsylvania who hate Obamacare's medical device tax.

The logic of including the tax in the law was pretty clear - all those newly-insured people are going to create new demand for medical devices, and device makers are going to get some windfall profits. So Obamacare grabs some of those windfall profits back to pay for the coverage expansion.

So being a New Democrat, Congresswoman Schwartz saw an opportunity to deliver a policy win for some special interests on a low-profile issue that liberals weren't paying much attention to, and she co-sponsored a House Republican bill to repeal the tax.

Congresswoman Schwartz was also one of the only Democrats to join a Republican effort to kill the Independent Payment Advisory Board (IPAB) - a boring-sounding but important piece of Obamacare.

Basically every year the health care wonks at the Center for Medicare and Medicaid Services (CMS) makes a bunch of recommendations for cost-saving payment reforms, changing the way the public insurers pay doctors and hospitals, and every year Congress ignores those recommendations, largely due to lobbying from doctors and hospitals who don't want to be paid less money.

But Americans pay about double for the same medical treatments that citizens of other rich countries pay, for no good reason. We don't even get better health outcomes for it. The prices are so high because the hospitals are so much larger and more concentrated than the insurers, giving them more power to set prices, and Medicare and Medicaid aren't even allowed to try to negotiate down prices. They have to pay what the medical industrial complex says they have to pay.

So IPAB was created as a backstop, as one of the only actual cost-control sticks in all Obamacare. In the event that health care costs grew too fast, some of these payment reforms would start kicking in automatically. And if members of Congress wanted to stop any of them, they would have to propose alternative and equivalent savings.

Republicans hate this idea because they want to dismantle Medicare, not use Medicare as a means to control costs. They think that if Obamacare's cost controls don't work, it'll make it more likely that we end up with something like Paul Ryan's vouchercare. Instead of controlling costs by cutting payments to doctors and hospitals, we'd control costs by cutting benefits to people using public insurance.

Under pressure, Allyson Schwartz eventually backed off the Republicans' IPAB bill, but the moment was pretty instructive. When Congresswoman Schwartz thinks liberals are watching, she votes with the team. When she doesn't think they're watching, she votes with the special interests.

When Republican Governor Tom Corbett rolled out his "private option" non-Medicaid non-expansion plan came out last year, a Schwartz staffer bragged to me on background that Schwartz had been careful not to rule out leaving in place the fake Medicaid expansion plan, as evidence of how bi-partisan and open-minded to Republican ideas she was. A few weeks later when I pressed the campaign for an official position on the "private option," I got confirmation that Schwartz did not intend to leave CorbettCare remnants in place and would accept the real Medicaid expansion.

That's nice, but the episode just confirmed my instinct that Congresswoman Schwartz's Third Way modus operandi is to pull a fast one on liberals whenever she thinks she can get away with it, and then change her position if people raise a fuss.

Her primary score captures this well. In an uber-safe D+13 district, Congresswoman Schwartz only votes with progressives 82.9% of the time. Remember - no Republican holds anything above a D+5 so there is basically zero risk of the seat changing parties. Meanwhile, up in PA-17, freshman Congressman Matt Cartwright is voting with progressives 92% of the time in a D+4. Schwartz could easily get away with voting like that. Why hasn't she?

Pennsylvania has become a pretty solidly blue state at the state level, 2010 being a major exception, and the Governor has a lot of power to implement many Obamacare provisions at the Executive branch level. There's no question that Schwartz knows her way around health care policy issues, but the flip-side of that is that putting her in charge of Obamacare implementation is extra dangerous if liberals don't have the attention span to watch her every move.

The chances seem good that under Governor Schwartz, Pennsylvania would end up with one of the reddest health care reform efforts of any blue state.

Originally posted to PrimaryBlog on Tue Apr 22, 2014 at 01:12 PM PDT.

Also republished by Obamacare Saves Lives.

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