Healthcare Reconciliation

Healthcare Reconciliation


With the historic passage of a partisan health care insurance reform measure, the US Senate Majority Leader Sen. Harry Reid kept his most recent promise to pass the bill by Christmas. Differences with the House version means that the bill will almost certainly require reconciliation and another 60-vote “filibuster override” in the Senate in 2010. lists the “significant differences” between the two bills as including differences on the idea of a public option, size and reach of new federal taxes, scope of the employer mandate, penalties for the constitutionally-questionable individual mandate, Medicare expansion, and taxpayer funding for abortion. More detail on the differences is provided in the link.

The House may compromise on taxes, employer mandates and, being members of a major political party and no stranger to government coercion, the individual mandate (a court test on this matter would not come until after the bill is signed into law). But the public option and abortion question could prove to be sticking points.

While the hard work continued over the last few months in the Senate, the American people found more and more to dislike with the Democrat’s plan.’s average of all polls shows nearly 52% of Americans oppose the plan and only 40% support it in December.

House Democrats may be a bit edgy in the new year; a mid-term election that historically loses seats for the majority party looms in November. National polls still show the Republicans with higher negative numbers, but Democrats will dismiss the anti-incumbent attitude at their peril. As MSNBC notes:

For the first time, Obama’s overall job approval rating has fallen below 50 percent (to 47 percent). In addition, for the first time since Sept. 2007, a plurality (45 percent) sees the Democratic Party in a negative light. And the percentage believing the country is on the wrong track (55 percent) is at its highest level in the Obama presidency.

“This survey underscores what I consider a dramatic and unmistakable change in the political landscape,” said Democratic pollster Peter D. Hart, who conducted the survey with GOP pollster Bill McInturff. “For Democrats, the red flags are flying at full mast.”

The same poll, commissioned by NBC and the Wall Street Journal, showed that the ambitious health care plan was a factor. While not mentioned in the MSNBC story, the Wall Street Journal did cite the statistic:

Democrats’ problems seem in part linked to their ambitious health-care plan, billed as the signature achievement of Mr. Obama’s first year. Now, for the first time, more people said they would prefer Congress did nothing on health care than who wanted to see the overhaul enacted.

The questions and statistics are provided in this pdf file, and they show that the public’s preference for Democrats over Republicans is down to 2 points, a slide from 9 points in April, and within the poll’s margin of error.

But its not a slam dunk for Republicans. The Tea Party movement, derided regularly in the media with porn-influenced smears, is more popular than either the Democrat or Republican party, with 41% of the people saying they were very positive or somewhat positive about the movement. That means Republicans may find themselves in trouble as well. The political winds seem to be favoring fiscal conservatives now but with a more limited government view. Libertarians hope that means eschewing government intervention in either the marketplace or the bedroom. Yet recent votes in New England and the mid-Atlantic states seem to favor the GOP in both leadership positions and social issues like gay marriage.

It’s clear that catching the anti-incumbent tide will take a lot of paddling for a candidate of either party. A Republican challenger doesn’t have the millstone of the 2009th Congress around their neck, and the burden of the Bush years is getting lighter all the time. Especially since the Obama policies regarding Iraq and Afghanistan seem mirror images of the pilloried Bush policies.

Political uncertainty is sure to fester in the minds of Democratic House and Senate members as they work to reconcile the two approaches to health insurance reform. The majority may feel lonely without any members of the opposing party to help share the blame in a bi-partisan manner. The echos of promises past may haunt them, as more details that some of the initial goals are not met. “Bending the cost curve in the right direction” is not the same as “reducing costs”, and providing “insurance for all” is reduced to “insurance for 60% of the uninsured.” The whispers of the estimated 20 million still uninsured probably won’t bother them, but the loud voices of the American electorate probably will. Will 60 votes be there for Sen. Reid in the spring?

Cross-posted to

  • Nick Benjamin

    The individual mandate is in both bills. The penalty for violating it is actually slightly higher in the House bill. It would take huge balls to reconcile two bills with a mandate, and somehow come up with a bill that had no mandate.

    The main fights in Conference will be on the Excise tax, subsidy levels, and abortion. The public plan is dead because we need Lieberman. Many leftists will bitch and moan, but losing them means picking up Blue Dogs so they have virtually no negotiating clout. Stupak will almost certainly make it into the final legislation — if it couldn’t get through the House without that Amendment before it won’t do it without it now.

    I sincerely hope the Senate keeps the Excise Tax in. The Unions hate it, but the Excise Tax is a start at getting rid of the Employer Tax Exemption, and I’ve yet to see a wonk who did not agree that Exemption was not a major reason our health system is so screwed up.

    IMO the combined bill has to pass. The Dems have pissed off the right by trying to do this. Moderates don’t like the controversy. And leftists are crying bloody murder because our pet public option was killed by Lieberman. Dropping reform won’t help that at all. In terms of turnout passing reform will help because it will give leftists a win, and thus a reason to vote next November. It will also end the controversy, but dropping the bill would engender further controversy over whose fault this was.

  • gerryf

    I love how folks on the right run around saying that the bill is unpopular only because of the things are in it without considering that a good number of people are unhappy because of what is NOT in it.

    oh, and those “porn-influenced smears”? Right, blame the media for pointing out that a bunch of rightwing homophobes had chosen perhaps the worst label for THEMSELVES.

    If you don’t want to be labeled something, spend a little time beforehand and don’t label yourself something that has multiple meanings. I have a kid in middle school who was savvy enough to see that label as bad news. Maybe if the fringe right weren’t so cloistured in their own little world they might have seen that coming. We wouldn’t want the right to actually investigate anything they’ve already made up thier minds about, though.

  • Doomed

    My prediction.

    The public option is mandated. Abortion is funded. The bill is passed. Goes back to the senate and Reid uses the nuclear option of 51 votes.

    Allowing 9 to bug out and not support the bill.

    They already know the country hates this bill no matter what is passed.

    They might as well pass what they really want. Government run health care. Then they can claim they really used 60 votes to get the bill to a vote while spinning it wildly with the House passed it with a large margin. The public really wants a public option…pretending that all those polls that show NO to a this bill and hell no to a GOVERNMENT run public option is just GOP spin and everyone knows they are tea party of NO obstructionists who hate America.

    Thats my prediction. Do the Democrats dare?

    Harry Reid promised that any bill sent to the presidents desk would have a public option in it. Do they dare?

  • mw

    “Will 60 votes be there for Sen. Reid in the spring?” – FH

    The votes will be there. Once this stopped being about Health Care reform, and instead became the “Save My Presidency” Bill, passage of something called Health Care reform became a foregone conclusion. What the bill does or does not do is irrelevant (well except for the payoffs to deserving Senators and Representatives). The only important thing now is that something, anything passes.

    So it will.

    It will be fun to watch though – expect some serious arm wrestling among the Dems. After all, who wouldn’t want to be the 60th Senator in – and get that tasty last payoff. Yum.

  • Frank Hagan

    gerryf – the polls don’t go into detail on why people don’t like the proposals, but we do know that as details have been made available, more and more people don’t like it. The link to does provide some historical perspective, with only 26% – 35% opposed back in April – May of this year. That opposition has been steadily climbing since then.

    BTW – I never heard anyone in the Tea Party movement refer to “tea bagging” anyone, or to themselves as “tea baggers”. It was a leftist media smear by the likes of Keith Olbermann, and most of those guilty of using it have apologized.

    Nick – the excise tax does break Obama’s commitment to not raise taxes on “anyone earning less than $250,000”, but we all knew he was lying when he said that, so I suppose there’s no real harm. Those that believed him will grow up a bit, perhaps.

    Doomed is probably right; the Dems will cheat if they can’t get the 60, because as mw notes, it is a “save my presidency” issue now and not about the original issues (since it doesn’t solve either the uninsured problem or the cost issue). Falling on your sword for honor’s sake may be noble, but convincing someone else to go on the suicide mission for you is always harder. It will be a hard vote in the House.

    I should enjoy November, 2010 very much.

  • Buffalo Dave

    This whole health care debate really upsets me. People don’t realize that the public option is the first step to complete and total government takeover of the system. The country is fundamentally changing for the worse in a huge way right under our noses. There will come a day very near when the average person asks himself how he could have been so blind to what was happening.

    The combined bill will pass to the detriment of this great country.

  • Nick Benjamin


    A Conference Report cannot be amended. It can be filibustered, but all filibustering the report will do is kill the bill totally. Which means the guy who tries to be the 60th Senator this time will enrage the base. And gain nothing politically by being against it after he was for it.

    Unless something huge changes in conference committee, that is. A new public option would count, and some changes to the language on abortion would count; but pretty much anything else is fair game.

    Frank, the tax isn’t on the wage-earner, it’s on the insurer. So if a company sells a $26,000 policy they’ll pay a tax on the last $1,000. De facto you’re right. It’s the same as a tax on the dude buying the policy, and many of those dudes make less than $250,000. But de jure there’s a difference.

  • blackout

    Frank, the phrase originated with the tea party movement (“Tea Bag the Liberal Dems Before They Tea Bag You!!” sign at a rally referring to the act of mailing a teabag to politicians) and the juveniles at MSNBC played up the sexual entendre. It was at least a partial self-skewering. Regardless, there’s nothing inherently *porn-influenced* about it. It is sexual terminology in general, and sometimes, as your wiki link points out, a matter of male dominance removed from sexual connotation, but the leap from that to porn is stretching things. If I call you a c***sucker is that porn-influenced? And last time I checked, three MSNBC talking heads and Anderson Cooper don’t constitute *the media*. The mockery emanated almost entirely from the left. You make the distinction in subsequent comments so it’s too bad that didn’t make it into the article. When Brian Williams and Bill Moyers start saying it you can apply the phrase *the media* without qualification…

  • mw

    “Which means the guy who tries to be the 60th Senator this time will enrage the base.” – nb

    As opposed to the way the base embraced and cheered the 59th (Lieberman) and 60th (Nelson) Senators the first time through.

  • Doomed


    You do make a good point that this bill only has support from the left. Essentially this bill is highly unpopular with the progressives. Moderates, Conservatives.

    Almost no one likes this bill and yet the government is going to pass a 2.5 trillion over the full 10 years its in effect while only promising 900 billion in taxes.

    So Somewhere down the road another congress is left holding the bag of an ill conceived bill that is fiscally irresponsible and will most likely put the Democrats out of bidness for 4-6 years.

    And if they do this. If they pass this bill…then rest assured that when the next time the gop gets these kinds of numbers they will outlaw GAY marriage or whatever bill they see fit that THEIR BASE WANTS.

    Not saying its RIGHT…just saying this is the precedent this congress is setting for future bodies to point to as justification for doing stupid things in the name of their BASE.

    And now were hearing that the democrats want to vote away the Filabuster so they can pass stuff right and left….Im sure that will go over good with them when the GOP is in charge.

  • Nick Benjamin


    “Which means the guy who tries to be the 60th Senator this time will enrage the base.” – nb

    As opposed to the way the base embraced and cheered the 59th (Lieberman) and 60th (Nelson) Senators the first time through.

    Oops. I forgot an important word:
    All the guy who tries to be the 60th Senator this time will enrage the base.

    If there was any way for a Senator to profit by being the 60th vote this time you’d have an excellent point. But there just isn’t. So anybody who tried would be a) the laughingstock of DC, because you can’t amend a Conference Report, and b) join Lieberman in hell as far as the base is concerned.

    You are forgetting an important part of paying for the bill: cost control.

    You could claim you don’t believe it will work — I wouldn’t neccesarily disagree with you on that, but I support them anyway because if these cost controls don’t work no cost controls will ever work and we’re fucked — but it is intellectually dishonest to ignore them completely.

    As for your claims regarding the bill you contradict yourself. On the one hand “Almost no one likes this bill,” and on the other “the next time the gop gets these kinds of numbers they will outlaw GAY marriage or whatever bill they see fit that THEIR BASE WANTS.” Either nobody likes this bill or a significant minority (the Democratic base) likes it.

    As for the Gay Marriage claim, they can’t do that. The Federal Government cannot force Iowa to stop issuing marriage licenses to gay people. Even if the Feds could your argument is irrelevant.

    It’s virtually impossible to think of a scenario where the GOP gets 60 Senate seats, the entire house, and the Presidency in the foreseeable future. As time goes on this gets less and less likely because the GOP base is divorced from the fastest-growing groups in the country. Latinos, blacks, and young whites are much more left-leaning then the current GOP. You could expand that base pretty easily if you’d just compromise on a few issues — notably Affirmative Action and Illegal Immigration — but that ain’t happening any time soon.

    In the unlikely event they do get 60 Senate seats, 218 House Seats, and the White House they will do what they want. They won’t look back and say “Geez those nice guys didn’t screw us on healthcare. I guess we’ll have to drop this Christian Nation stuff, not cut taxes, and leave Social Security alone”

  • Frank Hagan

    Nick, the Senate bill is rumored to remove the “cafeteria plan” style deductions, effectively raising taxes on the middle class by prohibiting “before tax” deductions. I haven’t checked this out in the bill itself (which is finally posted on-line, I think). Raising taxes on employers or on insurance companies is passed along, unless they go broke. Then unemployment rises, and more people “need” the public option. Perhaps that’s the plan …

    And remember, no one is claiming to reduce costs anymore. They are claiming to “bend the cost curve down”, which is a little like saying buying a Toyota “bends the cost curve down” if you were planning to buy a Lexus.

    The two hinges of the ideological movement to institute health care for everyone is that people can’t afford insurance, and many people are uninsured. I don’t think insurance coverage has much to do with life expectancy, but the Democrats obviously do. The proposed system still leaves 20 million people uninsured; the Democrats must believe they are not worth saving. A pretty brutal assessment, and only the beginning as we see “comparative effectiveness” studies — influenced heavily by politics and special interests — that limit choice in health care.