Research Briefing

New Changes Don’t Add New Cost Controls, Just Buys Votes. Will It Buy The Votes Of These Dems Who Care About Costs?

EIGHT DEMOCRATS SAID EARLIER THIS MONTH THEY WANTED MORE FOCUS ON COST CONTROLS IN REID’S UPDATED BILL

Eight Freshmen Democrats Believed More Can Be Done To Control Costs. “The health reform legislation now being considered by the Senate makes great strides in beginning to fix what is fundamentally broken in our present health care system -- but we believe that we can go even further.” (Sens. Mark Begich (AK), Michael Bennet (CO), Roland Burris (IL), Kay Hagan (NC), Ted Kaufman (DE), Paul Kirk (MA), Jeff Merkley (OR), Jeanne Shaheen (NH), Mark Udall (NM), Tom Udall (CO) & Mark Warner (VA), “Eleven Freshman Senators Announce Health Amendments To Expand Innovation, Lower Cost,” Press Release, 12/8/09)

THIS WAS ECHOED BY SEVERAL OTHER DEM SENATORS

Sen. Mary Landrieu (D-LA) Said More Needs To Be Done To Bring Down Costs. “[T]here is a great deal more work that needs to be done. I would like to mention briefly just a few of the significant changes I would like to see be made to this bill. … No. 2, in order to really deliver our promise to hold down costs for families, we should think about focusing on ways to prevent premiums from being excessively raised between the time this bill is enacted, if it ever is, and the time it actually goes into effect.” (Sen. Mary Landrieu, Floor Remarks, 11/21/09)

Sen. Blanche Lincoln (D-AR): “Until We Hear Back From CBO… It's Going To Be Hard To See Whatever I Can Support, For Sure.” (David Lightman, “Health-Care Showdown Looms But Outcome Still Uncertain,” McClatchy Newspapers, 12/13/09)

Sen. Ben Nelson (D-NE) Worried Reid’s Bill Doesn’t Do Enough To Curb Costs And Can’t Vote For It Unless His Concerns Are Corrected . “Nelson, D-Neb., said that he has concerns about issues large and small in the bill (HR 3590), including the CLASS Act — a provision to create a voluntary long-term disability insurance program — and cuts in Medicare payments to home health care providers and nursing homes. In addition, he is concerned that the bill raises taxes and fails to do enough to curb health care costs, and that some Medicare providers would be underpaid. ‘Until those things are corrected, it’s not something I can vote for right now, and not something I can vote for cloture right now,’ he said on a conference call with reporters Wednesday.” (Drew Armstrong, “Sen. Nelson A Holdout On More Than Abortion Restrictions,” CQ Today, 12/16/09)

Sen. Jim Webb (D-VA) Doesn’t Know If He’ll Vote Foreid’s Bill And Says “The Bottom Line Should Be To Achieve A More Cost-Effective Health Care System.” “Like all of my colleagues in the Democratic Party, I voted in favor of proceeding to debate the proposed health care reform legislation. I have yet to decide whether I will support final passage of the bill. … The bottom line should be to achieve a more cost-effective health-care system that increases accessibility, affordability, and quality of care, and which does not burden our economy along the way.” (Sen. Jim Webb, Op-Ed, “Webb Cites Concerns, Amendments, Votes On Health Care,” The Winchester Star, 12/15/09)

Sen. Claire McCaskill (D-MO) Won’t Vote For Reid’s Bill If Health Care Spending Goes Up. WALLACE: “[M]cCaskill, just to -- just to button this up, if you get the report on the Reid compromise and the whole bill, as you say, and it -- and it indicates that the cost curve of health care -- overall health care spending goes up, not down, you'll vote against it.” MCCASKILL: “Absolutely.” (FOX News’s “Fox News Sunday,” 12/13/09)

Sen. Mark Warner (D-VA) Won’t Support The Final Bill If It Doesn’t Bring Down Costs Or Lower The Deficit. “I will only support a final bill if I am convinced it will lower the deficit, drive down health care costs over the long term, and improve the value and quality of the health care Virginians receive.” (Sen. Mark Warner, “Statement From Sen. Mark Warner On Health Care Vote,” Press Release, 11/21/09)

BUT NONE OF THE CHANGES REID MADE CONTROLLED COSTS

CBO Declared That The New Changes Will Not Help To Lower Premiums. “Although CBO and JCT have not updated the estimates provided in that letter, the effects on premiums of the legislation incorporating the manager’s amendment would probably be quite similar. Replacing the provisions for a public plan run by HHS with provisions for a multi-state plan under contract with OPM is unlikely to have much effect on average insurance premiums because the existence of that public plan would not substantially change the average premiums that would be paid in the exchanges. The provisions contained in the manager’s amendment to regulate the share of premiums devoted to administrative costs would tend to lower premiums slightly, and the provisions prohibiting the imposition of annual limits on coverage would tend to raise premiums slightly.” (Douglas W. Elmendorf, Letter To Sen. Harry Reid, 12/19/09)

Reid’s New Non-Profit, Public Option Compromise Wouldn’t Lower Costs Or Have Any Significant Effect. “The proposal would call on OPM to contract for two national or multi-state health insurance plans—one of which would have to be nonprofit—that would be offered through the insurance exchanges. Whether insurers would be interested in offering such plans is unclear, and establishing a nationwide plan comprising only nonprofit insurers might be particularly difficult. Even if such plans were arranged, the insurers offering them would probably have participated in the insurance exchanges anyway, so the inclusion of this provision did not have a significant effect on the estimates of federal costs or enrollment in the exchanges.” (Douglas W. Elmendorf, Letter To Sen. Harry Reid, 12/19/09)

INSTEAD, IT WAS REALLY ALL ABOUT CUTTING DEALS WITH HANDOUTS AND FAVORS.

Sen. Harry Reid (D-NV) Used His Manager’s Amendment To “Craft [Bill] One Favor At A Time.” “For Reid, success means emerging from the marathon debate with a bill backed by the 60 senators needed for final passage, something he hopes will come to pass as soon as late next week. Democrats' concerns will be addressed in individual amendments, but many others will be crowded into an omnibus ‘manager's amendment,’ a package Reid is expected to offer at the end of the process that will include many of the perks and fixes that members of his caucus are requesting. As a longtime member of the Senate Appropriations Committee, where crafting bills is done one favor at a time, Reid is hardly a stranger to deal-making.” (Shailagh Murray, “Reid's Recipe For Getting Health-Care Deal Done,” The Washington Post, 12/4/09)

Adding “Special Goodies” For Senators To Claim Credit For. “The term ‘Christmas tree’ has its own special meaning on Capitol Hill. It usually refers to a bill that has been decorated with ‘ornaments,’ loaded up with special goodies for the folks back home. But the term is particularly apt this week, as Senator Harry Reid, the majority leader, works to have a vote on a heavily festooned health care bill by Christmas Eve.” (Katherine Q. Seeyle, “Senators Add The Ornaments And Trimmings,” The New York Times’s “Prescriptions” Blog, 12/19/09)

WILL ANY DEMS REFUSE TO BE THE 60^TH VOTE AND STAND UP FOR COST CONTROLS?

Sen. Reid Claims He Has The Votes. “Senate Majority Leader Harry Reid (D-Nev.) coyly hinted Saturday that he's confident he now has enough votes to pass a healthcare bill. Reid said it "seems" as though all 60 Democrats will vote to pass the Senate's health bill when it comes up for a vote this week.” (Michael O’Brien, “Reid Praises Health Deal; Confident He Has 60 Votes,” The Hill, 12/19/09)