As the Senate begins debate on legislation to overhaul the nation’s health care system, Democrats and Republicans are expected to offer an array of amendments on the public option, abortion, immigration and the financing of the bill, among other issues. Senate floor action is expected to last most of the month, with Senate Majority Leader Harry Reid, D-Nev., hoping to pass a bill before Christmas.
A transcript of the interview is below:
JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill, a conversation about efforts to overhaul the health care system. Here to discuss what’s ahead this week as Congress returns from its Thanksgiving recess are Mary Agnes Carey of Kaiser Health News, Eric Pianin, a long-time Washington journalist, and joining us for the first time, Drew Armstrong, who covers health care policy for Congressional Quarterly. Welcome to you all.
Beginning today, Monday, there are really going to be two venues we need to be paying attention to, the Senate Floor, where there will be public debate, and the private, probably more important debate, inside of Senate Majority Leader Harry Reid’s office. Take us inside there, Drew.
DREW ARMSTRONG: Well, Senator Reid’s office sits no more than 20 or 30 meters off the Senate Floor, and I think if you were standing between those two things, you would see a steady procession of people coming on, making speeches on the Senate Floor about what they want in the Bill and then heading directly to Senator Reid’s office to talk to him, and he’s going to be meeting with a handful of key senators and he’s got quite a task ahead of him.
He’s got three or four moderates in his caucus who he really needs to hold onto to get this Bill passed these 60 vote hurdles, these procedural hurdles that are going to let him move forward with debate and eventually get the Bill off the floor. To do that, he’s going to have to focus really hard on continuing to woo Ben Nelson from Nebraska, Blanche Lincoln from Arkansas, Joe Lieberman from Connecticut, and I’m forgetting a fourth here, Mary Agnes, help me out.
MARY AGNES CAREY: Landrieu?
DREW ARMSTRONG: Landrieu, Mary Landrieu from Louisiana, the Louisiana Purchase, and then also he is going to be focused very hard on making sure that members of the left side of his caucus stay on so that he doesn’t compromise whatever Bill he eventually does get through with these amendments and compromises too far to the center and lose folks on the left who are demanding some very, very progressive approaches to health care. He has to worry about them as well, so it’s going to be this really delicate balancing act that he tries to keep going on even after during Part I of the delicate balancing act and crafting the Bill.
JACKIE JUDD: Because if you satisfy one group, of course the other group becomes dissatisfied, but Eric at this late date in the health care reform debate, are the Centrist Democrats who Drew mentioned, would they really ultimately vote no?
ERIC PIANIN: Well, I think it’s going to be a real challenge for them and a lot depends on timing. I mean, we are still midway really in the process. The Senate has yet to vote — debate and vote on this Bill. Assuming that they do get something through, possibly before Christmas, which is Senator Reid’s goal
JACKIE JUDD: But do you think there’s a Democrat who wants to be known as the lone holdout who stopped health care reform?
ERIC PIANIN: Well, my point is it depends on the timing. Now, if the decision has to be made some time in January, as the midterm elections really begin to heat up and a lot of these Centrists or Moderate Democrats are beginning to feel more and more pressure back at home, it might be a little easier to make the decision not to vote for something than let’s say late this year when members’ principles in the end might be the decisive factor.
I think the closer you get to next year’s election, the more distractions there are in terms of concerns about spending, the budget, the war, all these things may become more important really in the minds of some of these Centrists than whether or not to support the Health Care Reform Bill.
JACKIE JUDD: And timing is, if not everything, so much about of this, and Mary Agnes, tomorrow night the President will speak about his policy in Afghanistan. Later in the week, there will be a jobs report. Are you hearing from people on the Hill more and more the question of is this the right moment?
MARY AGNES CAREY: I think that Republicans will certainly raise that concern. They will look at the economy. If the unemployment numbers increase on Friday, which is expected that might actually happen, they will look at that and say is this the right time if we’re facing more troop deployment in Afghanistan, looking at the economy, would the Health Care Bill put too much stress on the economy?
The counter argument is for many proponents of health care reform, you can’t fix the economy unless you fix health care. It’s such a big cost to businesses and to individuals, but I think that will absolutely be a part of this debate.
ERIC PIANIN: We’re really dealing with a three dimensional chess game and it’s not just whether Harry Reid can put together 60 votes in the Senate. It’s whether in putting together 60 votes in the Senate, he is losing support in the House. Nancy Pelosi has many different challenges than Harry Reid does in holding together her large, kind of unwieldy, Democratic caucus, so it is important that the Democrats and Obama succeed in each step in this process.
But at some point there’s a day of reckoning when you’re going to have to reconcile all the deals that Harry Reid has cut with his side versus all the deals that Nancy Pelosi has cut on her side, whether it has to do with abortion or immigration reform or the public option. And then there’s the great reconciliation of interests and negotiations for a final Bill, and again the clock is ticking and events could dictate how people vote in the end.
DREW ARMSTRONG: Eric brings up a really interesting point here which is this sort of game of chicken that I think both Houses are going to be playing with each other. People are already looking to conference the process where the House and the Senate are going to come together and combine these two Bills, and the person with the strongest bargaining position is the person that has the fewest number of votes to lose.
I think in the House they had 221 votes for the Bill. They needed 218, so they can lose three people. In the Senate, they are not going to be able to lose a single one. So, basically you’ve got two cars speeding down the road at each other right now, and neither one is willing to get out of the way.
I mean, nobody can really afford to budge a single bit, but they are going to go into these conference negotiations, assuming the Senate does pass a Bill, and say hey we can’t change our Bill a single bit. If we do, we’re going to lose so and so, and we won’t be able to pass it out of that chamber, pass the conference report out of that chamber, I mean.
That is one of the key dynamics going on here. You want to compromise just enough to get your Bill as close as you can to where you can go into those House Senate conference negotiations and say hey, this has got to be it. We’ve got to do it this way or there’s not going to be a Health Care Bill for the President to sign.
JACKIE JUDD: Well, we’ve been taking about strategy, let’s talk about the substance of the Bill for a moment. The big, most troublesome issues in the Senate where the Centrists and the Liberals will perhaps clash, walk us though those, probably top on the list, the public option.
MARY AGNES CAREY: The public option is absolutely that. Harry Reid, Senator Reid, the majority leader, in his Bill would allow states to opt out of the public option. Ben Nelson, who Drew mentioned earlier, one of the Centrists that’s a key focus likes the idea of allowing states to opt in. Olympia Snowe, Republican of Maine, they’ve been courting her vote in the hope to get 60 votes. She likes the idea of a trigger where the public option would not be implemented unless it were deemed that health insurance is not affordable to a large majority, possibly 95-percent of residents of a particular state. The public option will take an immense amount of time on negotiation.
There may also be negotiations over the issue of abortion, over immigration, over the financing of the Bill. House and Senate are very different on that. And if you think about these issues individually, they are incredibly hard to do. Harry Reid, the majority leader, has got to pull all of these together and then go into conference to try to, if the Senate does pass a Bill, defend that package. So, there are some incredible obstacles for him to face.
ERIC PIANIN: Mary Agnes, do you think the public option will really be make or break for this legislation? How much support does it really have among the American people and how important is it as an element of this package? If you look at the CBO estimates, only six million people would be directly affected by it under the House Plan, and far fewer under the Senate Plan.
MARY AGNES CAREY: Yes, it’s about three to four million in the Senate Plan. I mean, it’s been one of the ironic things about the health debate. We’ve talked a lot about the public option, it’s got a ton of press attention, yet it’s just a small number of people that it would affect, so I think it’s one of those things that may be left to the end. You may have negotiations around a lot of the other provisions because the reason the public option I think will be critical is because it’s so volatile for many people.
We’ve mentioned Joseph Lieberman, an independent from Connecticut, has said he will not vote for a package that has the public option. Other moderate Senators have expressed concern about it, so I think it may kind of come and go in the negotiations. I think there will be amendments on the Senate floor.
You’ll have members like Bernie Sanders, again an independent from Vermont, who will want a much tougher public option. I think Jay Rockefeller, a Democrat of West Virginia, will want a much tougher public option, so it’s definitely going to be a key point of debate, but that may be one of the last things that resolve.
DREW ARMSTRONG: I think Mary Agnes is right here. There have been a lot of questions, is the public option, you know, there’s so much attention paid to it, we sometimes wonder is this a media creation or is it really the thing that is going to make or break this? I think you do have to look to the prism of which are the policies where you could lose the largest number of Senators out of the Democratic caucus that’s got to vote for this thing?
And there are four people in the caucus, the folks we’ve mentioned, who really are on the fence. You look at abortion, which I think everybody knows, plenty controversial, and you’re only looking at losing one or two Democrats over that. Ben Nelson has said he has some serious concerns over that, so Ben Nelson on the abortion issue, four different people on the public option, I mean you count the votes and you see how serious it is with each issue and I think the public option really does come up tops.
JACKIE JUDD: Republicans want to get their teeth into it because it’s something that resonates with their base in particular, that it’s the nose under the tent towards the single payer plan.
MARY AGNES CAREY: I think that is their concern that yes, the numbers may say a small amount now, but they also worry about how things could change over time. Right now we’re talking about negotiated rates in the public plan. I guess this would be the administrator of the public plan talking to hospitals and doctors and other providers to negotiate rates, what at a future time if those were changed?
Many progressives want it tied to Medicare rates. They think that would make a lower priced public option and a stronger competitor to health insurers. Republicans I think will make the case that this could happen down the line and that it could be a very significant change in the health care system.
JACKIE JUDD: I have one final question. There was an article in the Wall Street Journal today that talked about what one person who was quoted as saying that there will be message amendments on the Senate floor, that is amendments that have no chance of passing but will either send messages to particular constituents or messages to either gin up or subdue public sentiment, how many are we looking at? Is there going to be weeks of this kind of thing?
ERIC PIANIN: I think it’s inevitable with the major Bill on the floor that you’re going to have these wedge issues, these messages if you will offered by either side, and again it’s a game of chicken, each side sort of challenging the other, daring the other to vote against something or to vote for something, whether it’s an issue of immigration or abortion or something to deal with the economy and the impact of this legislation on jobs.
I mean, the jobs, we can’t stress enough how important the economy and the jobs issues are right now and if unemployment continues to creep up well past 10-percent, it’s going to be a major problem for the Obama Administration going forward, so this Bill, it’s a huge, un-wielding, easily attacked package and the Democrats have their work cut out for them because the more they’ve tried to satisfy all the different factions, the more they have added to it. It’s a 2,000 page Bill.
And Republicans have raised a lot of concerns about costs and impact down the road, but the reality is there is a certain element of mystery to this Bill, and the potential for unintended consequences impacting the health care system down the road for better or worse, and there are no guarantees that a lot of these programs will end up costing people more in terms of premiums or taxes, so it’s a real challenge at this point for Obama and the Democrats.
DREW ARMSTRONG: I think when we talk about message amendments, you’re seeing, in some ways the Democrats are going to want to give the Republicans a fair shake at the debate, so you’re going to see a lot of message amendments that are traditional, I think, Republican standbys. They are going to want to have some sort of debate about medical malpractice.
I can promise you the abortion debate is not going to end with whatever compromise the Democrats come up with, but you are also going to see message amendments on the Democratic side. To get to 60 votes, the Democrats had to build a big tent caucus and that means a lot of very diverse views in there that the result of which has been to get everybody happy enough to get 60 votes.
A lot of people are going to have to hold their nose when they vote for things in here, and so you need to find a way to ruffle those feathers, sorry, soothe those ruffled feathers heading into this final vote, which means you are going to have to give the public option advocates a vote to put a strong public option in there. Even though they know they are going to lose, you’re going to have to give the pro-abortion rights people a vote to really do what they want to do on abortion.
You’re going to see a lot of these issues where it’s about soothing the Democratic caucus, giving people a chance to feel that they have been hurt, even if they lose the vote, that they get a chance to say hey, go back to the constituents, say hey we really fought for you on this, we believe it, but the votes just aren’t there. They know that they are going to have to hold their nose to vote for this thing. You’ve got to show the American people that they are going to have to hold their nose in support of some of these things as well.
JACKIE JUDD: But that they tried.
DREW ARMSTRONG: Exactly so it’s about messaging inside the big tent Democratic caucus as well as it is about messaging for the opposition.
JACKIE JUDD: Okay, well thank you all very much. We’re really entering a very interesting phase of this debate. Thank you, Drew Armstrong, Eric Pianin, Mary Agnes Carey, and thank you for joining us. I’m Jackie Judd.