Senate Majority Leader Harry Reid, D-Nev., continues to push his party to approve health care overhaul legislation before Christmas, but concerns over many issues, including abortion funding and a possible early buy-in for the Medicare program, could cause that timetable to slip.
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 the Senate continues its deliberations are Mary Agnes Carey of Kaiser Health News and Eric Pianin, a long time Washington journalist. Welcome to you both.
Mary Agnes, I’ll start with you. Since we spoke last week, Senate democratic leaders have sent certain new ideas to the Congressional Budget Office for analysis. What was sent and when is the CBO scoring as it’s called expected to be back?
MARY AGNES CAREY: The scoring is expected to be back early this week. That’s what they are certainly hoping for. Provisions in there include a Medicare buy-in for those as young as 55 to age 64. A greater role for the Office of Personnel Management, OPM, to help negotiate health care plans that would be offered all over the country to people.
JACKIE JUDD: And this is in lieu of the earlier public option?
MARY AGNES CAREY: Right, the public option, there has been a lot of concern on Capitol Hill, particularly in the Senate, from Senate moderate Democrats. It’s too big of an expansion for government and the thought had been that maybe for the pure public option as we have in the House, or a pure public option, you might not get 60 votes in the Senate so this OPM provision is very important there.
And also it’s thought that they would have trigger language that would basically say that if private plans didn’t step forward to offer these health insurance plans that OPM would administer, you would have a trigger mechanism to make sure that people have choice of health plans all over the country.
JACKIE JUDD: With these current ideas out there, Eric, what does the head count look like at this moment?
ERIC PIANIN: Right now, it’s touch and go for the Senate leadership because every time they add a new provision, a new wrinkle to the Bill, they may pick up some support here but they lose support there. So actually these latest proposals that Mary Agnes was outlining, they are very controversial and several of the moderate Democrats, Ben Nelson in particular, along with Joe Lieberman, an independent, are very unhappy about these.
Nelson in particular thinks that this is perhaps a major step toward a single payer insurance plan down the road, so he is even more uncomfortable with this than the earlier provisions.
JACKIE JUDD: And Politico has an article that also identifies another Democrat, who we really haven’t spent much time at all talking about over the past few months, that is Jim Webb, a Democrat from Virginia. What are the issues he has?
ERIC PIANIN: That’s right. He’s a freshman Democrat from Virginia and I think that his biggest concern is proposed cuts in Medicare. In the sense, he’s throwing his lot with the Republicans who have made a huge issue out of how the Democrats plan to pay for this whole insurance plan and a big part of it is as much as $500 billion in reductions in Medicare and Medicaid costs over the next ten years.
Republicans are holding themselves out as the champions of the elderly, the seniors, and they are saying no, this would undermine the Medicare program, and Webb has a lot of concern about this, so he has been voting with the Republicans on some of these procedural votes in the run-up to the big showdown.
JACKIE JUDD: You know, we have spent so many times over the past few months talking about how Democrats are trying to pick up support of certain Republicans, like Olympia Snowe, but we haven’t spent that much time, exactly the point you were making, Eric, the efforts Republicans are making to peel off Democrats. Are there others who they are working on?
MARY AGNES CAREY: Well, Eric just mentioned Ben Nelson. He is very concerned about the abortion funding language in the Bill. He is concerned about the Medicare buy-in and the longer this goes and the closer you get to final passage as people express their concerns, as Senator Reid tries to work to resolve them.
I think that Mitch McConnell, the minority leader, the Republican leader in the Senate, would be more than happy to welcome any Democrat who wanted to into the fold because their plan is to stop this legislation at every point and every turn that they can.
JACKIE JUDD: You mentioned Ben Nelson, of course, and the issue over abortion, give us a status report on that.
MARY AGNES CAREY: Well, there was a vote last week that would have put more restrictive abortion funding language in the Senate Bill and that was defeated. What Ben Nelson had wanted to do along with Orrin Hatch, as a Republican from Utah, is to have much, much tighter funding restrictions placed in the Bill and that was defeated, so now Harry Reid is trying to resolve that issue.
There are other Democrats as well, Bob Casey of Pennsylvania, for example, has issues around the abortion funding, so I don’t quite know what that middle ground is going to be, but I know it’s something that they are working on to try to resolve because it’s a key issue.
JACKIE JUDD: Eric?
ERIC PIANIN: I think that the challenges for Harry Reid are great and the clock is ticking and there is real concern now among the Democrats that they may not be able to make their deadline of getting a vote in the Senate by Christmas, and the larger concern is the longer this thing drags on, the more opportunity Republicans have to try to undercut it.
Republicans have a lot going for them. The polls are turning against the Democrats. More and more Americans are having reservations about the entire approach. The more the Democrats struggle to put together a winning formula, the more unwielding the package becomes and the more vulnerable it becomes to critics like Mitch McConnell who goes on television and says the American people don’t want this plan. We ought to cut it back. We ought to go back to the drawing boards, and this is what Joe Lieberman was saying on television over the weekend as well.
The initial plan wasn’t too bad, except for the public option, which he is adamantly opposed to in part because his state has a big concentration of insurance companies, but also he raises a legitimate point, the more you pile onto this thing, the more unwielding it becomes, the more expensive potentially it could become, more questions that are raised about the wisdom of moving ahead.
JACKIE JUDD: Well, Mary Agnes, what is your prediction, if I may ask that there will be a vote by the 23rd?
MARY AGNES CAREY: That is such a great question and I want to say I want to stop predicting but I can’t help myself. I think that they will get a vote by the 23rd. You’ve just got to think this through.
If you don’t have a vote, if you don’t have passage, or a vote either way, before they go home for Christmas, it just makes it phenomenally difficult to start it again when they get back. They certainly could. There has been talk if there is not a vote for Christmas, maybe they would be there between Christmas and New Year’s.
There is nothing of course finalized. The schedule is extremely fluid. But I think there is a very strong chance that we will see a vote in the Senate before they go home, but I could be wrong, before they go home for Christmas, rather.
JACKIE JUDD: You’ve covered all bases.
MARY AGNES CAREY: Thank you very much.
JACKIE JUDD: Thank you both. We will see what happens next week. And thank you for joining us. I’m Jackie Judd.