The House today considered a bill to provide up to $7.4 billion in aid to individuals whose health was affected during rescue and recovery following the 9/11 attacks. The bill was widely supported by both Republicans and Democrats.
Republicans, knowing that Democrats wanted to support the bill (and knowing it would be politically damaging not to support the bill), were reportedly attempting to add amendments to the legislation which would enact Republican-favored proposals on issues which had nothing to do with the 9/11 attacks. Democrats understood the Republican game and moved to pass the legislation through a parliamentary procedure called suspension of the rules. “Suspension of the rules” is commonly used by both parties. It requires an affirmative vote of 2/3 of the House (far more than the usual majority vote requirement in the House) for a bill’s passage. The benefit of the maneuver is that it disallows all amendments on the legislation so that non-germane amendments cannot be added to popular legislation.
Republicans voted against suspension of the rules, and consequently the 9/11 health rescue and responder bill failed to pass.
Anthony Weiner (D-NY) blasted a fiery response at his Republican House colleagues for voting against a bill not based on the merits of the bill but based on opposition to a parliamentary tactic.
His speech is posted in the video below:
Both parties play the game of adding non-germane amendments to popular legislation, but Weiner is correct to stand up in opposition to the practice.
In a September 2009 interview with George Stephanopoulos, President Obama argued that the individual mandate was “absolutely not a tax increase.” In court filings responding to various lawsuits filed by state attorneys general challenging the constitutionality of the individual mandate, however, the Obama administration is taking the position that the individual mandate is “a valid exercise” of Congress’s power to impose taxes. Since news of the administration’s legal position broke, the President has taken heavy criticism for allegedly changing its position on the issue. While some criticism is merited (mostly for breeding confusion), the “change” of positions by the administration is not nearly as dramatic as it initially appears.
Continue reading »
Republicans are arguing that a report recently issued by the Centers for Medicare and Medicaid Services (CMS) (Warning: PDF) says the health care reform law will actually increase health care costs. John Boehner, the House Minority Leader, said:
This report once again discredits Democrats’ assertions that their $1.3 trillion government takeover of health care will lower costs, and it confirms that this bill violates President Obama’s promise to ‘bend the cost curve.’ It’s now beyond dispute that their bill will raise costs, which is exactly what the American people don’t want.
Is that what the report actually says? As is often the case on health care topics, the first place to go to find out is the report itself. The second place is Ezra Klein:
…here are two graphs using the report’s data. The first looks at national health expenditures with and without the Affordable Care Act:
Now look at the change in the uninsured:
Ezra concludes:
And that actually understates the case. Third Way, the centrist policy outfit, sent over its own analysis of the data. “The fact is that by 2019, national health spending per insured person will be $15,132 compared to $16,812 without the new law,” they write. “That’s 10 percent less spending per insured person than it would have been, according to the actuary’s report.
So though total spending nudges up (though by the end of the first 10 years, it’s coming back down), spending per insured person actually comes down. As Third Way says: “The actuary’s report shows that the nation will be getting a bigger bang for its health care buck. For a mere two-tenths of one percent more in health care spending, the new health care law will cover most of the uninsured and more Americans will be healthier and living longer because they will be getting treatments like cancer care and heart surgery that had previously been denied them.
With health care reform now the law of the land, Republicans find themselves asking, “Now what?”
Initially, the battlecry was “Repeal and Replace!” Quickly, however, those calling for replacement learned that even after 15 months of debate and discussion, Republicans can’t agree on an alternative bill- even one they would propose hypothetically. Erick Erickson, of Redstate.com, put it succinctly:
Let me be blunt: any Republican who says we will repeal and replace will themselves be replaced. We want repeal period.
This is not to say we will not offer up our own ideas, of which there are many. This is to say that right now there is no consensus on what to replace this monstrosity with, so instead of nuancing just promise to repeal it. We don’t need cute and clever politicians right now, we need a commitment to repeal Obamacare.
Much has been made of the health care polls over the course of the past six months or so. Citing polls reflecting lower than 50% support for health care reform, Republicans have made the argument that Democrats are “ignoring the will of the people,” or “shoving health care reform down our throats.” Such arguments implicitly suggest that if a congressperson votes for any bill that doesn’t have majority support, that congressperson is misbehaving. The media, politicians, and probably your neighbors have parroted the Republican line so many times it is becoming THE argument against health care reform. But does the argument make any sense?
It depends, I suppose, on what you believe a legislator’s role is, or ought to be. Legislators are clearly not required to follow polls when casting their votes. Indeed, Congress’ proclivity to “stick its finger to the wind” prior to voting is an oft cited complaint by many Americans. How many times have you heard someone complain that a congressperson “has no convictions” and only “follows the polls?” I would guess many of the Republicans complaining that Democrats aren’t following the polls right now have uttered the opposite complaint of a congressperson in the past.
Continue reading »
Most people by now know that the new health care reform laws require individuals (with some exceptions) to purchase health insurance. Having lost the battle in the legislature, Republicans are now taking the battle to the courts. To date, thirteen state Attorneys General have filed suit against the U.S. departments of Health and Human Services, Treasury and Labor to challenge the mandate.
I am not going to rehash all of the constitutional issues at play. Suffice it to say I think legal challenges to the individual mandate are highly unlikely to prevail. For those interested in an in-depth analysis concluding the mandate is constitutional, you can read Prof. Mark Hall’s analysis here or the American Constitution Society’s review here. For a shorter analysis (written for a layperson) which also concludes the individual mandate is constitutional, you can read Slate’s article here. Of course, not everyone agrees the mandate is constitutional. For an in-depth analysis concluding the mandate is unconstitutional, you can read ACLJ’s thoughts here, or the Federalist Society’s analysis here.
While I recommend the readings above (if you are at all interested in constitutional law, you will find them fascinating), most miss a fairly obvious point. Even assuming the individual mandate in its current form is found unconstitutional (which I already opined is unlikely), it is easily reworked into something clearly constitutional. I get the sense many Republicans believe if the mandate in its current form is stricken by the courts, the issue is over. Nothing could be further from the truth. As Ezra Klein argues:
The theory behind the mandate is simple: It’s there to protect against an insurance death spiral. Now that insurers can’t discriminate based on preexisting conditions, it would be entirely possible for people to forgo insurance until, well, they develop a medical condition. In that world, the bulk of the people buying insurance on the exchanges are sick, and that makes the average premiums terrifically expensive. The mandate is there to bring healthy people into the pool, which keeps average costs down and also ensures that people aren’t riding free on the system by letting society pay when they get hit by a bus.
Klein is correct. The mandate isn’t just liberals trying to be mean, it is a needed counterbalance to the requirement that insurers can’t discriminate based on preexisting conditions. Consequently, if the courts strike down this version of the mandate, another version will rapidly take its place.
People also fail to realize that the recently enacted mandate does not provide for any criminal liability for failure to buy health insurance, nor does the government have the power to place a lien on any of your properties if you don’t pay. The sole penalty is that you are assessed an additional tax ($750), but you aren’t obligated to pay that specific tax (you can read the bill yourself- scroll to page 336 of the bill). This sounds silly, of course, but the government is betting people will pay the tax even without the threat of actual penalties (and if that doesn’t work, I would imagine penalties will be added at some point).
But let’s pretend the mandate is stricken. How could a new mandate be reworked to pass constitutional muster?
One possibility would be to pass a tax credit for all who purchase health insurance. To ensure revenue isn’t lost due to creating a new tax credit, taxes may need to be raised slightly (which isn’t politically popular, and likely why it wasn’t tried this way in the first place). Those who purchase health insurance would effectively avoid any tax increase by purchasing health insurance (although a tax increase wouldn’t even need to be assessed on everyone; all that would matter to the government would be ensuring revenues don’t drop following enactment of an insurance tax credit). This isn’t significantly different than the mortgage interest deduction (that isn’t a tax credit, but regardless…). In effect, those who do not have a mortgage are taxed at a higher rate than those who do have a mortgage. That is every bit the “mandate” as a tax on those who don’t purchase health insurance. The net economic effect is identical: those who have purchased a product (a mortgage or health insurance) are taxed less than those who do not have that product.
It seems to me, then, that in the most likely scenarios, the state Attorneys General who are suing over the mandate are either going to lose outright (in which case they are wasting taxpayer money), or they are going to win and the mandate will be revised to pass muster. Consequently, state Attorneys General are likely setting themselves up for a tremendous personal failure with these suits. They are setting expectations of a legal “win” absurdly high among the conservative base. When they can’t deliver on what they have promised, and have spent significant state funds in the process, the AGs will face many angry voters. Even worse, they will have unintentionally fed into the (incorrect) conservative narrative that “activist judges have once again ignored the Constitution,” thereby further undermining the judiciary. Republicans are risking an awful lot with almost no upside.
After decades of rising health care costs and several failed attempts to do something about them, Democrats are going to pass the most comprehensive health care reform package in the nation’s history. This is a spectacular moment in American history, and many people deserve a lot of credit- most notably, Speaker Pelosi, President Obama, and Leader Reid.
In the coming weeks, months and years, we will learn whether the reform bill was successful in what it proposes to do: ensure that over 95% of Americans have health care, and drive down health care costs. I believe the best available information today suggests the answer will be yes on both issues, which is why I am so excited the reform bill is passing.
It strikes me, though, that embedded within the story of health care reform’s passage is another important message- our representative democracy is functioning, even if imperfectly.
The democratic process can be, and has been, ugly. Campaigns of misinformation and demagoguery have hampered reform efforts throughout the past year. However, something has emerged that has been long too absent in the process: interest by the citizenry.
Americans have watched and participated in the health reform process perhaps more than any bill since the 1960s. Concerned Americans from both parties have attended rallies and townhall debates; they have written and called their congressperson to give their opinion; they have held protests and contributed money to the side they support; they have found the text of proposed legislation and read through it for errors; they have turned to newspapers, media outlets, and the internet to investigate and learn more about the proposed legislation; they have vigorously discussed the proposals with friends and family.
Admittedly, the tone and substance of the debate and process has often been negative, reactionary, and heated. The fine line between making a passionate argument and inciting violence has sometimes been crossed into the latter. Oftentimes (though certainly not always), the anger many Americans feel has been driven by a mistaken belief about what the bill actually proposes to accomplish. To counter mistaken beliefs, however, we have all been treated to substantive policy discussions from the President, leaders of Congress, analysts and more.
It is easy to focus on all the anger, passion, contempt, and demagoguery and miss the underlying fact that Americans are interested in this process and this issue, and that their interest is improving both. For example, how many times, during the course of history, has a Senator said he would vote in favor of a bill but only if his state received some special benefit? Countless. But how many times has the public focused on that trade and made their opinion known so forcefully in opposition? I can’t recall such an instance in my life until this debate. Undoubtedly Senator Nelson thought little attention would be brought to what has since been dubbed the “Cornhusker Kickback,” but an interested citizenry demanded that deal be revoked and it was. Democrats proposed passing the Senate bill through a parliamentary maneuver called “deem and pass,” but Americans were outraged and “deem and pass” fell by the wayside in favor of a straight up or down vote. The Senate filibuster rules and the budget reconciliation process have almost never been the subject of consideration by any but the most wonkish among us. Now those phrases are becoming household names and Americans are interested in learning more about them, even reforming them.
Critics of the bill are probably screaming right now that the process has failed because support for the reform bill remains below 50% in most polls (although the latest NBC-WSJ poll shows the bill receiving a plurality of support). Those critics should recall that members of Congress aren’t elected to do whatever a poll tells them to do. It would behoove our representatives to be aware of polls to get a sense of how their constituents feel on a given topic, but they are expected to exercise their best judgment on issues, even where that means straying from popular opinion. This process has seen many members of Congress vote in favor of health care reform, for example, because they believed it to be the right thing to do, even if polls in their districts suggested passage was unpopular. Some of those who voted for the bill in the face of unfavorable polling will lose their position in Congress if they can’t satisfactorily persuade their constituents that they were right in their vote. That’s how the process is supposed to function.
The process hasn’t been perfect, of course. Far from it. It has been, however, an improvement over how politics typically functions within the United States (quietly, in the background, with few paying attention). There are many Americans who will wake up tomorrow and feel like they didn’t like the process at all, or like their beliefs were shorted or even ignored. Such Americans need to recognize that their involvement has significantly altered the substance of the final bill and the process followed to adopt it. They made a difference. Some on the fringe will direct their frustrations towards withdrawing from the system altogether, or towards tearing down the system, even with violence, rather than continuing to engage. Those individuals are wrong and misguided. If the rest of us continue to be involved and interested, however, the political process and substance of our governing law will only improve from here.
I have seen several reports indicating that Rep. [fill in the blank] is/is not going to support passage of health care reform over the past several days, but I haven’t seen anyone actually aggregate them all in one place. I tried to do just that.
Results below (all are Democrats unless otherwise indicated; click on the “XX” in the vote column for the hyperlink to the story describing the Representative’s vote):
| Representative Name | Original Vote | Now Leaning Yes | Now Leaning No | Now Undecided | Now Definitely Yes | Now Definitely No |
| John Adler (NJ) | No | XX | ||||
| Jason Altmire (PA) | No | XX | ||||
| Brian Baird (WA) | No | XX | ||||
| John Boccieri (OH) | XX | |||||
| Rick Boucher (VA) | No | XX | ||||
| Bart Gordon (TN) | No | XX | ||||
| Stephanie Herseth-Sandlin (SD) | No | XX | ||||
| Larry Kissell (NC) | No | XX | ||||
| Suzanne Kosmas (FL) | No | XX | ||||
| Frank Kratovil (MD) | No | XX | ||||
| Dennis Kusinich (OH) | No | XX | ||||
| Michael McMahon (NY) | No | XX | ||||
| Walt Minnick (ID) | No | XX | ||||
| Scott Murphy (NY) | No | XX | ||||
| Glenn Nye (VA) | No | XX | ||||
| John Tanner (TN) | No | XX | ||||
| Michael Arcuri (NY) | Yes | XX | ||||
| Dan Maffei (NY) | Yes | XX | ||||
| Bill Owens (NY) | Yes | XX | ||||
| Dan Lipinski (IL) | Yes | XX | ||||
| Kurt Schraeder (OR) | Yes | XX | ||||
| Shelley Berkley (NV) | Yes | XX | ||||
| Bart Stupak (MI) | Yes | XX | ||||
| Jerry Costello (IL) | Yes | XX | ||||
| Kathy Dahlkemper (PA) | Yes | XX | ||||
| Joe Donnelly (IN) | Yes | XX | ||||
| Steve Driehaus (OH) | Yes | XX | ||||
| Brad Ellsworth (IN) | Yes | XX | ||||
| Marcy Kaptur (OH) | Yes | XX | ||||
| Paul Kanjorski (PA) | Yes | XX | ||||
| Dale Kildee (MI) | Yes | XX | ||||
| Jim Oberstar (MN) | Yes | XX | ||||
| Charlie Wilson (OH) | Yes | XX | ||||
| Solomon Ortiz (TX) | Yes | XX | ||||
| Raul Grijalva (AZ) | Yes | XX | ||||
| Joseph Cao (R-LA) | Yes | XX | ||||
| Steve Kagan (WI) | Yes | XX | ||||
| John Spratt (SC) | Yes | XX | ||||
| Dan Boren (OK) | No | XX | ||||
| Bobby Bright (AL) | No | XX | ||||
| Arthur Davis (AL) | No | XX | ||||
| Collin Peterson (MN) | No | XX | ||||
| Mike Ross (AR) | No | XX | ||||
| Ike Skelton (MO) | No | XX | ||||
| Gene Taylor (MS) | No | XX | ||||
| Jerry McNerney (CA) | Yes | XX | ||||
| Mike McIntyre (NC) | No | XX | ||||
| Chet Edwards (TX) | No | XX | ||||
| Jim Marshall (GA) | No | XX | ||||
| Jim Matheson (UT) | No | XX |
The vote count is obviously very fluid, and some of the individuals listed above have sent mixed signals on their possible vote. Where more than one position has been indicated, I have taken the most recent public position for inclusion in the table above.
Some of the votes above are also speculative. The identity of the “Stupak 12,” for example, has not been officially confirmed, but it is believed to include the individuals listed in the table in bold font (there are actually 14 names for the Stupak 12 listed, due to conflicting reports on the identity of the 12).
In summary, we have the following:
Former “No” Votes Now Voting:
Leaning Yes: 6
Leaning No: 1
Undecided: 5
Definitely Yes: 0
Definitely No: 15
Former “Yes” Votes Now Voting:
Leaning Yes: 0
Leaning No: 9
Undecided: 13
Definitely Yes: 1
Definitely No: 0
216 votes are now required to pass health care reform (Rep. Abercrombie, Rep. Wexler, and Rep. Murtha are not in the House anymore and were all former “yes” votes; Rep. Massa was a former “no” vote who is no longer in the House).
If the vote were held today, based on the table above, the vote would be (assuming all leaning votes are cast in the direction in which they are leaning and all others vote as they voted for the original House bill):
Yes: 201
No: 214
Undecided: 16
Counting all those who are “leaning yes” or “leaning no” as “undecided,” the tally as of now is as follows:
Yes: 196
No: 204
Undecided: 31
Speaker Pelosi has her work cut out for her. Assuming all “leaning” votes are cast in the direction they are leaning, she will need to find 15 more votes to swing this in her favor (if leaning are counted as “undecided,” she will need to find 20 more votes). That said, this is certainly doable. She has 13 “undecided” votes to work with (or 31, depending on how you count it), plus 11 who have not expressed an opinion who previously voted “no” (see note below for the full list). Furthermore, any compromise on abortion could sway several of the “Stupak 12,” and it is even possible they may become convinced the current abortion language is sufficiently strong (see here for a good summary of why). Of the “Stupak 12,” the only Representatives thus far to have stated they will not vote for the bill without an abortion “fix” are Berry, Driehaus, Lipinski and Stupak.
This fight is far from over. Please call your representative today and push them to vote “yes” for health care reform.
NOTE: Several original “no” votes have not expressed an indication on how they will vote this time. Those Representatives are: Barrow (GA), Boyd (FL), Chandler (KY), Childers (MS), Davis (TN), Griffith (AL), Holden (PA), Markley (CO), Melancon (LA), Shuler (NC), and Teague (NM) (11 total).
UPDATE: Dennis Kusinich added to the “no” column., Spratt added to the “undecided” column, and Kagan added to the “leaning no” column.
UPDATE II: Due to a helpful update on www.thehill.com, we have significantly updated the table from the earlier version. Earlier, I had placed all suspected members of the “Stupak 12″ into the “leaning no” category. The Hill has clarified that many of them should instead be listed as “undecided” instead, other than the four listed above who will not support the bill without changes to abortion language.
UPDATE III: Matheson moves to “undecided,” and Marshall moves to “no.”
Mitt Romney had this to say about health care reform:
Well, actually, one of the things I learned when I was governor is that we have universal health care in America already. Everybody in this country, if they become ill, goes to the emergency room, even without insurance, and is able to receive, under the law, free care.
What we decided was it was a better idea to help people get insurance than just to hand out free care at hospitals, which was very expensive and oftentimes came after somebody was already quite ill. So we found a way, we think pretty good way, to get all of our citizens insured. We think it’s going to improve their health care. Not a perfect plan, but we believe a lot better than what we had in the past.
And unlike the president’s plan, ours was a state program, not a federal program, so each state could create their own ideas. We did not have to raise taxes, and we did not cut Medicare.
“Under the law,” we all have a right to “free care” in an emergency room? GREAT! I definitely shouldn’t be paying for health insurance, then.
This isn’t the only time he has said health care is free, either.
Here he was on Morning Joe, claiming emergency room care is “entirely free care for which [people] have no responsibility”:
Visit msnbc.com for breaking news, world news, and news about the economy
As it becomes increasingly more apparent that Democrats are going to attempt to amend the already-passed Senate bill through a process known as reconciliation, Republicans are suddenly deciding they don’t like reconciliation. Senator Lamar Alexander (R-TN), for example, recently claimed that if Democrats use reconciliation, it will “end the Senate as a protector of minority rights.” As the chart below shows, Senator Alexander (and many other current Republican Senators) haven’t seemed bothered by reconciliation in the past (data below thanks in large part to Greg Sargent).
| Senator Name | Percent of Senator’s Votes Cast FOR Reconciliation Measures |
| Alexander | 100.0 |
| Barrasso | 100.0 |
| Bennett | 91.7 |
| Bond | 78.6 |
| Brownback | 100.0 |
| Bunning | 85.7 |
| Burr | 66.7 |
| Chambliss | 100.0 |
| Coburn | 66.7 |
| Cochran | 66.7 |
| Collins | 88.9 |
| Corker | 100.0 |
| Cornyn | 100.0 |
| Crapo | 100.0 |
| DeMint | 66.7 |
| Ensign | 100.0 |
| Enzi | 88.9 |
| Graham | 75.0 |
| Grassley | 85.7 |
| Gregg | 83.3 |
| Hatch | 85.7 |
| Hutchinson | 78.6 |
| Inhofe | 81.8 |
| Isakson | 100.0 |
| Kyl | 100.0 |
| Lugar | 92.9 |
| McCain | 64.3 |
| McConnell | 71.4 |
| Murkowski | 100.0 |
| Roberts | 88.9 |
| Sessions | 88.9 |
| Shelby | 78.6 |
| Snowe | 72.7 |
| Thune | 66.7 |
| Vitter | 66.7 |
| Voinovich | 71.4 |
| TOTAL AVERAGE | 84.6 |
NOTE: Senators Brown, Johanns, Risch, LeMieux and Wicker have not had the opportunity to vote on a reconciliation bill and, thus, are not included in the table above.
For all reconciliation votes on which current GOP Senators have voted, Republicans have supported reconciliation 84.6% of the time. Senator Alexander, who fears minority protection in the Senate will end if reconciliation is used, has voted FOR reconciliation bills 100% of the time (4 opportunities to vote on reconciliation bills, 4 votes cast for reconciliation). Senator McCain has supported reconciliation bills less frequently than any other current GOP Senator, but even he has voted FOR reconciliation bills 64.3% of the time (9 of the 14 times he has been presented with a reconciliation bill).
There is absolutely nothing new about using reconciliation in the Senate. More to the point, there is absolutely nothing inappropriate about using reconciliation for this specific bill. Republicans know all of this, obviously, but they also know what Senator Conrad is learning: reconciliation isn’t particularly easy to explain in a 15-second sound bite on the Sunday news shows. They are attempting to derail democratic (small “d” on purpose) attempts to pass health insurance reform through obfuscation and obstinacy. It’s high time they were called on it.
For those interested, the table below shows all current GOP Senator votes on reconciliation bills since they came into office. I am not an expert with Google docs, so hopefully it is a workable format.
Legend:
Black cells: votes preceding the Senator’s election to office
Green cells: votes cast for reconciliation
Red cells: either a vote cast against reconciliation or no vote cast at all
Recent Comments