Nancy Pelosi’s Obamacare Bailout Also Funds Abortion Coverage

In the words of her former House colleague Rahm Emanuel, Nancy Pelosi never wants to let a crisis go to waste. The House speaker not only wants to use the coronavirus pandemic to entrench Obamacare, she wants to make taxpayers fund abortion in the process.

A recent summary of the legislation Pelosi plans to introduce as an alternative to Senate Republicans’ “stimulus” bill laid out the strategy. House Democrats want to force insurers to reopen enrollment in the Obamacare Exchanges, and cover their losses via a taxpayer-funded bailout.

Leftist Wish List

The available summary of the bill—the summary!—totals 62 pages, and nearly 25,000 words. It contains a veritable menagerie of liberal big-government programs and boondoggles. For instance, it creates a “cash for clunkers” program for the government to buy old airplanes. (I’m not making this up—check out page 53 of the summary.)

Page 13 of the summary also notes that the bill would spend $400,000 so Congress’ Office of the Attending Physician can buy “N95 masks, surgical masks, gloves, swabs, test[s]…and personal protective equipment.” Somehow, the fact that Pelosi ensured Congress appropriated funds to protect itself failed to surprise this jaded observer.

New Open Enrollment Period

Division G of the 1,404-page legislation includes a variety of health-care provisions, only some of which directly relate to the coronavirus pandemic. For instance, Section 70301 (which begins on page 337) would create a “one-time special enrollment period for the [Obamacare Exchanges], allowing Americans who are uninsured to” purchase coverage.

This proposal raises an obvious problem: Moral hazard. If individuals know they can forego coverage during the usual open enrollment period and obtain coverage later, healthy individuals will do just that: only buy insurance when they need it.

Some may argue that those who lose their jobs due to coronavirus—either a temporary furlough, or a permanent layoff, during the resulting downturn—need a way to buy coverage after losing their insurance. But individuals who lose employer coverage already have a way to purchase a new plan: They automatically qualify for a special enrollment period, during which they can replace their former employer plan with exchange coverage.

Bailout Funds

News reports suggest that insurers support reopening the exchanges for a special enrollment period. However, the insurance industry also wants federal dollars to offset their potential losses from such a move.

Insurers obviously did not account for the costs of coronavirus treatments last spring and summer, when they set their 2020 premiums; no one knew of the disease at that point. The unexpected costs associated with treating the disease will likely eat into insurers’ margins for 2020.

But allowing people to buy “insurance” in the middle of a pandemic will raise insurers’ costs even further. Consider that life insurers are already imposing waiting periods for at least some applicants during the pandemic. One actuary believes life insurers will shut down applications entirely, due to the overwhelming risks they face.

By contrast, health carriers will allow anyone to apply for “insurance” during the pandemic, “if the government cover[s] anticipated losses.” Hence Section 70308 of Pelosi’s “stimulus” bill (beginning on page 404) provides for a two-year program of risk corridors.

Pelosi’s bill would recreate an Obamacare program in place from 2014 through 2016 that would have exposed taxpayers to billions of dollars in losses, but for language inserted at the insistence of Republican members of Congress. Just a few months ago, insurers took a case over risk corridors to the Supreme Court, asking for the justices to give them the bailout funds that Congress declined to pay.

Taxpayer Funding of Abortion Coverage

But as I noted nearly three years ago, when Republicans wanted to pass a “stability” bill bailing out Obamacare insurers, providing new federal dollars to insurers by definition represents taxpayer funding of abortion coverage. Only codifying the Hyde amendment’s pro-life protections for the risk corridor program would ensure that the bailout dollars will not flow to plans that cover abortion.

Separate provisions included in Section 104 of Division T of the bill (beginning on page 1089) would also substantially increase the generosity of Obamacare subsidies. The provisions would reduce the percentage of income that individuals would have to pay towards their premiums, with the federal government picking up a greater share of the tab. The same section would also eliminate the current income cap that prevents households with incomes of over 400% of the federal poverty level ($104,800 for a family of four in 2020) from receiving subsidies.

Joe Biden also included these changes to the Obamacare subsidy regime in his own health plan, released last summer, illustrating Pelosi’s attempt to exploit the coronavirus pandemic to enact Democrats’ pre-existing agenda. As with the risk corridors funding, if the legislation does not include strong pro-life protections, it means that billions of federal taxpayer dollars will flow to plans that cover abortion.

Of course, Pelosi did not include these Hyde Amendment protections in the summary of her bill, and likely would not allow a measure containing the protections to come to the House floor. Instead, the legislation represents a giveaway to both health insurers and the abortion industry.

Ironically, Senate Democrats objected to Republicans’ “stimulus” bill because they claimed it included a “slush fund” designed to bail out corporations. Perhaps they should have a conversation with Pelosi, because the Obamacare “slush fund” included in her bill would do the exact same thing.

This post was originally published at The Federalist.

This post was updated subsequent to publication with additional details regarding the introduced bill.

Don’t Just Bail Out a Flawed Medicaid Program

In recent days, some observers have discussed the possibility of targeted assistance to state Medicaid programs affected by the coronavirus outbreak. Unfortunately, the legislation proposed by House Speaker Nancy Pelosi (D-CA) falls far short of that marker, providing a gusher of new spending with no long-term reforms to the program. Conservatives should insist on better.

The House’s bill, introduced late in the night Wednesday, contains several noteworthy flaws. By increasing the federal Medicaid match for all states by 8 percentage points for the entire public health emergency, it prevents the targeting of assistance to those states most affected by coronavirus cases.

Increasing the federal match for able-bodied adults to 98 percent encourages states to prioritize these individuals over disabled populations, while discouraging states from rooting out fraud. The legislation also precludes states from making any changes to their Medicaid programs for the duration of the bailout, reinstituting the fiscal straight-jacket contained in President Obama’s “stimulus” bill.

Like that 2009 package, Pelosi’s legislation proposes tens of billions in new spending for an already-sprawling Medicaid program without any structural changes. But if Pelosi or conservatives wish to pay for the short-term largesse via long-term changes to Medicaid, they need not look far: President Obama’s budgets included several proposals that, if enacted into law, would change incentives in Medicaid for the better.

One area ripe for reform: Medicaid provider taxes. Hospitals and other medical providers often support these taxes—the only entities that ever endorse new taxes on themselves—because they immediately come right back to the health care industry, after states use the tax revenue to draw down additional Medicaid matching funds. In 2011, none other than Joe Biden reportedly called this form of legalized money laundering a “scam.”

At minimum, Congress should immediately enact a moratorium on any new provider taxes, or any increases in existing provider taxes, cutting off the spigot of federal dollars via this budget gimmick. Lawmakers can echo President Obama’s February 2012 budget submission, which would have saved $21.8 billion by reducing states’ maximum provider tax rate.

That proposal delayed its effective date by three years, “giv[ing] states more time to plan”—which would in this case delay the changes until the coronavirus outbreak subsides. Another positive solution: Codifying the Trump administration’s Medicaid fiscal accountability rule, which includes welcome reforms reining in states’ most egregious accounting gimmicks, effective a future date.

More broadly, Congress should also consider the ways the existing matching rate formula encourages additional Medicaid spending by states. For instance, current law provides all states with a minimum 50 percent match rate, encouraging richer states to spend more on Medicaid. Absent that floor, 14 states—11 of them blue—would face a lower match; Connecticut’s rate would plummet from 50 percent to 11.69 percent.

Gradually lowering or eliminating the federal floor on the match rate, beginning 2-3 years hence, would discourage wealthier states from growing their Medicaid programs beyond their, and the federal government’s, control. Had lawmakers enacted this proposal as part of the 2009 “stimulus,” New York—which would have a federal match rate of 34.49 percent in the current fiscal year absent the 50 percent minimum—might have right-sized its Medicaid program well before the program’s current budget crunch.

Alternatively, Congress could embrace Obama’s budget proposal for a blended Medicaid matching rate. Replacing the current morass of varying federal match rates for different populations could save money, and eliminate the perverse incentives included in Obamacare, which gives states a higher match rate to cover able-bodied adults than individuals with disabilities.

Judging from her initial bid in the “stimulus” wars, Pelosi has taken Rahm Emanuel’s advice never to let a serious crisis go to waste. If she wishes to emulate Obama’s first chief of staff, conservatives should insist that she also enact some of the Medicaid changes proposed in Obama’s own budgets, to begin the process of reforming the program.

This post was originally published at The Federalist.

The Left’s Health Care Vision a Prescription for Brute Government Force

Even as Democrats inveigh against President Trump for his alleged norm-shattering and contempt for the rule of law, their health care plans show a growing embrace of authoritarianism. For instance, Rep. Adam Schiff (D-CA) recently dubbed the President’s July 25 call with Ukrainian President Volodymyr Zelensky “a classic mafia-like shakedown.” He knows of which he speaks, because the Democratic agenda on health care now includes threats to destroy any entities failing to comply with government-dictated price controls.

The latest evidence comes from Colorado, where several government agencies recently submitted a draft report regarding the creation of a “state option” for health insurance. The plan would not create a state-run health insurer; instead, it would see agencies dragooning private sector firms to comply with government diktats.

The plan would “require insurance carriers that offer plans in a major market,” whether individual, small group, or large group, “to offer the state option as well.” In these state-mandated plans insurers must offer, carriers would have to abide by stricter controls on their administrative costs, in the form of medical loss ratio requirements, than those dictated by Obamacare.

For medical providers, the Colorado plan would use “payment benchmarks” to cap reimbursement amounts for doctors and hospitals. And if hospitals decline to accept these government-imposed price controls, the report ominously says that “the state may implement measures to ensure health systems participate.”

In comments to reporters, Colorado officials made clear their intent to coerce providers into this price-controlled system. Insurance Commissioner Michael Conway admitted that “If our hospital systems don’t participate, this won’t work….We can’t allow that to happen.” The head of Colorado’s Department of Health Care Policy and Financing, Kim Bimestefer, said that “if we feel that the hospitals are not going to participate, we will require their participation.”

State officials did not elaborate on the mechanisms they would use to compel participation in the state option. But they could attempt to require hospitals and insurers to participate in the new plan to maintain their license to operate in Colorado—a likely unconstitutional condition of licensure.

In threatening this level of coercion—agree to price controls, or we’ll shut down your business—Colorado Gov. Jared Polis imitated his fellow Democrat, House Speaker Nancy Pelosi. Pelosi’s proposed drug pricing bill, up for a vote in the House as soon as next month, would impose excise taxes of up to 95 percent of a drug’s sale price if companies refuse to “negotiate” with the federal government.

In its analysis of Pelosi’s legislation, the Congressional Budget Office (CBO) noted that, because drug makers could not deduct the 95 percent excise tax for income tax purposes, “the combination of income taxes and excise taxes on the sales could cause the drug manufacturer to lose money if the drug was sold in the United States.” Perhaps unsurprisingly, CBO concluded that the excise tax would not generate “any significant increase in revenues,” as “manufacturers would either participate in the negotiating process”—because they have no effective alternative—“or pull a particular drug out of the U.S. market entirely.”

CBO also noted, in a classic bit of understatement, that Pelosi’s bill “could result in litigation,” for threatening losses on any company that dares defy the government’s offer of “negotiation.” But the left seems uninterested in abiding by limits on government power—or the consistency of its own arguments. As I noted this spring, other proposed legislation in Congress would abolish the private health care market. Less than one decade after forcing all Americans to buy a product for the first time ever, in the form of Obamacare’s insurance mandate, liberals now want to prohibit all Americans from purchasing care directly from their doctors.

These recent proposals continue a virulent strain of authoritarianism that has permeated progressivism’s entire history. Franklin Roosevelt threatened to invoke emergency powers during his first inaugural address, and Rahm Emanuel infamously said during the Great Recession that “you never want a serious crisis to go to waste.” Make no mistake: The health care system needs patient-centered reform. But the true crisis comes from the progressives who would utilize blunt government force to seize control of one-fifth of the nation’s economy.

This post was originally published at The Daily Wire.

Hillarycare Redux? A Review of “The System”

A young president promising hope and change takes over the White House. Immediately embarking upon a major health-care initiative, he becomes trapped amidst warring factions in his party in Congress, bickering interest groups, and an angry public, all laying the groundwork for a resounding electoral defeat.

Barack Obama, circa 2009-10? Most definitely. But the same story also applies to Bill Clinton’s first two years in office, a period marked by a health-care debate in 1993-94 that paved the way for the Republican takeover of both houses of Congress.

In their seminal work “The System,” Haynes Johnson and David Broder recount the events of 1993-94 in detail—explaining not just how the Clinton health initiative failed, but also why. Anyone following the debate on Obamacare repeal should take time over the holidays to read “The System” to better understand what may await Congress and Washington next year. After all, why spend time arguing with your in-laws at the holiday table when you can read about people arguing in Congress two decades ago?

Echoes of History

For those following events of the past few years, the Clinton health debate as profiled in “The System” provides interesting echoes between past and present. Here is Karen Ignani of the AFL-CIO, viewed as a single-payer supporter and complaining that insurance companies could still “game the system” under some proposed reforms. Ironic sentiments indeed, as Ignani went on to chair the health insurance industry’s trade association during the Obamacare debate.

There are references to health care becoming a president’s Waterloo—Johnson and Broder attribute that quote to Grover Norquist, years before Sen. Jim DeMint uttered it in 2009. Max Baucus makes an appearance—he opposed in 1994 the employer mandate he included in Obamacare in 2009—as do raucous rallies in the summer of 1994, presaging the Obamacare town halls 15 years later.

Then there are the bigger lessons and themes that helped define the larger debate:

“Events, Dear Boy, Events:” The axiom attributed to Harold Macmillan about leaders being cast adrift by crises out of their control applied to the Clintons’ health-care debate. Foreign crises in Somalia (see “Black Hawk Down”) and Haiti sapped time on the presidential calendar and press attention, and distracted messaging. During the second half of 2009, Obama spent most of his time and energy focused on health care, leading some to conclude he had turned away from solving the economic crisis.

Old Bulls and Power Centers: “The System” spends much more time profiling the chairs of the respective congressional committees—including Dan Rostenkowski at House Ways and Means, John Dingell at House Energy and Commerce, and Patrick Moynihan at Senate Finance—than would have been warranted in 2009-10. While committee chairs held great power in the early 1990s, 15 years later House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid called most of the legislative shots from their leadership offices.

Whereas the House marked up three very different versions of health-care legislation in 1993-94, all three committees started from the same chairman’s mark in 2009. With Speaker Paul Ryan, like John Boehner before him, running a much more diffuse leadership operation than Pelosi’s tightly controlled ship, it remains to be seen whether congressional leaders can drive consensus on both policy strategy and legislative tactics.

The Filibuster: At the beginning of the legislative debate in 1993, Robert Byrd—a guardian of Senate rules and procedures—pleaded for Democrats not to try and enact their health agenda using budget reconciliation procedures to avoid a filibuster. Democrats (begrudgingly) followed his advice in 1993, only to ignore his pleadings 16 years later, using reconciliation to ram through changes to Obamacare. Likewise, what and how Republicans use reconciliation, and Democrats use the filibuster, on health care will doubtless define next year’s Senate debate.

Many Obama White House operatives such as Rahm Emanuel, having lived through the Clinton debate, followed the exact opposite playbook to pass Obamacare.

They used the time between 1993 and 2009 to narrow their policy differences as a party. Rather than debating between a single-payer system and managed competition, most of the political wrangling focused on the narrower issue of a government-run “public option.” Rather than writing a massive, 1,300-page bill and dropping it on Capitol Hill’s lap, they deferred to congressional leaders early on. Rather than bashing special interest groups publicly, they cut “rock-solid deals” behind closed doors to win industry support. While their strategy ultimately led to legislative success, the electoral consequences proved eerily similar.

Lack of Institutional Knowledge

The example of Team Obama aside, Washington and Washingtonians sometimes have short memories. Recently a reporter e-mailed asking me if I knew of someone who used to work on health care issues for Vice President-elect Mike Pence. (Um, have you read my bio…?) Likewise, reporters consider “longtime advisers” those who have worked the issue since the last presidential election. While there is no substitute for experience itself, a robust knowledge of history would come in a close second.

Those who underestimate the task facing congressional Republicans would do well to read “The System.” Having read it for the first time the week of President Obama’s 2009 inauguration, I was less surprised by how that year played out on Capitol Hill than I was surprised by the eerie similarities.

George Santayana’s saying that “Those who cannot remember the past are condemned to repeat it” bears more than a grain of truth. History may not repeat itself exactly, but it does run in cycles. Those who read “The System” now will better understand the cycle about to unfold before us in the year ahead.

This post was originally published at The Federalist.

The Obamacare Big City Bailout

Bloomberg reports this week on the latest Obamacare trend sweeping across the country: Cities and states may soon attempt to unload unsustainable health costs on the federal government by dumping employees and retirees onto exchanges.

Both Chicago and Detroit have explored using the exchanges to reduce massive budget shortfalls, and it could set an example for others. Bloomberg quotes one expert from the Rockefeller Institute of Government: “We can expect other cities to pick up on this.… I expect [employee dumping] to mushroom.”

The incentives for cities—or even states—to dump their workers onto exchanges are significant. Bloomberg notes that reducing retiree health costs could save Detroit approximately $150 million per year—at a time when the city faces a $386 million budget deficit and $17 billion in long-term debt.

Of course, these budgetary maneuvers aren’t really “savings”—they merely represent a shift of unsustainable costs from cities and states onto the backs of federal taxpayers. If more individuals than expected—particularly retirees, who are likely to be older and sicker than the population as a whole—require federal exchange subsidies, the cost of Obamacare could rise by trillions. And if cities and even states set an example by dumping their health care obligations on the federal government, private-sector employers could well follow suit.

The spokesman for Chicago mayor Rahm Emanuel called the city’s retiree health system “fiscally unsustainable,” but merely shifting that responsibility to Washington may be about as effective as moving deck chairs on a budgetary Titanic.

Meanwhile, like other Americans losing their coverage due to Obamacare, retirees themselves appear none too keen on getting dumped onto the exchanges. Bloomberg quotes one retired Detroit police officer expressing his outrage:

Imagine if they said tomorrow your Social Security, your Medicare is going away and you’re going on Obamacare.… How would you feel?

This post was originally published at The Daily Signal.

President Obama’s “Principles”

Presented here entirely without comment are four quotes from the Obama Administration:

  1. Barack Obama, July 2012: “It’s less a tax or a penalty than it is a principle.”
  2. Barack Obama, September 2009: “For us to say that you’ve got to take a responsibility to get health insurance is absolutely not a tax increase.”
  3. Obama Administration’s Justice Department, January 2012: “The Minimum Coverage Provision Operates As A Tax Law” (emphasis original)
  4. Rahm Emanuel, June 2009: “The only non-negotiable principle here is success.  Everything else is negotiable.”


House Democrats Want to Enact Legislation WITHOUT Voting on It

This morning’s article from CongressDaily reveals that, despite the rumors surrounding the Senate’s consideration of a reconciliation bill, House Democrats are continuing to embark upon their “Slaughter Strategy” of enacting the Senate bill into law without ever voting on it.  This would of course violate the President’s repeated demands for an “up-or-down” vote on his health proposals—and it would classify as the parliamentary “trick” promised by Speaker Pelosi’s office weeks ago.

Given these developments, many may ask exactly what in the Senate bill House Democrats find so offensive that they are afraid to take an up-or-down vote on passing the measure – is it the “Cornhusker Kickback,” the “Louisiana Purchase,” “Gator Aid,” and all the other backroom deals assembled to obtain votes for the bill?  Is it the “Cadillac tax” on health plans that their union constituents find offensive?  Is it the bill’s federal funding for insurance plans that cover abortion, and for abortions performed at community health centers?  Or is it the very notion of a $2.3 trillion government takeover of health care?


Dems Dispute GOP Claims On Order Of Reconciliation

Friday, March 12, 2010
by Anna Edney with Dan Friedman contributing

A Republican claim said to be based on advice from the Senate parliamentarian does not throw Democrats off plans for how to pass a healthcare overhaul, according to aides and sources.

On Thursday, Senate Republicans pushed the idea that the $871 billion Senate-passed overhaul bill must first be signed by the president before the Senate could vote on a reconciliation bill that will include changes to the upper chamber’s bill.

“The Senate Parliamentarian’s office has informed Senate Republicans that reconciliation instructions require the measure to make changes in law,” a GOP aide said.

Senate Budget Chairman Kent Conrad was under the same impression, but the House is not worried.

A House leadership aide said Thursday the House has different rules and is safe with the choices it has to proceed. That includes a rule that would declare the Senate bill passed upon passage of the reconciliation package, in effect helping House Democrats avoid an uncomfortable vote on the Senate-passed bill.

The aide then said the president would sign the Senate-passed bill before the Senate votes on reconciliation. It would appear that could cause a problem with House members who distrust the Senate to actually pass the reconciliation bill, but the aide said the House is good with proceeding that way.

At the same time, Senate Republicans’ characterization of what the parliamentarian relayed to them leaves out a second part.

The reconciliation package cannot directly amend the Senate bill if it is not law, but Republicans were also told the reconciliation package can be written to tweak existing law or create a law. That means if written carefully, the Senate bill does not have to become law before reconciliation comes up, though it is difficult.

A Republican aide confirmed the parliamentarian told them the additional information.

Meanwhile, the House Rules Committee will make a decision on how to proceed after CBO numbers come in on a final reconciliation bill. Rules could meet as early as Wednesday. The House Budget Committee will meet on the reconciliation bill Monday, meaning CBO scores should come before then. Budget Committee Republicans plan to hold a press conference today to push back against reconciliation.

House Majority Leader Hoyer‘s office will brief staff on health legislation at 10 a.m., following a 9 a.m. Democratic Caucus meeting. Hoyer’s office did not answer whether the discussion will be on the final reconciliation bill.

House and Senate leaders met Thursday evening with White House Chief of Staff Emanuel and health reform czar Nancy-Ann DeParle but exited with no updates.

Leaders were still determining whether student loan legislation should be part of the reconciliation package. But a leadership aide said opposition appeared to have “changed dramatically.”

Following a Senate Democratic Caucus meeting Thursday afternoon on putting student loan legislation in the reconciliation package, Senate Majority Whip Durbin said the caucus is leaning toward its inclusion. Senate Health, Education, Labor and Pensions Chairman Tom Harkin made a presentation at the meeting in favor of including the student loan bill, while Conrad made one that was not totally opposed, according to senators.

Meanwhile, the healthcare effort is affecting efforts to renew dozens of tax breaks for businesses and individuals, extend benefits for laid-off workers and prevent a drastic cut in Medicare physician payments. The Senate passed its $140 billion measure Wednesday, but used nearly $40 billion in offsets the White House has set aside for the healthcare bill.

“I think health care will be the priority, which means that some of the offsets [in the extender bill] may have to be replaced,” Durbin said. “I think we’ll find things.”

White House Admits: President Obama to Offer “Rewards” for Health Care Votes

A story in today’s Washington Post about the President’s trip to St. Louis to stump for his health care proposal includes several paragraphs of interest.  Specifically, the piece reports that White House officials are saying the President is “ready to offer…rewards” to House Democrats who vote for his government takeover of health care, including “election-year visits to competitive congressional districts, where a presidential appearance can bring in hundreds of thousands of dollars in campaign funds.”

Even as the Administration attempts to persuade Senate Democrats to give up some of their backroom deals, it appears to be engaging in another attempt to trade special favors – this time, fundraisers for struggling House Democrats – in exchange for votes.  Is this what Press Secretary Robert Gibbs meant when he said the White House would do “whatever it takes” to pass a health care takeover bill?  And how many White House “rewards” will it take for House Democrats to abandon their principles – and their constituents – and vote for the health care bill?   With nearly three in four Americans calling for Democrats to scale back their government takeover or abandon their bill entirely, how high will the “going rate” in this latest escapade soar?


In St. Louis area, Obama pounds drum for health-care initiative

By Scott Wilson
Thursday, March 11, 2010; A03

ST. CHARLES, MO. — President Obama made an impassioned case Wednesday for his health-care proposal, delivering a folksy, partisan argument for reform as industry groups prepare a multimillion-dollar advertising campaign to defeat it.

Stripping off his suit jacket and pushing up his sleeves within minutes of entering a stuffy high school gym in this St. Louis suburb, Obama criticized his Republican opposition, Washington’s wasteful spending and rising insurance premiums. He spoke with evident anger about “political gamesmanship” in Washington leading to “terrible consequences,” as he evoked the outsider’s message that he delivered successfully in his 2008 campaign.

“Congress owes America an up-or-down vote,” he said over raucous applause, which greeted his remarks at several points. “The time for talk is over. It’s time to vote.”

Obama’s appearance at St. Charles High School was the most visible element of his endgame strategy to push through health-care legislation. Unfolding inside and outside the Capital Beltway, the effort is designed to revive the sense that passage is inevitable, a feeling that evaporated when Democrats lost their filibuster-proof Senate majority in January. One senior administration official described the final phase as “working both sides of the street.”

A populist message

Obama is visiting media markets that touch multiple congressional districts, particularly in swing states such as Missouri and Pennsylvania, which he visited earlier this week. He might head to Cleveland early next week for a town hall-style appearance to discuss health care, White House aides said Wednesday.

The president is delivering to his audiences a sharply populist warning that doing nothing about the health-care system would reward the insurance industry and Wall Street investors, easy targets in communities anxious about the economy. He is also calling on the public to make its opinion known to members of Congress as he works to secure enough House votes to pass the measure before he leaves the country late next week.

Wavering Democrats

At the same time, Obama intends to lobby wavering House Democrats to vote for a Senate version of the legislation and to support the subsequent reconciliation process, which Republicans have characterized as an unjustified use of majority power. Among the rewards Obama is ready to offer, White House officials said, are election-year visits to competitive congressional districts, where a presidential appearance can bring in hundreds of thousands of dollars in campaign funds.

“The president has breathed some new life into this effort,” said Dan Pfeiffer, the White House communications director. “The opportunity to get this done exists, but it won’t last forever.”

For much of the past year, the White House health-care strategy revolved around maintaining momentum behind the politically vulnerable initiative. The effort faltered, though, as Republican critics convinced more and more Americans that it was an unwieldy and expensive government intrusion. When Democrats lost a special election in Massachusetts, and with it the Senate supermajority, the health-care bill appeared moribund.

But late last month Obama introduced his own 11-page health-care proposal. He then followed it up with a seven-hour televised work session with Democratic and Republican congressional leaders, indicating at its conclusion that he would do whatever it takes to pass a bill.

“We will continue this momentum, as you’ve seen in the last few weeks,” said Rahm Emanuel, the White House chief of staff. “And we must keep people focused on the price of failure.”

In recent days, Obama has reduced his argument to a simple campaign-style choice with a clear set of campaign-style opponents, namely insurance companies, a recalcitrant Republican opposition and a Washington political culture he campaigned against in 2008.

As he did in suburban Philadelphia earlier this week, Obama framed the debate in his 35-minute speech in St. Charles as a choice between doing something about the health-care system or leaving it unchanged, even as insurance companies announce double-digit rate increases.

“I don’t believe we should give either the government or the insurance companies more control over health care in America,” Obama said. “I want to give you more control over health care in America.”

His visit to Missouri, a state he lost in 2008 by less than one percentage point, came against a backdrop of mounting industry opposition to his proposal.

The U.S. Chamber of Commerce has announced a $10 million advertising campaign opposing Obama’s proposal. Demonstrators in St. Charles displayed signs reading “Health Care Strictly a Power Grab.”

A senior administration official said the advertising effort “validates our argument that the bill is good for American families and not necessarily good for the insurance industry.”

‘This gets harder’

But the official, who spoke about internal White House strategy on the condition of anonymity, said the gathering opposition from the chamber and other groups “should be a warning sign to members of Congress.”

“This gets harder and not easier as time goes by,” the official said.

White House press secretary Robert Gibbs told reporters Tuesday that Obama had not made any phone calls to undecided lawmakers so far this week. Obama planned to meet at the White House on Thursday with the Congressional Black Caucus and the Congressional Hispanic Caucus in separate sessions on health-care legislation.

“We are not backing down, we are not quitting St. Charles, and we are going to get this done,” Obama concluded. Then he waded into the cheering crowd to shake scores of hands.

Of Summits and “Tricks…”

Even as the President was briefing reporters this afternoon to insist that his proposed bipartisan summit would yield a “constructive debate” about health care and that he was “open to any ideas,” Speaker Pelosi’s top health care aide was quoted by CongressDaily saying Democrats were working to develop a “prenegotiated” package that would be “very close to being done” before the Easter recess, about six weeks away.  He also noted that “there’s a trick” involved in passing the bill through the reconciliation process – to ensure that the legislation could be jammed through on a party-line vote.

In addition to undermining the notion that Democrats were “open to any ideas” on health care, some may find a particular irony in these comments, given that Speaker Pelosi in a House floor speech on December 8, 2003 criticized the way Republicans handled the House vote on the Medicare prescription drug bill: “The Republicans also run this Congress like the Republicans run Florida.  They cannot accept the result of a vote.”  Of course, Speaker Pelosi’s health advisor is now publicly advocating “tricks” so that Democrats can avoid the implications of Scott Brown’s election to the Senate – to say nothing of the message voters have been sending for months now, most recently in today’s new Gallup poll that has President Obama’s approval on health care at an all-time low.

Many Republicans may agree with Speaker Pelosi’s advisor that reconciliation is a “trick” – the question is, will the Democrats insist on imposing this “trick” on an American public that has rejected Democrats’ government takeover of health care?


Pelosi Aide Outlines Healthcare Endgame

Tuesday, Feb. 9, 2010
by Anna Edney

House Speaker Pelosi’s top healthcare adviser today outlined a plan that would allow both chambers to make changes to the Senate healthcare overhaul before the overhaul becomes law.

Wendell Primus said the plan is to have President Obama sign the Senate bill before signing the legislation making the changes, even though Congress will approve them in reverse to satisfy skeptical House members who refuse to pass the Senate bill before changes are made.

“The trick in all of this is that the president would have to sign the Senate bill first, then the reconciliation bill second, and the reconciliation bill would trump the Senate bill,” Wendell Primus told health policy experts gathered at the National Health Policy Conference hosted by AcademyHealth and Health Affairs.

Some have questioned whether rules would allow Congress to pass changes to a bill that is not yet law. House members have insisted both chambers approve the changes, which likely will go through the reconciliation process to require 51 votes rather than the 60-vote supermajority in the Senate, before they pass they Senate bill.

Primus also mentioned bill drafters would need to use certain language to ensure the plan works, although he did not elaborate.

“There’s a certain skill, there’s a trick, but I think we’ll get it done,” he said.

Negotiators first must agree on changes.

The Senate parliamentarian still needs to weigh in, he added.

Despite all these complications, Primus said, lawmakers will be “very close to being done” with an overhaul by Easter recess.

He said the prenegotiated package would be based on agreements reached before Democrats lost their 60-seat supermajority in the Senate last month after the special election in Massachusetts won by GOP Sen. Scott Brown.

“It is quite conceivable that we could have a prenegotiated package much like a conference report, if you will,” he added.

Those agreements include changes to the Senate’s excise tax on high-cost plans so it hits fewer people; increased federal subsidies; a plan to close the coverage gap in Medicare prescription drug coverage; and elimination of a deal that Senate Majority Leader Reid made with Sen. Ben Nelson, D-Neb., to gain his vote.

Reid inserted a provision in the Senate overhaul bill that requires the federal government to cover Nebraska’s entire costs for a Medicaid expansion.

Sweetheart deals such as Nelson’s and additional deals between the White House and industries soured the American public on the bill, Primus said.

Obama attempted this week to revive the overhaul by announcing a bipartisan healthcare summit at the White House later this month. House Republican leaders sent a letter Monday to White House Chief of Staff Emanuel asking that governors and state legislators be invited as well, given at least 36 state legislators have introduced legislation allowing them to opt out of a federal overhaul.

“One of the fundamental problems with the approach the Obama administration has taken to health care is that it seems rooted in a Washington-knows-best mentality.” House Minority Leader Boehner said. “Excluding the voices of America’s governors and state legislators from the proposed ‘summit’ would compound this error.”

When Is a Deal Not a Deal…?

To judge from today’s press reports from CongressDaily, when the deal is made by Democrats.  The apparent confusion and U-turns over the specifics of the hospital “deal” follows yesterday’s abrupt reversal on a government-run plan — where an article in Tuesday’s Wall Street Journal quoting Rahm Emanuel as saying that a government-run health plan could be “negotiable” prompted the White House to issue a statement yesterday morning stating the President “look[ed] forward to a final product” with a government-run health plan in it, as such a program was “one of the best ways to bring down costs.”