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Shocking News on Health Care: People May Get What They Voted For

5 years ago
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I don't know what or who people thought they were voting for a year ago, but no one can claim there wasn't truth-in-advertising. Granted, most normal folk probably didn't go online in spring 2007 to read candidate Barack Obama's 15-page health reform plan. Still, for anyone who cared, the whole thing was laid out right here -- and it tracks pretty closely with the landmark overhaul passed by the House.

Coverage of preventive services? Check. Guaranteed eligibility for insurance regardless of medical status? Check. Private plans and a new public plan competing in a new federally supervised insurance marketplace? Check. New requirements on employers? Check. Expanded Medicaid eligibility? Check. Subsidies to help the middle class buy plans? Check. Research into what treatments work best? Check. Incentives for better coordinated care? Check. Authority to negotiate better prices for drugs under Medicare? Check. Elimination of "excessive subsidies" for a private Medicare alternative called Medicare Advantage? Check. A plan updated for the general election looks even more similar to the House bill.

The main policy difference between then and now is that the House and Senate bills require individuals to buy health insurance. The requirement is in there because it was demanded by the insurance industry; it assures them of tens of millions of new customers, many of whom will be relatively young and healthy.

The irony is that during the primary campaign, Obama came under attack from both Hillary Clinton and John Edwards for leaving out that requirement. He was clearly trying to avoid giving Republicans any reason to call him a big-government socialist. It hasn't exactly worked out that way. Big government and socialism are the central GOP attack points as health reform makes its halting, exasperating way through Congress.

With so many House Democrats from conservative districts, there is stiff competition for what might be called the Marjorie Margolies-Mezvinsky (MMM) award. The freshman congresswoman was the deciding vote for President Clinton's 1993 budget, which among other things raised the gas tax. It turned out the bill also put the country on path to a budget surplus, but that took a little longer to notice. Margolies-Mezvinsky lost her suburban Philadelphia House seat in 1994 and she's been famous ever since. Republicans put out one release this week headlined "Are you there Obama? It's Me, Marjorie" and asked in another which Democrat was leading in the race to become the new MMM.

The National Republican Congressional Committee circulated a target list of 70 Democrats last summer. After the health vote, it's safe to say the most at risk, and chief contender for MMM status, is freshman Rep. Tom Perriello of Virginia. He won last year by just 727 votes after a recount. And by my count, he is one of 32 Democrats on that GOP target list who voted for both the health bill and the equally if not more controversial climate change bill the House narrowly passed in June.

Perriello appears to be one of the few imperiled members who took to heart Obama's pep talk Saturday. It's a difficult vote but "we aren't making sacrifices like the soldiers at Walter Reed" or Fort Hood, the president told House Democrats, according to a Democrat who was in the room. He urged them to "remember why you got into politics in the first place" and, perhaps reflecting on personal experience, told them Republicans would target them whatever they did.

In the end, 39 Democrats resisted him and voted no. Democrats had to make do with only one Republican defector, endangered New Orleans Rep. Anh Cao. There was a small measure of comfort in that House GOP whip Eric Cantor had to stop saying that the only bipartisan vote on the bill would be the vote against it.

House Speaker Nancy Pelosi is predicting that in the next and last round, when the compromise version of the House and Senate bills comes to the House floor, health reform will draw more than 219 Democrats and more than one Republican vote. That may well be the case. Some Democrats who voted no, such as Rep. Stephanie Herseth Sandlin, have said they are hoping the Senate will improve the bill. By that they generally mean make it more conservative -- which could in turn attract some moderate Republicans.

That, of course, assumes the Senate will get moving. A cost estimate from the Congressional Budget Office is expected by the end of the week, according to Jim Manley, a spokesman for Senate Majority Leader Harry Reid. The whole process, from passing a Senate bill to passing a compromise bill, could take less than a month -- even accounting for procedural snags and roadblocks.

"The House vote gives us a renewed sense of momentum," Manley told me. "We'll be in as many weekends as possible in December as we work to try to get a bill done." The pressure is coming from the White House as well as the House. Obama said Saturday he wants a bill by the end of the year, and said Sunday that "now it falls on the United States Senate to take the baton and bring this effort to the finish line."

Public opinion is the other wild card in trying to project final support levels for health reform. By the time the House-Senate compromise comes back for up-or-down votes, the public may be more familiar with what's actually in it. And that could calm their apprehensions.

House Democratic leaders consider their bill eminently defensible and are trying to show their members how to sell it. They have put out top-10 type lists of protections and provisions that would take effect right away (kids -- stay on the family plan until you're 27!). They have a handy interactive website that asks if you're insured or not, then tells you what the bill will do for you. They never tire of noting that insurance companies will no longer be able to drop people who get sick or deny coverage to those with pre-existing conditions. And they say it can never hurt to remind people that the bill has backing from AARP, Consumers Union and the American Medical Association.

The best sales job in the world may not be enough to save every Perriello in the party, or to get broad bipartisan support for health reform. That said, Margolies-Mezvinsky says she does not regret her 1993 vote, and the margin of victory is irrelevant in the end. Bills that win small go to the same place as bills that win big: To the president's desk for signing.

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