Baucus’s bill and Rockefeller’s power play: A pivotal day for health care reform

For more than a year, Senator Jay Rockefeller has been champing at the bit. Despite his role as the chairman of the Finance Committee’s Subcommittee on Health, he found himself excluded from the small circle of senators negotiating health care reform because of Max Baucus’s unwillingness to consult lawmakers with a liberal reputation. (Of course, he saw no harm in including a conservative Republican like Mike Enzi.)

Now that Rockefeller’s moment has finally arrived, he is showing every intention of making up for lost time and imposing himself on the health care landscape. And it looks like his determination might help progressives find their voice in the Senate debate.

Baucus’s centrist allies have not shied away from holding up the legislation to push it rightward. Some have taken the direct route of unambiguously coming out against key parts of the bill (Blanche Lincoln and Joe Lieberman). Others choose to play up their indecision and accentuate Democratic divisions; Kent Conrad, for instance, has become a master in the art of sabotaging a policy proposal without looking like a culprit as he continuously insists the votes are not there to pass a public option without specifying how he himself would vote.

Liberal senators have been unwilling to be as combative as their House counterparts in debating centrists, and the main front of opposition to the party’s Baucus wing has long looked to be the lower chamber’s Progressive Caucus. Not only is the bill produced by the HELP committee decidedly more moderate than the one written in the House, but no Democratic senator was playing up his support for a public option, to strong subsidies and to a robust exchange to such an extent as to get the press to report that Baucus’s compromise efforts could lead to truly major problems with the Senate’s left.

Given that situation, it became hard to see what could tip the balance towards progressives in their confrontation with centrists - especially once Barack Obama sided with the latter group in his Wednesday’s speech, at least as far as the public option is concerned. Yet, Rockefeller has started to change that dynamic.

It all started in a conference call organized by the Campaign for America’s Future, during which the West Virginia Senator unleashed. “There is no way in present form I will vote for it,” he said. “Therefore, I will not vote for it unless it changes during the amendment process by vast amounts.” Today, Rockefeller continued to blast Baucus on everything ranging from process concerns to his draft’s substance, reserving much of his scorn to the co-op proposal in a letter he wrote to the finance committee chairman:

First, there has been no significant research into consumer co-ops as a model for the broad expansion of health insurance. What we do know, however, is that this model was tried in the early part of the 20th century and largely failed.

It seems to me that, if you are proposing to implement consumer health insurance co-ops on the scale contemplated by the Finance Committee, then you certainly should know what has been the experience with them so far.

I believe it is irresponsible to invest over $6 billion in a concept that has not proven to provide quality, affordable health care, when we know that a public health insurance option will rein in costs and save taxpayers billions of dollars.

Can you blame such a senior lawmaker whose area of expertise this from being so frustrated to have been excluded from these negotiations for the past few months? Speaking of co-ops, by the way, Ezra Klein analyzes that Baucus’s version of a co-op proposal “is a neutered version of the co-op idea, which was in turn a neutered version of the public option” (which, we might add, was a neutered version of a single-payer plan).

Liberals needed to make Baucus’s bill look like the centrist option

Rockefeller’s comments have been all over the news and that has undoubtedly shaped the coverage of the release of Baucus’s long-awaited proposal today. Suddenly, concerns voiced by other Democrats sitting on the Finance Committee were taken more seriously: Wyden’s insistence that he is not comfortable with the bill’s affordability provisions, Burris’s claim that he will not support a PO-less bill and Menendez’s dissatisfaction with Baucus’s anti-immigrant rhetoric can only be more credible once it looks like Democrats will not neatly fall behind whatever Baucus proposes.

An NPR story I heard spent more time discussing Democratic opposition than GOP objections, and a New York Times graph clearly identifies Baucus as the representative of centrist Democrats rather than as the party’s overall representative. (That might seem to be a given, but it was starting to be muddied by the increasing identification between Baucus and Obama’s stances. “The much-ballyhooed, long-wrangled-over Baucus health care proposal, which has largely become President Obama‚Äôs blueprint…,” wrote the Times this morning.)

What is the effect of this?

First, it makes Baucus’s proposal look more centrist than it would otherwise. Had liberals not upped the volume, the dominant story this morning would have been Baucus’s failure to bring Republicans on board - and that would have helped Olympia Snowe, Chuck Grassley (and other Republicans who are not looking to negotiate) insist that the Montana Senator’s bill is too liberal. Instead, equally discussed today was the prospect that Baucus has compromised so much as to endanger the bill on the left.

Liberal discontent forces everyone to contemplate just how much Baucus has already agreed to during Gang of Six negotiations - and it makes it all the more bizarre that he has agreed to follow through on compromises even though he obtained the support of none of the Republicans (Snowe, Enzi and Grassley). When Rockefeller asks what then was the point of scaling back Medicaid expansion and reducing subsidies, what will Baucus answer?

All of this disrupts the narrative Baucus and Conrad have spent months developing: the bill will get closer to 60 votes the more it is pushed rightward. Now, the press has to include a paragraph about how stripping the bill of a public option could lose Rockefeller’s vote whenever it discusses a centrist senator’s claim that the votes “are not there” to create such a plan. In these conditions, it will be much harder for Baucus to justify watering key provisions down further.

What is next?

None of this means that the public option will suddenly find its way in the Baucus bill, but no one expects Rockefeller to get everything (or even most) of what he wants. Not even Rockefeller expects that. This is a legislative process, and compromise will happen. But the bottom line is that compromise kept happening in a rightward direction, consistently diluting provisions liberals believe should be in the bill.

Rockefeller and his allies’ decision to intervene now means that Olympia Snowe will stop looking like the only senator worth following and that Baucus will be forced to make concessions to the left before his bill even emerges out of the Finance Committee. “Jay has done so much for health care and there will be a lot of opportunities for all of us to work together to find a compromise,” Baucus said today. How often have we heard him discuss the need to compromise with a liberal Senator as opposed to a centrist Republican?

One example of an issue on which the Finance Committee’s liberal discontent could make a difference. The Congressional Budgetary Office’s preliminary analysis of the Baucus bill finds that it would reduce the deficit over a 20-year window. Given the Democrats’ goal is to have a deficit-neutral bill, this gives the Montana Senator some wiggle room in negotiations.

On the one hand, he can boost the spending size - increase the size of the bill (which, at $860 billion is under what many experts say is needed to insure universal coverage) and grant higher subsidies. That latter topic has indeed become a major source of liberal angst, as analyses show that Baucus’s proposed levels would not be enough to make health care affordable for those who would be required to buy it. On the other hand, Republicans like Grassley will insist that Baucus take this opportunity to decrease the revenue part of the bill - namely lower taxes.

It’s difficult to imagine Baucus willingly taking the former route, as he has been very reluctant to increase subsidies even though Snowe was reportedly in favor of doing so. But if he suddenly faces a full-on rebellion among Finance Committee’s Democrats - if he realizes that he needs to “find a compromise” with “Jay” - will this not be the type of issue on which liberals can expect to reap some rewards?

The 60th vote?

In what is another development that could boost liberals, reports are now indicating that the Massachusetts legislature will soon vote on whether to allow Deval Patrick to appoint an interim Senator who would seat until the January special election. The House could vote as early as tomorrow, and while I keep reading that this reform lacks a clear majority in either chamber, I can only assume that the legislature’s Democratic leaders would not agreed to bring the bill to the floor had they not whipped the issue enough to make sure they’ll have majorities. A state legislator even said that the bill could be on Patrick’s desk by September 24th, allowing the governor to quickly appoint Kennedy’s temporary replacement.

That means Democrats could have 60 Senate votes by the end of September. That would undoubtedly change the dynamics of the Senate debate: While there is no doubt that a number of Democrats are just as reluctant to support the bill as Snowe (if not more so), they would no longer be able to hide behind the need to find Republican support. If Landrieu or Conrad are unwilling to support cloture on the health care bill, they would at some point have to say so rather than invoke the lack of votes - and there is ample evidence to suggest they would rather not go that far. And it would strengthen the White House and Reid’s hands as they plead with Nelson and Lincoln to at least vote for cloture, even if they intend to vote against a final bill.

13 Responses to “Baucus’s bill and Rockefeller’s power play: A pivotal day for health care reform”

  1. 1 Guy

    This is very good news. There are as many liberal Democrats who could torpedo healthcare as there are conservative Dems. Franken, Feingold, Sanders and Rockefeller for example.

    Baucus’s bill serves one very important purpose and that is to show that Republicans were not really interested in negotiating or coming to a compromise. If the public (and the President and Baucus) come to see that the GOP just is not interested (i.e. party of NO again) then that gives the Dems a much freer hand to go ahead by themselves. Remember they have huge majorities in both chambers and Obama won a near landslide. Bush and the GOP back in 2001 managed to get a lot of their agenda through (>$1 trillion tax cuts etc) with Bush barely “winning” the election and the GOP having a 1 seat majority in the senate.

  2. 2 fritz

    I don’t see how this bill gets out of committee. There will be a ton of amendments during markup. The liberal (progressive) Democrats will want to make it more in line with the other health care bills but will be voted down by Republicans + any two of Baucus, Nelson ,Conrad or Lincoln and the Republicans will be able to make it even more unpalatable by adding anti-reform amendments supported by any two of the above mentioned Democrats.
    When the final committee vote happens Rockefeller, Kerry, Wyden, Schumer and maybe more Democrats will find it very difficult to hold there noses and support the final, even more odious, bill.
    Once out of committee it may actually be easier to get a bill out of the Senate and into conference where the real dealmaking will take place.

  3. 3 Guy

    Fritz - does a bill have to come out of this committe. Can`t the HELP committee bill go to the floor in the senate, get voted on and then go to conference?

  4. 4 Taniel


    Detailed Senate rules are not my specialty, but it seems to me that would be hard to do since the Finance Committee does have clear jurisdiction over this: Don’t forget that the HELP Committee bill does not include sections on how to finance the bill since that was up to Finance to design.

    Based on what happened in the House, it looks like the leadership has some wiggle room, however: Remember that Pelosi and Waxman threatened to skip over the Energy and Commerce Committee if the committee’s Blue Dog members did not support the bill by recess. That did not end up happening.

    The difference here, of course, is that it is one big obstacle to moving the legislation along is the chairman of the committee himself: Even if it were possible to do so, Baucus would be enraged if Reid were to force the bill to skip Finance (and, once again, I really can’t imagine the Democratic leadership being interested in doing such a thing so I’m just voicing this hypothesis for the sake of discussion). That does not compare to the House, where the committee chairman were favorable to the bill and Waxman himself supported the skipping idea.

  5. 5 Guy

    Thanks Taniel - it comes back to my first post. Hopefully by allowing Baucus to try negotiating with the GOP (a fools errand in most people’s perspective) for the past 6 months he will have learnt (or will soon come to the realisation) that it is not possible. The GOP cannot come back to the American people and say they were not given an opporunity to influence the final bill.

    As many have said elections have consequences and the Dems clearly won (at all levels) in 2008 so in the end Baucus will toe the consensus Democratic position. Otherwise he should not stay a Democratic senator!

  6. 6 Taniel


    You write: “He will have learnt (or will soon come to the realisation) that it is not possible.” I think that assumes Baucus (who Fox News is now calling a Republican!) has been playing up the need to secure Republican votes for process reasons (i.e. he is interested in bipartisanship for the sake of bipartisanship) rather than for substantial reasons (i.e. he is ideologically opposed to the type of reform more liberal Democrats want and is thus looking for a way to insure the bill is centrist). And I don’t think that’s the case; otherwise, how do we explain the fact that he included Enzi while excluding Rockefeller?

    If they play their cards right, liberals can hope to turn the table on Grassley/Enzi/Snowe since it would have presumably been harder for them to push for the bill to move back to the left had these Republicans agreed to back Baucus. In particular, I am not sure why Grassley did not agree to back Baucus’s bill: Since it is clear it will have to be moved to the left at various points of the process, it would be easy for Grassley to later drop his support and secure coverage that makes Democrats look like they dropped their commitment to bipartisanship.

  7. 7 fritz

    Baucus may not be happy, but if he can’t get enough support to get his bill out of his committee in a reasonable amount of time (say two weeks) then he may have no choice but to let Reid take over.
    I think in the end this is the bill that will be the core the Senate Democrats use to build on as it is well constructed; has a number of good ideas and has the financial structure needed to pay for it.
    There will be a lot of arm twisting by the Senate leadership and the White House to get this out of committee as soon as possible: note the WH summons of J. Rockefeller yesterday.
    I think the the long range plan is to get a bill out of the Senate with or without some form of public option and to conference where it can be joined to the house bill that will have a strong public option. Once a bill comes out of conference; and there is something positive for the White House to sell to the public it will be very difficult for Senate Democrats and even a few Republicans to vote against cloture.
    A short sidebar: Today as I watched one of those cable news debates between Democratic and Republican strategists I saw displayed a perfect example of how Democrats (progressives) & Republicans(conservatives) looked at the health care debate and most other debates. The Democrat referred to how the plan would help the 40 million + uninsured get health care and the Republican talked about how people with heath care now would ask what was in it for them and how they would oppose reform because it might lessen or take away their health care. I immediately thought of the JFK quote “Ask not what your country can do for you rather ask what you can do for your country”.

  8. 8 Guy

    Taniel - I understand your point about Baucus for ideological reasons wanting a more “centrist” bill. But I think it suited the President and Democratic party for one of the five committees to spend alot of time “negotiating” with the GOP. The GOP made a tactically mistake walking away because it does show that they are not interested in compromise. There was a poll out recently that showed most people thought the Dems had negotiated in good faith but only 30% of people thought the GOP had done the same. By waling away the GOP has confirmed in the mind of the public and journalists who help shape the narrative that the GOP is not interested.

    Fritz is right - when a compromise bill, which is to the left of the finance committee bill, comes out for a final vote then it will be hard placed for any Dem to vote against it. I still expect the two Senators from Maine to come on board at some point because otherwise they will have a very vigorous challenge when they come up for re-election (it is not like they have to worry about a primary challenge).

  9. 9 Maurice

    I really can’t see Conrad being much of an obstacle once any bill gets to the floor, but I find it rather frivalous trying to predict anything at the moment.

    And Guy, I’m not so sure that Snowe or Collins don’t have to worry about a conservative challenge. Former Reps. Dave Emery and Jim Longley have been voicing some discontent with them over the past year or two. And Longley does have the luxury of his father’s last name.

  10. 10 Taniel

    It’s tough to see Snowe vulnerable in the general election, whoever her opponent. Collins might be - but then again she crushed a top-tier Democrat in a year like 2008.

    Also, based on everything I have been reading I find it hard to see Collins voting for the bill (unless Baucus-Snowe succeed at moving it even more to the right and keeping it there). As long as the House and the vast majority of Democratic Senators succeed at getting a more liberal bill out of the conference committee, the only Republican who might vote for it is probably Snowe.

    Keep in mind that Massachusetts is pressing forward with the replacement scheme, so keeping Democrats unified could soon be more important than getting Snowe’s vote. I agree that Conrad will probably not be the biggest obstacle but he has been one of the most insistent that the “votes are not there” for the type of bill liberals want. We’ll see how things proceed, of course, there is still a lot left to be determined.

  11. 11 Guy

    I really cannot think that in Maine a more conservative GOP nominee would win in the general election. This would probably ensure both women stay as nominees for their party. Agreed that they both beat top tier Dems in the past but Maine is a Democratic state and voting against a top priority like healthcare will be a powerful issue to use in future elections. The two senators should feel pressure to represent their constitutents who are predominately Independent or Democratic.

  12. 12 Nathan

    I wonder if Baucus himself could become a Dem vote against cloture. His actions seem to reflect a real opposition to the kind of health care bill liberals want. If he crafts a centrist bill, but a significantly more liberal one winds up on the Senate floor, is it plausible that he’ll join a Republican filibuster? His positioning so far doesn’t auger placid support for a liberal bill. Maybe Republicans aren’t backing his bill because they suppose he’ll ultimately help them kill any bill.

    As one of a handful of right-leaning readers here, that was wishful thinking on my part. The freedom to do others good and profit by it, on which we Americans used to pride ourselves, has promoted medical innovation totally unparalleled in world history. If we actually let Congress–so renowned for insight and foresight that it’s approval rating sometimes soars past 30%–demolish this system, it will be a tragedy. At any rate, more Americans think so than approve of Congress.

    If Max Baucus opposes his party on this, he could easily write a book explaining why government shouldn’t too eagerly meddle with successful sectors of the economy. It would probably sell well in Montana.

    And it will never happen. Wishful thinking aside, Baucus is no conservative interloper. If that were so, he wouldn’t propose a “watered down” bill designed to squeeze medical R&D while raising the price of health insurance.

    Baucus’ bill will raise the cost of care via taxes on insurance companies, pharmaceutical companies, and equipment manufacturers, who’ll pass the cost on to their customers. By raising the cost of care, this bill could increase popular receptiveness to the public option, and maybe even single-payer. If you want to replace the current system, you have to break it first; you have to foment a crisis not to waste!

    But there’s something more sinister than that about this bill. The surcharges on pharmaceutical firms and medical equipment manufacturers will make health-care more expensive in the short term. In the long term, they’ll reduce the quality of care. Heavily-taxed companies will pass part of the cost on to citizens, but they’ll also tighten their R&D belts. Some firms will go out of business. Hospitals will find it harder to afford state-of-the-art equipment, even though state-of-the-art won’t mean what it once did. Government will swoop in with a public option, paying itself no crippling taxes, and paying less for medical care than it would have if technological progress hadn’t been thwarted.

    Sound far-fetched? Well, even Congress can’t spend a 850 billion dollars without achieving anything. For those who doubts such Machiavellian schemes could come from the pure hearts of Congressional staffers, I have a question: Why are the bill’s surcharges on insurance companies, drug companies, and medical equipment firms based on market share, instead of profits? Why incentivize fewer lifesaving machines, fewer lifesaving drugs, and fewer insured people? The only reason I can think of is to make way for a public option or single payer.

    Probably you disagree. But it’s a plausible narrative for Republican Senators. If you’re still scratching your head over why they aren’t flocking in droves to the Finance Committee “compromise,” read the Forbes article I linked to above. It’s written by Dean Zerbe, a former top advisor to Sen. Grassley, probably dovetails well with the thinking of Republican Senators.

    You don’t have to be negotiating in bad faith to oppose Sen. Baucus’ bill from the right. It isn’t a moderate bill; it’s a radical and expensive transformation of the medical industry.

  13. 13 Guy

    Nathan - good to hear from people with a different view. I read Forbes and they have a definite free market, right wing slant. No worse than other publications but still a fact.

    I would accept your argument about the wonderful innovative US healthcare system if it actually produced benefit for patients. Lets compare the UK, Canada and the US. The US spends twice as much money (as % of GDP) and yet does not do better on life expectancy, infant mortality or other clinically valid metrics. Also these wonder drugs (I work in Pharmaceutical R&D) do cost money but an increasing number are generic and therefore cheap and the industry has too many “me-too” drubs, do we really need 7 versions of Lipitor?

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