Editore"s Note
Tilting at Windmills

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November 8, 2009

ONE CHAMBER DOWN, ONE TO GO.... It wasn't easy, but last night, for the first time, the House of Representatives approved legislation to reform the nation's dysfunctional health care system.

By the time House Speaker Nancy Pelosi banged the gavel, the final tally was 220 to 215. In all, 39 Democrats -- some who thought the bill was too liberal, some who found it too conservative -- joined with Republicans to oppose the legislation. One House Republican, Rep. Anh "Joseph" Cao of Louisiana, joined with the majority.

Now, given the narrow margin -- the bill needed to 218 to pass, and 220 was obviously cutting it close -- it might seem as if the House leadership struggled to keep the caucus together. From what I hear, that's not what happened. Pelosi recognized which House Dems from "red" districts were under the most pressure to oppose the bill, and once she had the majority she needed, the leadership effectively told the center-right Dems they could go ahead and break ranks.

As for the bigger picture, there's quite a bit of work to do before reform becomes law, but it's worth pausing to appreciate the historic significance of last night's accomplishment. A lot of presidents have pushed health care reform initiatives before this year, and a lot of lawmakers have tried to get to this point. When it comes to domestic policy legislation, health care reform has been something of a holy grail -- but before nine hours ago, the House had never even voted on, better yet passed, a bill of this significance.

And yet, here we are.

President Obama, who helped secure a majority by appearing on the Hill yesterday morning, issued a statement last night heralding the milestone.

"Tonight, in an historic vote, the House of Representatives passed a bill that would finally make real the promise of quality, affordable health care for the American people.

"The Affordable Health Care for America Act is a piece of legislation that will provide stability and security for Americans who have insurance; quality affordable options for those who don't; and bring down the cost of health care for families, businesses, and the government while strengthening the financial health of Medicare. And it is legislation that is fully paid for and will reduce our long-term federal deficit.

"Thanks to the hard work of the House, we are just two steps away from achieving health insurance reform in America. Now the United States Senate must follow suit and pass its version of the legislation. I am absolutely confident it will, and I look forward to signing comprehensive health insurance reform into law by the end of the year."

The Senate still has heavy lifting to do, and unlike the House, Majority Leader Harry Reid (D-Nev.) has to figure out how to generate a supermajority to support reform without a single defection from the Democratic caucus. The upper chamber will have to address the question of the public option, financing, subsidy rates, and what to do with the odious Stupak amendment (which passed last night, 240 to 194).

But in the meantime, there's cause for some preliminary rejoicing. There are all kinds of hurdles between the status quo and much-needed reforms, and last night was a big one. We're this close.

Steve Benen 8:00 AM Permalink | Trackbacks | Comments (24)

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Rep. William Jefferson stuffing $90,000 in bribes in his freezer helps deliver "bipartisan" health care reform.

http://www.talkingpointsmemo.com/archives/2009/11/one_gop_vote.php?ref=fpblg

Obama has some seriously good Karma.

http://www.youtube.com/watch?v=EqP3wT5lpa4&feature=related

Posted by: Newton Whale on November 8, 2009 at 8:10 AM | PERMALINK

Morning Steve. I think it's important to recognize that all major legislation of this magnitude - like SS or Medicare before it - started out imperfect and was then improved upon (SS was only available to a few when it was first passed, and now it's universal, etc.). So this is just the beginning, and its opponents have always recognized that. I hate the Stupak amendment, as a woman, and I look forward to it being removed at some point. And there are other provisions in the bill that I wish weren't weakened, but in the end I have to celebrate this event.

And I especially celebrate a bill that the insurance industry obviously loathes. That's my litmus test.

Posted by: brooklyn on November 8, 2009 at 8:11 AM | PERMALINK

I'm in shock over how happy the House vote made me. Really, at this point, the senate has to get it's act together and pass something. The best part of what Pelosi accomplished, she wrote a deficit netural bill that cuts the deficit more than the Senate finance committee and covers more people.

The House has a strong hand to make it's bill the bones of the House/Senate merger.

Couple this with the stimulus opportunities in the budget and the democrats may have some good news to run on in 2010.

Posted by: Rhoda on November 8, 2009 at 8:16 AM | PERMALINK

Look for a version of the Stupeck amendment to be attached to the Senate bill in an effort to drive a wedge in Dem ranks...

Posted by: ben on November 8, 2009 at 8:18 AM | PERMALINK

One step closer in removing reproductive rights from women aided and abetted by Democrats.

Posted by: Jay on November 8, 2009 at 8:21 AM | PERMALINK

Since I haven't seen the Stupak amendment posted anywhere online, I don't even know what it says. So before I go postal on it, let me just note that, at the current time, we have no federal funding for abortion, other than in cases of rape, incest, or the health of the woman. If this is the language of the Stupak amendment, it does nothing to bring us "one step closer in removing reproductive rights from women" and instead just maintains the status quo. Does that status quo suck? Yes, it certainly does...but even it is not the primary barrier for women seeking abortions. The lack of doctors who will perform the procedure is the biggest barrier for a huge part of the country, and this bill even with the Stupak amendment does nothing to address that reality, pro or con.

As others have noted, Rome wasn't built in a day and there will be many opportunities - both legislative and judicial - to revise this provision. No one got "thrown under a bus" with this amendment - the reality is that poor women without private health insurance have been under the bus for a long time already. The Stupak amendment leaves them there. Not good, but not what some here are portraying. That having been said, I'm not even sure that many private health plans cover abortion at the current time - I'm sure quite a few plans do not - which means that many women covered under private insurance have long been in this boat along with women covered under Medicaid and VA health plans. In what way this one provision is more important than the overall bill escapes me.

Posted by: Jennifer on November 8, 2009 at 9:08 AM | PERMALINK

Jennifer -

The difference with the Stupak Amend. is it covers more than just public plans (i.e. direct federal funding). The exchange, which is set up to allow subsidized shopping among private plans and to allows different choices and different options will now be covered: consumers in the exchange will not be able to use their subsidy to buy any private plan in the exchange that cover elective abortion (so no such plans will be offered there - and more problematic, it will discourage those companies developing plans for the exchange from having it in their similar non-exchange plans as well).

Posted by: zeitgeist on November 8, 2009 at 9:24 AM | PERMALINK

zeitgeist - I can see your last point as problematic (and as noted, I see the whole federal ban on paying for abortion problematic) but the rest of what you described fit my understanding of the impact of the amendment - which is, it will simply extend the status quo in regard to abortion - no federal funding for, federal funding including the subsidies. Still on balance I have to say that women who currently have NO access to coverage will be better off under what's been passed than they would have been without it. I still maintain that this provision does not eclipse the good that the overall bill represents.

Posted by: Jennifer on November 8, 2009 at 9:30 AM | PERMALINK

The reason we got just enough votes to pass this bill is so a few dozen blue dog democrats could have cover. The bill was always going to pass, the question was simply which blue dogs got to vote against it.

I know that makes Pelosi sound more powerful then she might seem, but I really believe that is the case.

As for repoductive rights insurance, I suggest that some women's organizations get together to support privately offered medi-gap insurance just like AARP does for Medicare.

Sucks I know but that's the best solution I see.

Posted by: Lance on November 8, 2009 at 9:36 AM | PERMALINK

It would help to have some reliable information on what percentage of private plans currently cover elective abortion.

Posted by: shortstop on November 8, 2009 at 9:45 AM | PERMALINK

shortstop - from reading elsewhere over the past half hour I see that most private plans do cover abortion. Not all. I'm sure that many fundie small business owners make a point of selecting plans that do not. In any case, having private insurance is not a guarantee that a woman seeking an abortion will be covered, and as noted, uninsured women and poor women on Medicaid are not currently covered for abortion services at all, except for those women on Medicaid whose pregnancies are the result of rape or incest or pose a risk to their health. Either way you look at it, the Stupak amendment represents status quo rather than curtailment of what's already in place.

Posted by: Jennifer on November 8, 2009 at 9:59 AM | PERMALINK

Can you share a link, Jennifer? I'm having trouble locating info other than the Guttmacher study, which apparently only covered self-reporting insurers and thus may be suspect.

We all agree on the symbolic aspect of this legislation -- it sucks -- but I'd like to better assess the practical aspect of it. I agree with you that this amendment largely represents an extension of the status quo, and would note that the 8 million federal employees join Medicaid and VA patients in currently receiving no federal funded coverage.

Posted by: shortstop on November 8, 2009 at 10:09 AM | PERMALINK

federally

Posted by: shortstop on November 8, 2009 at 10:10 AM | PERMALINK

shortstop - Look here.

Posted by: Jennifer on November 8, 2009 at 10:18 AM | PERMALINK

It wasn't easy, but last night, for the first time, the House of Representatives approved legislation to reform the nation's dysfunctional health care system.

yea, well they did it by stabbing women in the back, attacking their inalienable right to dominion over themselves. They did it by condemning poor women to back alley abortions. What they did is complete bullshit. Democrats proved once again, they have no spine and they have no values.

Posted by: pluege on November 8, 2009 at 10:39 AM | PERMALINK

Yes pluege. The sky is falling. Also.

Posted by: Jennifer on November 8, 2009 at 11:04 AM | PERMALINK

Jennifer, that's got the problematic Guttmacher survey again. However, it also has another, Kaiser. Note the huge disparity between the two numbers:

Currently, the majority of plans already cover basic reproductive health care, including abortion care. A Guttmacher Institute survey found that 86.5 percent of employment-based health plans cover medical abortion and 86.9 percent of employment-based health plans cover surgical abortion. The Kaiser Family Foundation’s 2003 Employer Health Benefits Survey found that 46 percent of workers have coverage for abortion services. And when looking at larger firms, the rate is more than 50 percent.

Posted by: shortstop on November 8, 2009 at 11:15 AM | PERMALINK

shortstop - I think part of it may be that there's a big difference between "majority of plans" and "plans which cover the majority of people". As you noted, 8 million federal employees cannot choose from plans with this coverage. If an insurer has 20 different products, and 17 of them have abortion coverage while 3 do not, but those 3 are popular with federal employees and have been chosen by several large employers, they could easily have 85% of the plans offering the coverage, but only 45 - 50% of the people they insure covered under those plans. I'd go with the 45 - 50% figure as the more accurate - that's what is actually available to people because they don't get to tell the employer which plan to offer. That seems the right way to interpret the date, as it doesn't matter how many insurance plans that theoretically offer coverage for abortion if people don't have access to those plans. In short, we're both right - women, at least half of those covered by private insurance, are pretty much screwed on abortion coverage at the current time.

Posted by: Jennifer on November 8, 2009 at 11:33 AM | PERMALINK

Good point, Jennifer, on the diff between percentage of plans and percentage of people covered. I'm frankly surprised that this number is as high as 46%. I expect we'll hear more about this in coming days.

Posted by: shortstop on November 8, 2009 at 11:42 AM | PERMALINK

Why should the government limit in any way health care provided to women exercising their constitutional rights?

Why should the "status quo" (even if true, which its not) be acceptable with anything having to do with health care?

Posted by: zoot on November 8, 2009 at 12:27 PM | PERMALINK

the government does hundreds of immoral, illegal, and unethical things all the time, like invasion, occupation, and destruction of countries, torture, extraordinary rendition, maintenance of black sites, indefinite detention, trumped-up monkey trials, abuse of states secrets to thwart citizens exercising their rights, and on and on. They do all these things with taxpayers money. They do them in direct contradiction of the morals and conscience of many taxpayers. They do them without the slightest concern for those taxpayers. But when it comes to women legally exercising their Constitutional rights, suddenly the government has to be concerned about the sensitivities of a minority of taxpayers because they shriek louder than anyone else. Suddenly limits on legal consitutional activity is OK.

The position is ridiculous, moral corrupt, rife with hypocrisy, and devoid of values.

Posted by: gak on November 8, 2009 at 12:37 PM | PERMALINK

Steve, you write: "Majority Leader Harry Reid (D-Nev.) has to figure out how to generate a supermajority to support reform."

Oh how I wish we could stay away from buying into the growing conventional wisdom that a supermajority is required to pass legislation. It simply is not. The reality is (and the language should be) that a supermajority is required "in order to allow the Senate to vote." Period.

Posted by: John on November 8, 2009 at 1:03 PM | PERMALINK

I should have said, "The reality is (and the language should be) that, only in the once rare circumstance that the minority party mounts a filibuster, is a supermajority required "in order to allow the Senate to vote." Period.

Posted by: John on November 8, 2009 at 1:06 PM | PERMALINK

I second John's urging that we stop with the supermajority crap.

If I were Harry Reid, I would cancel the holiday recess until a bill was passed. I would make the GOP filibuster and continually call for votes on the bill so noone can go home. I would make the opposition bitch and moan and then make them the media topic on why they don't want healthcare reform. Make them defend their indefensible positions. But that would take a spine, guts and a pair of triple A cajones.

I say bring on the pain.

Posted by: bdop4 on November 8, 2009 at 1:25 PM | PERMALINK
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