Where We Are With Health Care Reform

Ken AshfordHealth CareLeave a Comment

Well, the bottom line is this: after moments of debate and Tea Party protests and misinformation and subcommittee reports, etc., Congress is getting set to vote on health care reform.  That's where we're at.

Oh, I supposed I could talk about the minutae of parliamentary procedures, like everybody else, but your eyes will glaze over.  Basically, Democrats in the House are employing a procedure known as a "self-executing rule" or more precisely, "deem and pass", wherein the House votes on the Senate's health care reform bill with the assumption that there are certain amendments tacked on to it.  They're not voting to approve the actual Senate bill (the Senate hasn't voted on it yet and it has passed the buck to the House); the House merely voting on a rule which deems the Senate bill to look like X, and approving that bill if the Senate bill eventually looks that way.

Eyes glazed yet?  Don't worry.  What you need to know is this:

The GOP, the Wall Street Journal, rightwing blogs, Fox News, and the usual rightie troops are crying foul loudly.  "That procedure is unconstitutional!  You're not voting all the bill directly" blah blah blah.

Anybody want to guess if the GOP ever used that very same parliamentary procedure in the past, when Republicans controlled the House?

Why, yes they did.  Of course they did.  35 times in 2005-2006.

(And yes, Democrats complained then, but they didn't call it "treasonous" like many on the right are doing now).  The hypocrisy of the right now is plain for all to see.

If you're wondering why this is in the House rather than the Senate, the Christian Science Monitor explains why:

Since Senate Democrats lost their filibuster-proof majority with the election of Sen. Scott Brown (R) of Massachusetts, Democratic leaders have decided to try to pass the Senate's version in the House – in part to avoid the Senate's procedural hurdles as much as possible. The problem is, many in the House don't like the Senate bill and won't pass it.

The proposed solution has been a package of "fixes" to the Senate bill. It's not a perfect answer, because the Senate will also need to pass the fixes – and will need to resort to the controversial process of reconciliation to avoid a filibuster. But Democrats see it as the least worst option.

The drama now unfolding is how to rally 216 House Democrats to the fixes.

The "fixes" include lowering the cost, and getting rid of certain "sweetheart deals", like the "Cornhusker Kickback" – a particular provision of the bill that benefits Nebraskans.  (And that paragraph is about all the substance of the health care bill you'll see on the news)

But parliamentary rules aside, the big question is whether there are enough votes in the House for health care refrom to pass.  The magic number is 216, and although some people are trying to take a whip count, it is anybody's guess as to whether it will pass.  There are somewhere between 11-15 Democrats who are on the fence.

One Democratic holdout was two-time presidential candidate Dennis Kucinich of Ohio, who avowed not to vote for health care reform unless it contained a public option.  He voted against the Democrat's health care reform last November for that reason.  The current plan on the table, of course, does not contain the public option.  But Obama and others have talked to Kucinich and reports this morning are that he is changing his vote to "yes".  Whew.  Could be a big boost.

The Hill reports the following:

All House Republicans are expected to vote no.

If every member votes and all GOP lawmakers vote no, the maximum number of Democratic defections to pass a bill is 37, which would result in a 216-215 tally.

Right now, the Hill counts 36 Democrats as a "no" (a firm "no", a likely "no", or a leaning "no"), including three representatives from North Carolina: Larry Kissel, Mile McIntyre, and Heath Shuler.

8 Democrats are a firm "yes", and 17 Democrats (including N.C. representative Bob Etheridge) are leaning "yes", and a full 53 Democrats are undecided.

In short, it doesn't look good.

UPDATE — Ezra's take:

On the deem and pass question, Democrats are wrong, but Republicans are wronger.

The problem with deem and pass isn't, well, deem and pass. It's the wrongheaded view of House members who have convinced themselves that there's something irreparably wrong with the Senate health-care bill. But the Senate bill, like the House bill, is a very good, if imperfect, piece of legislation. It's better on cost controls than the House legislation but worse on affordability. Structurally, however, the two are very similar: They both include subsidies for individuals and small businesses to purchase regulated insurance products from exchanges and an individual mandate to ensure that the healthy don't game the system.

The bigger problem with the Senate bill is the deals attached to it. But the deals aren't, from a policy perspective, particularly important. They're just politically important. And politics is politics, so the deals will come out. But just because Fox News pretends that they somehow define the legislation is no reason for House Democrats to adopt the same argument.

If the Democrats are wusses, the Republicans have chosen to foment a hysterical, corrosive cynicism. "Any veteran observer of Congress is used to the rampant hypocrisy over the use of parliamentary procedures that shifts totally from one side to the other as a majority moves to minority status, and vice versa," writes congressional expert Norm Onstein. "But I can’t recall a level of feigned indignation nearly as great as what we are seeing now from congressional Republicans."

Deem and pass — more technically known as a "self-executing rule" — is a common congressional procedure, as you can see from the graph atop this post. Republicans used it dozens of times when they were in power. But now that Democrats are doing the same, the GOP is painting it as a threat to the republic itself. That may be good politics, but it is bad civics. They are scaring the bejesus out of their constituents and assuring that even if the legislation does pass, a substantial fraction of the country will think tyranny has come to America. That tyranny, as the Republicans know, is in the form of majority votes that accord with the rules of Congress. But they will happily destroy this Congress in order to secure a slightly better shot at controlling it.