The Ashford Zone Blog

As discussed below, the CBO scoring on the House health care bill is a god-send for reform advocates, making many Democrats in the House "giddy".  Ezra Klein asks the right question: given the excellent report (which the GOP is still struggling to countermand), won't it be difficult for wavering House Democrats to vote "no"?

Won't it be substantively difficult for many House Democrats to vote no?

If you're a liberal House Democrat, here's what you'd be voting against: Legislation that covers 32 million people. A world in which 95 percent of all non-elderly, legal residents have health-care coverage. An end to insurers rescinding coverage for the sick, or discriminating based on preexisting conditions, or spending 30 cents of each premium dollar on things that aren't medical care. Exchanges where insurers who want to jack up premiums will have to publicly explain their reason, where regulators will be able to toss them out based on bad behavior, and where consumers will be able to publicly rate them. Hundreds of billions of dollars in subsidies to help lower-income Americans afford health-care insurance. The final closure of the Medicare Prescription Drug Benefit's "doughnut hole."

If you're a conservative House Democrat, then probably you support many of those policies, too. But you also get the single most ambitious effort the government has ever made to control costs in the health-care sector. According to the Congressional Budget Office, the bill cuts deficits by $130 billion in the first 10 years, and up to $1.2 trillion in the second 10 years. The excise tax is now indexed to inflation, rather than inflation plus one percentage point, and the subsidies grow more slowly over time. So one of the strongest cost controls just got stronger, and the automatic spending growth slowed. And then there are all the other cost controls in the bill: The Medicare Commission, which makes entitlement reform much more possible. The programs to begin paying doctors and hospitals for care rather than volume. The competitive insurance market.

Perhaps the only thing a conservative might still object to is abortion funding, although that cow has been beaten dead.  The Hyde Amendment already prevents federal spending on abortion, and the language in the bill only reiterates that.

On the prediction markets, health care reform passage (before June 30) has risen to almost 80% (it was in the 30% area a month ago):

As I mentioned yesterday, we're at the moment-of-truth for health care reform passage in the House, and it's a nailbiter.  In order to pass, a lot of Democrats neeed convincing (many are on the fence, and it is assumed that all House Republicans will vote "no").  A lot of wavering Democrats were concerned about whether HCR would explode the deficit.

The non-partisan CBO report came out this morning, and it's good news for the Democrats seeking health care reform:

House Democrats, gearing up for a possible vote on Sunday to pass health care legislation, pledged that the details they were about to publish would produce significant cost savings in the decades ahead.

The House Democratic leader, Rep. Steny H. Hoyer of Maryland, said that the nonpartisan Congressional Budget Office had determined that the package of legislation would produce “the largest deficit reduction of any bill we have adopted in Congress since 1993,” when it passed President Clinton’s budget proposal including substantial tax increases.

In the first ten years, the legislation would reduce deficits by $130 billion, Rep. James E. Clyburn of South Carolina, the House majority whip, said after a meeting of the party’s caucus. The effect on deficits over the following decade would be much greater, a total of $1.2 trillion, he said. The savings would come largely from reductions in the growth of Medicare spending, with new fees and tax increases also contributing.

***

The bill that the House passed in November would have reduced deficits by slightly more — $138 billion compared with $130 billion — in the first ten years, while the version passed by the Senate in December would have reduced deficits by somewhat less — $118 billion — according to the budget office, whose estimates are considered authoritative.

The cost of the legislation has been a major concern for many centrist Democrats, a crucial bloc for leaders who are trying to muster the majority to pass the bill.

“We are absolutely giddy over the great news,” said Mr. Clyburn, who as the party whip is the keeper of its tallies, as the leadership seeks the 216 yes votes it will need for the decisive vote, expected this weekend.

Therefore, the House health care reform bill:

1. CUTS THE DEFICIT Cuts the deficit by $130 billion in the first ten years (2010 – 2019). Cuts the deficit by $1.2 trillion in the second ten years.

2. REINS IN WASTEFUL MEDICARE COSTS AND EXTENDS THE SOLVENCY OF MEDICARE; CLOSES THE PRESCRIPTION DRUG DONUT HOLE Reduces annual growth in Medicare expenditures by 1.4 percentage points per year—while improving benefits and lowering costs for seniors. Extends Medicare’s solvency by at least 9 years.

3. EXPANDS AND IMPROVES HEALTH COVERAGE FOR MIDDLE CLASS FAMILIES Expands health insurance coverage to 32 million Americans Helps guarantee that 95 percent of Americans will be covered.

4. IS FULLY PAID FOR Is fully paid for – costs $940 billion over a decade. (Americans spend nearly $2.5 trillion each year on health care now and nearly two-thirds of the bill’s cost is paid for by reducing health care costs).

Expect some more movement to the "yes" column.

The House is expected to vote on Sunday.

UPDATE: And it begins. Adam Smith (D-WA), an “undecided” who was always going to vote for the bill, told MSNBC just now that he’s a likely yes.

UPDATE II: And another: Elliot Engel, again, was always going to be a yes.

UPDATE III:  The GOP pushback is lame.  Here is what's being written at Ace of Spades, a top righty blog?

So even if there magical assumptions all come true (and they won't), the net reduction in the deficit is essentially zero. We're going to rework the entire health care system and if everything goes right, we won't even eliminate one month of deficits?

You see what they did?  They lumped the health care bill in with everything else that is contributing to the deficit, and then said there is no "net reduction".  In other words, the health care reform bill will reduce the deficit, but since the deficit is still growing (for other reasons), the health care reform bill (according to these bozos) is a failure.

Spin fail — especially when it comes from those who were claiming for months that health care reform would "explode" the deficit.

The wingers are now making up studies in their desperate, last-ditch effort to kill health reform bill. On Fox & Friends, co-host Brian Kilmeade said: "The New England Journal of Medicine has published a report and did a survey, and they said the impact of reform on primary care physicians, 46 percent, they say, feel reform will force them out or make them want to leave medicine."

This has been repeated all over the Internet.

Guess what?  The NEJM never conducted a study that says that.

Never.

Supporters and opponents of health care reform assembled outside Rep. Mary Jo Kilroy's (D-Ohio) office yesterday, and it was quite contentious.

Present was a man holding a sign, explaining that he has Parkinson's and needs health care reform to pass. When he sat on the pavement near the reform opponents, a conservative activist proceeded to lecture the man: "You're looking for a hand-out, you're in the wrong end of town. Nothing for free over here, you have to work for everything you get."

Another far-right protestor mocked the man, dropping a dollar bill on him, saying, "I'll pay for this guy. Here you go. Start a pot." Throwing another wadded bill, the protestor added, "I'll decide when to give you money. Here's another one, here you go." A moment later, he shouted at the man sitting on the street: "No more hand-outs."

Someone in the crowd is also heard saying, "You love a communist."

This is difficult to watch:

Then again, Rush Limbaugh gave the green light to mock people with Parkinson's.  Remember?

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.