News & Events

One last big try on health

Obama offers plan for summit, envisions way to bypass GOP

By Lisa Wangsness and Susan Milligan, Globe Staff  |  February 23, 2010

WASHINGTON – President Obama launched a final drive for a sweeping health care overhaul yesterday, offering a proposal that the White House hopes will help unite squabbling Democrats and, if necessary, could be used to bypass Republicans altogether.

Representing the first full-fledged health care plan offered by the president, the proposal was part of a two-track White House strategy: demonstrate a willingness to compromise across the aisle at a health care summit set for Thursday, but, at the same time, have a plan ready that might pass the Senate over GOP objections.

White House officials characterized Obama’s proposal as an “opening bid’’ for the Thursday discussion. But Republican leaders immediately criticized Obama’s move as a preemptive strike that undermined his assertions of bipartisanship.

“The White House is still clinging to a massive bill that Americans have overwhelmingly rejected again and again for months,’’ Senate minority leader Mitch McConnell said in a speech on the Senate floor.

The president’s plan retains most of the major elements of a bill the Senate passed on Christmas Eve, including an expansion of insurance to cover 30 million Americans who lack insurance, government subsidies to help them afford it, and a combination of new taxes and spending reductions to cover the $950 billion price tag.

White House officials said yesterday that the president’s proposal was crafted to allow it to pass without any Republican votes, if necessary, using a process called “reconciliation,’’ which lets the Senate bypass a fil ibuster and adopt legislation by a simple majority of 51 votes, as long as each provision affects federal revenue.

The health care initiative has been stalled since last month, when Massachusetts voters took away the Democrats’ 60-vote, filibuster-proof majority by electing Republican Scott Brown to fill the seat of the late Senator Edward M. Kennedy.

With Democrats as yet unable to develop a coherent strategy for moving forward, the White House sought to put a determined face on its latest move yesterday.

“The president believes the American people deserve an up-or-down vote on health reform,’’ said White House communications director Dan Pfeiffer in a conference call with reporters. “Our proposal is designed to achieve that if the Republican Party decides to filibuster. . . . That was certainly a factor in how we put the proposal together.’’

Pfeiffer said the president’s proposal is based on agreements House and Senate leaders made in January, before Brown was elected, when they had almost completed a final compromise.

The president’s move could put pressure on Republicans to offer serious alternatives at Thursday’s summit, which will be broadcast on television.

“If Republicans do what they say they’re going to do, namely come to the summit without putting [an alternative] on the table, I think the Democrats will have no choice but to go forward,’’ said Ron Pollack, executive director of Families USA, a leading advocate of the Democratic proposals.

Yesterday Senate Democrats – even some, like Senator Mary Landrieu of Louisiana, who have expressed reservations about moving forward with reconciliation – sounded energized.

“I’m happy that this proposal has come forward; we need to continue to push for health care reform,’’ Landrieu said. She characterized the GOP leaders as “very disingenuous’’ in their approach to health care and said she remained open to considering reconciliation. “If they have amendments, they should just put them up on the table, or be quiet.’’

Obama’s plan does contain some ideas championed by the GOP in years past – including reductions in Medicare spending growth, strategies to combat waste and fraud in Medicare, and a proposal for establishing a national private insurance plan. It does not, however, include some of the GOP’s most sought-after goals, such as caps on medical malpractice lawsuits. And it does not significantly pare down the size of the proposal, as the Republicans want.

The proposal adheres more closely to the Senate bill than to the version passed by the House earlier last year. It does not contain a government-sponsored health plan, or “public option,’’ that was rejected by the Senate after months of wrangling between liberal and moderate Democrats.

It would reduce the number of individuals and families with high-value, high-benefit health care plans that would be subject to a 40-percent “Cadillac’’ excise tax, and also delay the tax until 2018. It would eliminate a highly unpopular special Medicaid deal for Nebraska in favor of providing more generous Medicaid assistance to all states. It also includes new regulations requiring insurers to justify exorbitant rate increases.

Senate majority leader Harry Reid said it “brings together the best of the Senate bill and the best of the House bill in a fiscally responsible way.’’

But whether Reid and other Senate Democrats have the political will to push through a bill using the reconciliation process remained unclear yesterday. And even if the Senate were able to achieve such a feat, House leaders could have trouble duplicating their 220-to-215 vote of last year, given the increasing worries among moderate Democrats about voter ire in the 2010 midterm elections.

A contingent of House Democrats have said they also won’t support the Senate bill unless it contains the House bill’s stricter abortion coverage restrictions. Strict rules don’t allow provisions to pass under reconciliation unless they affect revenue, so abortion would have to be passed separately.

“Now they’ve given us a plan, but we need a strategy to get it through the House and the Senate,’’ said a senior Democratic aide who asked not to be named so he could speak candidly about the situation.

GOP leaders have called on Obama and his party to throw out their proposals and “start from scratch’’ on a new bill. Republicans have argued for a more incremental approach that would insure a fraction of the 30 million people the Democratic bills would cover.

“If the president wants to start with another warmed-over version of the majority’s failed bill, it will be a major disappointment for all Americans,’’ said Senator Mike Enzi, Republican of Wyoming, in a statement.

White House officials said yesterday the new plan would cost $950 billion over 10 years, similar to the bills stalled in Congress.

The price would be offset by a combination of reductions in Medicare spending, industry fees, taxes on high-cost health insurance, and penalties for individuals who do not purchase insurance and employers whose uninsured employees turn to the government for help affording coverage.

Individuals would have to obtain insurance or face a fine, and employers with more than 50 employees would have to help offset the cost to the government if their uninsured workers apply for federally subsidized insurance.

It would prohibit insurers from dropping or denying coverage based on preexisting conditions or gender.

The bill also requires insurers to justify large rate increases to state and federal regulators – a provision designed to add a new populist appeal at a time when Anthem Blue Cross of California has said it is raising rates by 39 percent.

Yesterday Karen Ignagni, president and CEO of America’s Health Insurance Plans, the main lobby for health insurers, said regulating rate increases on health insurers ignores the cause of those rate increases, including soaring prices charged by doctors and hospitals and the lack of incentives for young, healthy people to continue purchasing insurance and therefore help subsidize older and sicker people.

She said the president’s proposal, which contains a light penalty for not obtaining insurance, does not do enough to encourage universal participation.

“We’re a small part of the health care equation, and if we want to have a sustainable system, we’ve got to get to those underlying drivers,’’ she said.