The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Lack of GOP Support for Baucus Health Care Reform Matters, But Not So Much

Posted by Alan on September 15, 2009

After months of trying to craft health care reform legislation that would garner at least some Republican support, Senate Finance Committee Chair Max Baucus appears ready to move forward without GOP support – at least for now. According to the Associated Press, Senator Baucus will release his proposal on Wednesday without any Republican co-sponsor. The media will claim this is a huge setback for Senator Baucus and for President Barack Obama.

Maybe, but I don’t think so. First, there is a possibility at least one Republican will support the legislation when it comes to a vote in committee. reports that “Sen. Olympia Snowe (R-Maine), who is considered the likeliest Republican to sign onto the bill, said she wants to wait to see how the committee process plays out. “’I am committed to this process,’” Snowe said. “’I want this effort to continue and I am going to work through all these issues and the committee process will advance that as well and we will continue to work together.’” While the other two Republicans working on bi-partisan legislation sounded less upbeat, they have not completely closed the door to supporting bill either.

The second reason the lack of any Republican support may not matter much in the long run is that Senator Baucus’ bill will appeal to Democratic moderates. And while Republican votes would be useful, it is moderate Democrats that hold the key to health care reform. Without the support of most of the members of the Moderate Dems Working Group in the Senate or the Blue Dog Coalition in the House, Congress cannot pass health care reform legislation. There are 18 Democratic Senators who are a part of the moderate group. At least eight of them must support legislation for it to pass. In the House, where Democrats outnumber Republicans 257-to-178, there are at least 52 members of the Blue Dog Coalition. They need at least 13 of them to support reform legislation.

Yes, there are more liberals in Congress than moderates. And some of these liberals are threatening to oppose health care reform that does not meet their litmus test of including a government-run health plan. But it’s much easier for a moderate to oppose health care reform than it is for liberals.

A moderate can stand on the floor and claim the bill is too expensive or involves too much government. Given their districts, this is unlikely to hurt them politically. In fact, it will likely help them in the upcoming election.

For a liberal to oppose one of the most important priorities of the Democratic Party because it doesn’t go far enough is a much tougher message. They must claim that millions of Americans should go without health care coverage because the bill isn’t ideologically pure enough. They must explain why insurance carriers should be permitted to continue to deny coverage to individuals with pre-existing conditions because the legislation doesn’t include a public option. In other words, liberals need to argue that the status quo is better than any reform. That’s not only a tough argument to make, it’s a foolish one.

Senator Baucus would love for Republicans to support his health care reform bill. President Obama would too. But they don’t need Republicans to support the bill. They need moderate Democrats.

Senator Baucus is pitching his proposal to those moderates. If he succeeds and if President Obama can get liberals to vote for what they will perceive is a partial loaf, then health care reform passes. If either fails in their assignment, so does health care reform.

It’s that simple. And that complicated.


8 Responses to “Lack of GOP Support for Baucus Health Care Reform Matters, But Not So Much”

  1. Alan said

    As I’ve made clear over the past several months, I believe the Senate Finance Committee’s bill will closely mirror the finanl version of health care reform legislation likely to emerge from Congress. Not everyone agrees. Here is a posting on the HuffingtonPost by Mike Lux, a progressive, who believes Congress will produce a much more liberal bill. While our expectations differ, Mr. Lutz does a good job of articulating his reasoning. His scenario for what happens next is worth reading.

  2. One of the tidbits I heard while watching some of the Kennedy funeral and listening to the talking head pundits about is legacy was the Sen.’s supposed deep regret at not making a partial deal with Nixon to reform health care decades ago. Kennedy help firm for what he thought was completely right, and he got nothing for such ideological purity. He said later that he wished he had made an incremental deal that could be built upon in subsequent years.

    I am hoping that the diehard progressives take this to heart because it almost seems to me that the fear of change afflicting so many skittish Americans may be best remedied by baby steps that do not end in calamity. Only then will the recalcitrats be open to further incremental improvements.

    Alan, your perspicacity and high minded civility in this blog has, to me, been nothing short of breath-taking. You are surrounded by ruddy-faced blowhards on the right and the left, but you keep a decent tongue in your mouth!

    As Yeats put it, the best lack all conviction, the worst are full of passionate intensity. Here is a request from one of your blog-reading fans: can you give us your prediction of what you believe will happen with the reform movement and (should some form of this come into law) your sense of a time table for implementation.

    I ask for very personal and selfish reasons. I turn 57 in a week and a half, and my private insurer is set to redo the rates come March or February. As I suspect I have mentioned ad nauseam on this forum, we currently pay $1711.50 per month, or $20,538 per year, and it has been going up by about $200 per month. With $500 deductible and 80 percent coverage up to the first $5000 for each of the four of us, our total medical bills, not including dental or optical, have been averaging around $25,000 per year. My gross salary (self employed) is $62,000, so as you can see, this is a very heavy burden for us.

    Are we likely to see any relief in the next year? Two years? Three? If not, I can easily imagine that our monthly nut will climb well into the mid $2k range, maybe up to $3k per month.

    I know that a lot of your readers are health insurance brokers. Do you guys every look at a person’s situation and tell him frankly that there are no good options available, that he might be better off just going without insurance altogether and hoping to avoid a bus or tumor till Medicare kicks in?

    Thanks for any advice you all can provide. Sometimes the political is the personal.

    • Mark Goodman said

      James health insurance is arithmetic. You should see if you can switch to a HSA eligible plan. Do the math and you should find that you will save several thousand dollars regardless of your utilization.

      I wholeheartedly agree with you about Alan and this blog. None better!

      • Mark, though I made mention of this in another post, I have investigated the possibility of trying to get an HSA type policy. For $10,000 deductible, I will still have to pay around $900 a month, perhaps a tiny bit cheaper if I go through a writer’s association (I am a freelance magazine writer.)

        Both a local broker and the writers association gave me quotes for HSA policies through Assurant. Then, yet another local broker, who had recommended Assurant in the past, STRONGLY urged me not to consider this company because of the way it had treated one of her clients (refusing to pay for treatment for something necessary and claiming, falsely, that he had failed to disclose something.) She told me that their fine print is so labyrinthine and convoluted that it is relatively easy for the company to come up with reasons not to pay if a client ever actually exceeds his own $10,000 deductible.

        In any event, I just saw today a court decision in South Carolina, one of the most conservative and pro-business states in the union, that called Assurant’s actions “reprehensible.” They were fined $15 million for rescinding a college student’s policy after he gave a blood transfusion and tested positive for H.I.C.

        All I want is to be convered in the event of a catastrophy so my family won’t lose everything. To pay $900 a month for the privilege of spending my own money on every conceivable regular healthcare expense, it seems to me, is like spending $10,800 a year pretty much just for catastrophic coverage.

        If it looks like a decent chance this will be rescinded if I actually need it, what is the point?

        You don’t even get peace of mind from such usury!

    • Rick said

      Jim, if I understand the message, your annual medical bills paid by insurance total approx 20k per year, and your health insurance premium cost is approx 20k annually. If that’s correct, I feel you are treated very fair as most all your annual medical bills are paid and your insurance remains available for an unexpected major event.

      • Alison said

        I third the comment that Alan Katz is a gift to us all. I read this blog and then watch it unfold usually as predicted here. Not only do I get knowledge here but I also learn alot from all the other seats at the table.

      • Rick, I probably didn’t make this clear. I went to the doctor once this year and last year total, and it was only to get a refill on a prescription. In the past three yers, my two sons have gone to the doctor only for mandatory sports physicals and school required immunizations. My wife goes periodically for recommended PAP smears and the like.

        None of us has had any major medical problem, knock on wood. What the problem is, I am pretty sure, is that both my wife and I take statin drugs for high cholesterol, and antidepressants for some past problems with depression (nothing horribly serious, no hospitalization or anything like that.) I am actually a masters swimmer, and last December had two #5 times in the world in my age group (55-59). I don’t mean to seem like a braggart here, but I just add this to show that I do take my health seriously and do not consider myself an inordinate risk the way private insurance actuaries seem to think.

        Our insurance company, BC/BS of MN, was fairly affordable when we were younger, but since 2006, the premiums have gone up from $950 a month to over $1700 a month. There has been no change in our health status. We are self-employed and have been told that because of taking statins and antidepressants, we will not qualify for other plans if we try to switch. It’s conceivable we could get a HSA type plan, though this is not guaranteed. However, one local broker told us she has stopped recommending the leading HSA provider in this area because their policies have so much fine print that if you do need something beyond your own $10,000 deductible, they tend to find ways to disallow it.

        Even if we could qualify for this kind of coverage, we would be looking to pay $800-900 a month.

        The reason why I have become so politicized about this whole debate is because it just seems inherently unfair to me that employment status alone should determine how much two individuals should pay for the exact same coverage.

        If I worked for a large corporation that could negotiate with insurers, I would pay a relative pittance.

        If I worked for a small corporation, perhaps one with an older workforce and a history of claims, I would pay significantly more, but still enjoy considerable legal protections vis a vis sudden jumps in premiums and exclusion from the group because of pre-existing conditions.

        But as a self-employed person, with no negotiating clout whatsoever, in fact a person prohibited by law from forming a group for the purposes of obtaining health insurance (I wanted to see if I could start a group for anyone who has placed in the Top 10 in the world in different recognized swimming events, but was told there is a law against this because it would drain healthy people from corporate groups), I am left to fend for myself.

        I have no negotiating clout whatsoever. What is so galling to me is how the Republican “Party of No” lionizes entrepreneurship and small business out of one side of their mouths, while doing everything in their power to tilt things to their corporate puppet masters’ advantage.

        From a self-employed person’s point of view, especially one who has made the mistake of ever taking any prescription medication, no matter how commonly prescribed and ubiquitously advertised, the current health care system seem the absolute opposite of a “free market” situation.

        Spend a few minutes in the barrel with me and the other self-employed trout, with Blue Cross and Aetna and United Healthcare and all the rest of them leveling their rifles at us, and see what you think of our system!

        • Rick said

          Aetna and United heathcare are for profit companies with operating margins after taxes of 4.5% & 3.7%. Aetna’s expense is 17.8% and I have no info on United Healtcare. Blue Cross is probably a non-profit.

          Jim, maybe solving your problem resides elsewhere. I would search for a Certified Financial Planner in your area by accessing the Certified Financial Planner Board of Standards, Inc. ( Who knows, maybe we’ll meet.

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