The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

It’s Official: Health Care Reform 2010 is a Democrats-only Affair

Posted by Alan on January 4, 2010

Both sides abandoned bi-partisanship concerning health care reform a long, long time ago. Now it’s official, as these things go.

With both chambers having passed a version of comprehensive health care reform the bills are headed for a House-Senate conference committee. Usually this committee, made up of both Democrats and Republicans, iron out differences between the two proposals and produces something both the House and Senate can be expected to pass.

There are a lot of formal, procedural issues involved in this process. Usually, for example, three formal votes need to be held in both the Senate and the House before the conference committee formally convenes. Since each vote can be filibustered in the Senate, Democrats would need to bring all 60 members of its caucus to the floor for each of these votes. Then, at least in the Senate (I’m not sure about the House) there can be votes on non-binding recommendations to the conference committee members. As noted in an Associated Press article, this would “require Democrats to vote on political controversies such as wiping out the legislation’s proposed cuts in Medicare ….” As 2010 is an election year, this is a political weapon Democrats would prefer to keep out of the hands of the GOP.

So, according to the AP article, Democrats in Congress, along with the White House, are intent on bypassing the traditional conference committee procedures, reducing the opportunity for the GOP to force embarrassing votes or to delay a final version of health care reform legislation. I don’t pretend to be an expert on Congressional procedures, so I can’t explain how this is done or why it’s permitted. But the “why” and “how” is less important than the fact of it.

What this means is that negotiations over the final version of health care reform will be conducted solely among Democrats. This was going to happen anyway as there is no common ground between the parties on the legislation. As a result, the votes of Democratic moderates become even more clearly critical to passage of the reform legislation. It also means that Congress is far more likely to achieve its goal of putting health care reform legislation on President Barack Obama’s desk before his State of the Union address anticipated to be given in early February.

Republicans will still be vocal on health care reform. They’ll still seek to delay the legislation. Their task, however, will now be much more difficult.

17 Responses to “It’s Official: Health Care Reform 2010 is a Democrats-only Affair”

  1. Patrick said

    The reality that something needs to be done has never been so clear. But, to force a tax on someone that can’t afford the insurance to begin with, well that’s asinine.

  2. No republicans and essentially half the Democrats in Congress voted against this bill and they characterize it as a historic success that will be good for everyone. As John Stossel says, “Give me a break!” 0 Republican and 212 Democrats don’t think so. i don’t either. Here come the taxes.

  3. Meg McComb said

    I urge you to take a moment to click on this link for a ready-to-go
    letter to send to Washington. Our voices need to be heard while there
    is still time to make critical revisions in the pending Health Reform
    bill. In its present form, your health care insurance premiums are
    guaranteed to increase. For example, insurance carrier taxes would go
    into effect immediately, and within six months of enactment, the bill
    calls for no plan benefit limits. These provisions will force insurance
    companies to raise your next renewal premiums accordingly.

  4. Sean said

    Regarind the statement “no common ground”, that just isn’t true. The three things that block bi-partisanship in health care are these: 1) Another government entity that “determines” the best health care practices a la single-payer system/Europe style (Paul Ryan made this point in a New Yorker piece back in March) 2) Any addition government insurance programs 3) Republicans gain nothing from supporting Obama politically

    I don’t in any fashion support the mandate to purchase OR the mandate that insurance companies offer insurance to everyone -regarding the latter, at least not in the way it has been written so far. An elephant in the room on the insurance offer mandate is the restrictions that the “reform” bill is implementing on insurance policies -adding a cap to out of pocket costs for instance. An insurance company could afford to take on someone after they’ve been diagnosed with cancer as long as the person with cancer was held responsible to pay their fair share and keep the coverage after they’ve recovered. (If you don’t have car insurance and you hit someone, suprisingly, you’re actually expected to still pay for all of the damages.) This is why insurance portability, the lack of, is so infuriating. Their are non-government program ways to fix this. Sweden (not to be confused with Switzerland) is a perfect example -they don’t have any government run health programs but do subsidize the poor. They do mandate both sides of health insurance (issue/purchase) but they also aren’t an employer based insurance system and they have 100% of the insurance companies able to sell anywhere in the country. They let the insurance companies put pressure on hospitals, etc to keep costs down and to continue innovating. Insurance companies in Sweden can’t make a profit on the basic, minimum mandated coverage but can make a profit on any plan purchased that goes above the minimum coverage.

    Sweden’s health care and health insurance system has always struck me as the middle ground between the Republican and Democrat health system proposals.

  5. dave said


    Note- Medicare with its 3% payroll tax on income will run out of funds in 8 years, which happens to also be the time when large numbers of Americans will turn 65 and therefore qualify for the programs benefits. Will Congress raise taxes or reduce benefits?

    Note- States are already spending 30% of their budgets on health care and most are struggling to fund that along with education, roads, and local needs. What gives there?

    Note- The DEMAND side of health care is exploding. WHY? because we are an unhealthy nation. With increasing incidence of cancers, diabetes, inflammatory diseases like asthma, arthritis, and allergys to name a few. Mortality rates maybe declining for some cancers and heart disease, but incidence is on the rise. Obesity also is a major problem with no end in sight. This coupled with the fact that the baby boom generation has the most wealth and savings to spend will mean the baby boom generation will DEMAND and will offer to pay for more health care, regardless of what the rest of America says. This demand will mean higher prices and more spending on health care.

    • Nosedoc said

      Further adding to the cost of health care is Medicine’s successes in extending the life span of patients who would have previously died at much younger ages from their heart disease, obstructive sleep apnea and other chronic diseases. Patients with chronic disease are living longer, and costing the system more.

  6. Rhonda said

    Having worked as a hospital CEO I am looking forward to expanded access. It is very difficult to deal with situations where patients do not have health care and cannot get the care they need. And, costs are way out of control.

    This bill does not represent a “fix all”. Frankly I am not sure that it will fix anything. What I do know is that we must try (as hard as it will be)to take small steps towards fixing our system. It is definitely broken at this time.

    • Rick said

      “It is very difficuly to deal with situations where patients do not have health care and cannot get the care they need”

      Don’t you mean; patients do not have health insurance instead of health care? Do hospitals refuse the proper health care if the patient does not have health insurance?

      “to take small steps towards fixing our system”

      This health bill is not a small step. It is a giant new entitlement that I’m afraid this country cannot afford.

  7. Ron Masters said


    I too question the tactics (whatever congressional maneuvering, legal, constitutional) it is that will be used (abused) to accomplishes enactment of this mess.

    After all of the closed and locked door meetings, there is no surprise to the content of this AP story.

    The only thing that does surprise me is the continued arrogance with which the Democrats exhibit when they allow and most probably prompt the release of their overspending and government controlling initiatives

    To quote John McEnroe,”You can’t be serious!”

    I guess sugar coating my feelings may not have been successful.

    Happy New Year


  8. Meg McComb said

    Alan, do you think there is any chance that the constitutional challenge to the individual mandate being successful?

    • Alan said

      Personally: no. While there may be some basis for the suit, I don’t think the courts will overturn the individual mandate. But that’s speaking as an interested observer, not a lawyer. I haven’t researched the issue thoroughly.

      Further, I don’t think it would be good for the health care system if the individual mandate was overturned. No one is suggesting that requiring carriers to accept all applicants for coverage is unconstitutional. And as I’ve written in several posts, guarantee issue without a requirement for people to buy coverage is guaranteed to substantially increase premiums. This imbalance is one of the reasons premiums in New York are two or three times the cost of coverage in California.

    • JimK said

      The attached link is to an article from the Heritage Foundation. The Heritage Foundation is a Conservative “Think Tank” and, as can be expected, are opposed to the individual mandate. Proponents of the legislation state that their authority is governed by the Commerce Clause.
      However, the author of this article disputes this authority with regards to the individual mandate and makes a compelling case against this particular provision.
      According to the article the individual mandate is an unprecedented act in our legislative history and does not have precedential Supreme Court decisions to support its constitutionality.
      While I have not thoroughly researched the issue, it would appear that “Individual Mandate” provision of the Healthcare Reform legislation will be tested via the Supreme Court and given the current makeup of the Court I would not be surprised if the individual mandate was overturned.

      • npg said

        if the individual mandate is held to be unconstitutional, or if the “fines” are inadequate (they obviously have been designed to be too small) then the insurance industry will implode quickly….you cannot let people wait to buy insurance until they are sick….you can, but the private insurance industry will implode quickly…you also cannot applyh “fines” that are nowhere near the real cost of insurance…this is known by Democrats already, they have it all planned out….implode the system, crush the industry, and the then ride to the rescue on their socialist white horse with socialized medicine

        • Alan said

          NPG: Thanks for your comment. What’s interesting is that the push for no mandate or a weak penalty is coming from Republicans. Virtually all of the various plans put forward by GOP members of Congress include a mandate to sell coverage on the carriers, but no mandate on consumers to buy it. The Senate Finance Committee’s penalties were watered down in order to keep Senator Olympia Snowe’s support. I agree that some Democrats would be happy for a system that undermines private carriers, but when it comes to the “wait until you need it, then buy the coverage,” we’re looking at bi-partisan foolishness.

    • JimK said

      Just one other thing, there is some irony in the position taken by the Heritage Foundation and that is their view supports the constitutionality of a single payer system with an across the board tax for every individual.

    • Billy B said

      Many states have mandates for car insurance and have for years. If that has never been overturned, I don’t see why this would be.

      • JimK said

        It’s not quite the same thing: first automobile insurance is mandated by State law; second an individual is not required to purchase an automobile. What opponents of this legislation are saying is that the Federal Government is mandating the purchase of an automobile, metaphorically speaking.
        However, after reading additional material on the subject I have come to agree with Alan and that is the individual mandate provision will probably withstand judicial scrutiny.
        It still would be interesting to see how the Supreme Court would rule but I am not even sure they would agree to hear this case.

        The link below provides more information on the constitutionality of the individual mandate.

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