The hard bargains and steep costs of passing health reform

Unveiling a modified health reform bill on Saturday, Senate Democratic leaders appear to have cobbled together the 60 votes they’ll need to pass the most expansive overhaul to the nation’s health care system in generations. But winning that support comes at a steep cost.

Sen. Ben Nelson (D-Neb.) (WDCpix)

Sen. Ben Nelson (D-Neb.) (WDCpix)

To satisfy Democratic moderates, Senate Majority Leader Harry Reid (D-Nev.) had to drop the public option, the government-run insurance plan many experts argue is necessary to keep insurance costs down, and he had to add an abortion provision that reproductive rights groups say will leave millions of women without comprehensive health coverage.

The compromises are emblematic of the political pickle Democratic leaders have faced all year. Despite commanding the 60-seat majority needed to defeat Republican filibusters, party leaders have quickly discovered that uniting the disparate ideologies and regional interests represented by the diverse troop of Democratic senators is no simple task. The disagreements within their own caucus have led party leaders to dilute some of their top legislative priorities — like credit card reform — and drop others altogether, as was the case with mortgage bankruptcy reform. As The Washington Post’s Joel Achenbach wrote Saturday, “Life at 60 has been awkward for the Democrats.”

Nowhere has that statement rung more true than in the debate over health care reform, where conservative-leaning Democrats have had much greater success watering down the bill than all Republicans combined. For example, to satisfy Sen. Joe Lieberman (I-Conn.), who caucuses with the Democrats, the bill scraps the public option, instead proposing the creation of national insurance plans to be contracted by the government to private companies. Lieberman, representing the insurance-industry hub of Connecticut, has said the public plan would be too costly for the government at a time when federal deficits are already at record heights. For many months he’s hinged his support for the underlying bill on the absence of a public option — in any form.

Liberals have long said that a public plan is vital for creating competition in the largely uncompetitive insurance market, lowering costs and keeping the private insurers honest. Allowing private insurers to continue unchecked, they argue, is to empower the very industry that’s largely to blame for the ills plaguing the nation’s dysfunctional health care system

“Any measure that expands private insurers’ monopoly over health care and transfers millions of taxpayer dollars to private corporations is not real health-care reform,” Howard Dean, former head of the Democratic National Committee, wrote last week in The Washington Post.

In a huge concession to another moderate holdout, Democratic leaders included a provision that would allow states to ban abortion coverage for women receiving federal subsidies on proposed new, government-organized private insurance marketplaces, dubbed exchanges. Included to win the support of Sen. Ben Nelson (D-Neb.), that provision would also force women seeking abortion coverage to write two separate premium checks to their insurance company, ensuring that no federal funds pay for abortion services by separating the insurance payments. To entice Nelson, Democratic leaders also hiked federal Medicaid payments to Nebraska by $45 million over the next decade.

The abortion provision drew the immediate condemnation of women’s reproductive rights groups. NARAL Pro-Choice America issued a statement Saturday saying that the compromise is “outrageous,” and the Planned Parenthood Federation of America issued another calling the two-check system “unworkable.”

“There is no sound policy reason to require women to pay separately for their abortion coverage other than to try to shame them and draw attention to the abortion coverage,” said Planned Parenthood President Cecile Richards. “Moreover, it is highly unlikely that insurance companies will be willing to follow such an administratively cumbersome system, leaving tens of millions of women without abortion coverage.”

Nelson, for his part, accepted the criticisms without regret.

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Mike Lillis

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