Hume: Health Care Reform Was “Rammed Through”

From the March 27 edition of Fox News' Fox News Sunday:

HUME: I actually in my life have never seen anything like this. I've never seen a bill with this much consequence rammed through by one party alone. And it raised questions about the legitimacy of the measure from the start, and those questions persist today. [Fox News Sunday, Fox News, 3/27/11]

USA Today: Health Care Reform Debate In Congress Began In Spring 2009. A USA Today timeline of the health care debate notes that the Obama administration placed reform at the top of its legislative agenda in a February 24, 2009 address to Congress. This was followed by a summit between Obama, members of Congress, and representatives from the health care industry on March 5, 2009. [USA Today, 12/24/09]

House Did Not Pass Final Legislation Until March 2010. From a March 21, 2010, article in The New York Times:

After a year of combat and weeks of legislative brinksmanship, House Democrats and the White House clinched their victory only hours before the voting started on Sunday. They agreed to a deal with opponents of abortion rights within their party to reiterate in an executive order that federal money provided by the bill could not be used for abortions, securing for Democrats the final handful of votes they needed to assure passage.

Winding up the debate, Speaker Nancy Pelosi said: “After a year of debate and hearing the calls of millions of Americans, we have come to this historic moment. Today we have the opportunity to complete the great unfinished business of our society and pass health insurance reform for all Americans that is a right and not a privilege.” [The New York Times, 3/21/10]

Hume: Health Care Legislation Did Not Incorporate “Republican Ideas”

From the March 27 edition of Fox News' Fox News Sunday:

HUME: What I would about this is, think how different this would be now had the president and the Democrats in Congress been willing to incorporate some Republican ideas. A serious attempt at tort reform, for example. He would have gotten, I think, not only much of what he, the president, wanted, Republicans would have gotten some of what they wanted, a bunch of them would have voted for it, this notion that it is a partisan bill would be gone, the whole picture right now would look different from the way it does. [Fox News Sunday, Fox News, 3/27/11]

In Fact, The Bill Included Several GOP Ideas And Amendments

Obama: "[W]hen You Say I Ought To Be Willing To Accept Republican Ideas On Health Care, Let's Be Clear: I Have." From remarks made by the President at his January 29, 2010 meeting with the House GOP:

This is a big problem, and all of us are called on to solve it. And that's why, from the start, I sought out and supported ideas from Republicans. I even talked about an issue that has been a holy grail for a lot of you, which was tort reform, and said that I'd be willing to work together as part of a comprehensive package to deal with it. I just didn't get a lot of nibbles.

Creating a high-risk pool for uninsured folks with preexisting conditions, that wasn't my idea, it was Senator McCain's. And I supported it, and it got incorporated into our approach. Allowing insurance companies to sell coverage across state lines to add choice and competition and bring down costs for businesses and consumers -- that's an idea that some of you I suspect included in this better solutions; that's an idea that was incorporated into our package. And I support it, provided that we do it hand in hand with broader reforms that protect benefits and protect patients and protect the American people.

A number of you have suggested creating pools where self-employed and small businesses could buy insurance. That was a good idea. I embraced it. Some of you supported efforts to provide insurance to children and let kids remain covered on their parents' insurance until they're 25 or 26. I supported that. That's part of our package. I supported a number of other ideas, from incentivizing wellness to creating an affordable catastrophic insurance option for young people that came from Republicans like Mike Enzi and Olympia Snowe in the Senate, and I'm sure from some of you as well. So when you say I ought to be willing to accept Republican ideas on health care, let's be clear: I have. [WhiteHouse.gov, 1/29/10]

Republicans And Conservatives Were For The Individual Mandates Before They Were Against It.

• In 1993, Republican Sen. Don Nickles (OH) introduced the Consumer Choice Health Security Act of 1993 with 24 Republican co-sponsors (more than half the Republican caucus). In his introductory remarks on the bill, Nickles said that under his bill, "[e]veryone will be required to carry at least catastrophic health insurance for their protection and to stop cost shifting." [Congressional Record, Page S16728, retrieved via thomas.loc.gov, 11/20/93]

• Also in 1993, Republican Sen. John Chafee (RI) introduced a bill that required “each citizen or lawful permanent resident to be covered under a qualified health plan or equivalent health care program by January 1, 2005.” The bill had 18 Republican and two Democratic co-sponsors. [S.1770, 11/23/93]

• In 2003, Heritage Foundation vice president Stuart Butler argued in congressional testimony in favor or an individual mandate requiring “individuals to enroll themselves and their dependents in at least a basic health plan.” He added: “The obligations on individuals does not have to be a ”hard" mandate, in the sense that failure to obtain coverage would be illegal. It could be a “soft” mandate, meaning that failure to obtain coverage could result in the loss of tax benefits and other government entitlements." [Heritage Foundation, 3/10/03]

• In 2007, Sen. Ron Wyden (D-OR) introduced a bill stating: “Each adult individual shall have the responsibility to enroll in a [Healthy Americans Private Insurance] plan offered through the HHA of the adult individual's State of residence unless they had insurance through another system or were ”opposed to health plan coverage for religious reasons." The bill had 10 Republican co-sponsors. [S.334, 1/18/07]

• Wyden also introduced a version of the bill in 2009, the year Congress began working on the health care proposal that became law. Like the 2007 version, the bill stated: "“Each adult individual shall have the responsibility to enroll in a [Healthy Americans Private Insurance] plan offered through the HHA of the adult individual's State of residence unless they had insurance through another system or were ”opposed to health plan coverage for religious reasons." The bill had five Republican co-sponsors. [S.391 2/5/09]

Washington Post's Klein: “I Don't Think It's Well Understood How Many Of The GOP's Central Health-Care Policy Ideas” Are In Senate Bill. From a February 8, 2010, blog post on the website of The Washington Post:

At this point, I don't think it's well understood how many of the GOP's central health-care policy ideas have already been included as compromises in the health-care bill. But one good way is to look at the GOP's "Solutions for America" homepage, which lays out its health-care plan in some detail. It has four planks. All of them -- yes, you read that right -- are in the Senate health-care bill.

(1) “Let families and businesses buy health insurance across state lines.” This is a long-running debate between liberals and conservatives. Currently, states regulate insurers. Liberals feel that's too weak and allows for too much variation, and they want federal regulation of insurers. Conservatives feel that states over-regulate insurers, and they want insurers to be able to cluster in the state with the least regulation and offer policies nationwide, much as credit card companies do today.

To the surprise and dismay of many liberals, the Senate health-care bill included a compromise with the conservative vision for insurance regulation. The relevant policy is in Section 1333, which allows the formation of interstate compacts. Under this provision, Wyoming, Colorado, Arizona, Utah, and Idaho (for instance) could agree to allow insurers based in any of those states to sell plans in all of them. This prevents a race to the bottom, as Idaho has to be comfortable with Arizona's regulations, and the policies have to have a minimum level of benefits (something that even Rep. Paul Ryan believes), but it's a lot closer to the conservative ideal.

(2) “Allow individuals, small businesses, and trade associations to pool together and acquire health insurance at lower prices, the same way large corporations and labor unions do.” This is the very purpose of the exchanges, as defined in Section 1312. Insurers are required to pool the risk of all the small businesses and individuals in the new markets rather than treating them as small, single units. That gives the newly pooled consumers bargaining power akin to that of a massive corporation or labor union, just as conservatives want. It also gives insurers reason to compete aggressively for their business, which is key to the conservative vision. Finally, empowering the exchanges to use prudential purchasing maximizes the power and leverage that consumers will now enjoy.

(3) “Give states the tools to create their own innovative reforms that lower health care costs.” Section 1302 of the Senate bill does this directly. The provision is entitled “the Waiver for State Innovation,” and it gives states the power to junk the whole of the health-care plan -- that means the individual mandate, the Medicaid expansion, all of it -- if they can do it better and cheaper.

(4) “End junk lawsuits.” It's not entirely clear what this means, as most malpractice lawsuits actually aren't junk lawsuits. The evidence on this is pretty clear: The malpractice problem is on operating tables, not in court rooms. Which isn't to deny that our current system is broken for patients and doctors alike. The Senate bill proposes to deal with this in Section 6801, which encourages states to develop new malpractice systems and suggests that Congress fund the most promising experiments. This compromise makes a lot of sense given the GOP's already-expressed preference for letting states “create their own innovative reforms that lower health care costs,” but since what the Republicans actually want is a national system capping damages, I can see how this compromise wouldn't be to their liking.

(5) To stop there, however, does the conservative vision a disservice. The solutions the GOP has on its Web site are not solutions at all, because Republicans don't want to be in the position of offering an alternative bill. But when Republicans are feeling bolder -- as they were in Bush's 2007 State of the Union, or John McCain's plan -- they generally take aim at one of the worst distortions in the health-care market: The tax break for employer-sponsored insurance. Bush capped it. McCain repealed it altogether. Democrats usually reject, and attack, both approaches.

Not this year, though. Senate Democrats initially attempted to cap the exclusion, which is what Bush proposed in 2007. There was no Republican support for the move, and Democrats backed off from the proposal. They quickly replaced it, however, with the excise tax, which does virtually the same thing. The excise tax only applies to employer-sponsored insurance above a certain price point, and it essentially erases the preferential tax treatment for every dollar above its threshold.

(6) And finally, we shouldn't forget the compromises that have been the most painful for Democrats, and the most substantive. This is a private-market plan. Not only is single-payer off the table, but at this point, so too is the public option. The thing that liberals want most in the world has been compromised away. [Voices.WashingtonPost.com, 2/8/10]