What to watch for in the health reform battle

Yes, this post is long, but it is all important.

Here is what to watch for next.

First, watch for Senate Blue Dogs and liberals talking behind closed doors.

Democrats are arguing that today’s result wasn’t that bad – we got more votes than expected on the public option, the public option is on the march, it hasn’t lost any ground, the floor bill will still have the public option, and we have 60 votes for cloture and 51 votes, easily, for the public option, etc. The facts bear them out: the Finance Committee was a hostile environment for the public option, and the Senate floor and the House-Senate conference won’t be as hard. The timeline is still on track for the passage of a bill by Thanksgiving. Even Grassley admits the public option could pass on the Senate floor. The latest polls show that Americans still want affordable care they can count on, and the latest Kaiser poll shows that the public demand for health reform is spiking: 57 percent say reform is more important than ever.

And the big one: some Democratic Senators who haven’t yet endorsed the public option are approaching the guys who do support it, seeking points of agreement – these guys are looking for ways to vote “yes” in the end. So we will get to 51 on the public option.

A look at some individual Senators:

Bill Nelson is under pressure from paranoid seniors, but he voted for one of the two amendments today, so he is gettable.
Conrad voted “no” today, but he admitted that the Schumer formula comes close to a plan that can win 60 votes (he likes the fact that it’s not tied to Medicare rates) and much closer to something he himself likes, suggesting he won’t block cloture and could even vote for the bill itself.
Baucus claims he likes the public option, but voted against it because it can’t possibly pass, which is absurd; if we do get to the finish line successfully, and then he still votes against cloture and/or against the bill, his excuse will be exposed as crap. He can’t stand any more public embarrassment of that kind – his own constituents are furious with his footdragging.
Stabenow will work to push the floor bill to the left.
Menendez publicly slapped down Grassley’s lies on the public option – he’s on board.
Carper originally said he only wants public option with a trigger, and rejected the Rockefeller amendment, but then voted for the Schumer amendment with no trigger.
Snowe will be the belle of the ball as long as she’s on the fence, so she will stay mum; she wants affordable coverage.

Having Nelson and Carper publicly voting for the public option bumps up the nose count.

Next, watch to see which bill is used as the basis for forming the final Senate bill. The White House, Harkin, Dodd and Reid will cobble together the combined Baucus-HELP bill. Technically Reid is in charge of this, but he’s already hinting that he will hand the reins over to the White House, which is good. The White House prefers the public option in the floor bill, Harkin wants it, and they will get help also from Schumer, who is a member of the Finance Committee but also Number Three in the Senate leadership.

So a key issue is whether they will use the Baucus bill as their “chassis” to add or subtract amendments, or the HELP bill. If they use the HELP bill as a base, the GOP must introduce amendments to kill the public option; but if they use the Baucus bill, the Democrats must add amendments in order to add the public option, which would force some Democrats to weigh in on the provision before they are ready to show their hands. So a lot of Senators want to stick to HELP, I think.

Next, watch for any statements by any Senator, especially Nelson, on cloture. Something that Baucus is possibly confused about: the Democrats need 60 votes for cloture, but only 51 for the public option. Soon we will see more pressure from the Democratic leadership on Democratic Senators regarding the cloture issue: in effect, Obama will dare anybody to vote against cloture. The media will keep pinging guys like Nelson to declare on the cloture issue. Voting against cloture means defying the President and the party, and damaging the party; Obama’s gamble is that all those Blue Dogs will be satisfied voting for cloture and then against the bill, and that they won’t risk their careers just to block a popular measure – the public option. The trick is that Obama needs unanimity and the Senators know it. Note that no Democrat, so far, has had the balls to publicly oppose cloture. Which brings us to Nelson.

Ben Nelson says reform should have 65 votes, which is nonsense, and he opposes reconciliation, which is also nonsense because he supported reconciliation twice on Bush tax cuts (this is not a problem – we probably don’t need him on reconciliation). But the big deal is that he won’t commit to cloture. His recent statements could just be for local consumption, or he could really be an opponent of measures such as cloture on the public option, but doesn’t want to bring the whole party down on his head by coming out publicly against it. Ironically if he blocks cloture, he practically ensures the reconciliation option he (now) hates. Count on Emanuel to read him the riot act sometime real soon – how about a primary challenge by Bob Kerrey? Is he still around? Hold a gun to his head and force him to publicly filibuster his own president and explain why he’s doing it – to his constituents who want him to STFU and give them the public option.

Watch for more talk from Senate Democrats on the “have your cake and eat it too” option: Senate Blue Dogs can vote “yes” on cloture and then “no” on the bill itself, thus giving them political cover back home. Also, watch for Senate Democrats to do what their House colleagues did: put pressure on the Blue Dogs by insisting they will not vote for a bill without the public option.

Watch for these three provisions, in the floor bill:

First, a lot of Democrats hate the provision requiring people to buy insurance, but it actually helps them, because there are some Senators who don’t want to approve the requirement without also passing the public option, so that we are not held hostage by the private insurers.

Second, the public option will be easier pass if it has negotiated rates (Schumer’s “level playing field” option) instead of rates tied to Medicare (the Rockefeller way); that’s a weaker bill, but a more passable bill.

Third, one dangerous provision which needs to be removed: a Baucus-bill rule conferring decision-making authority to a group of state insurance commissioners who won’t defy the private insurers.

Watch for statements by key House Democrats on the House-Senate conference. In the conference, no bill could pass without the public option, barring a miracle, which should keep some Senate Blue Dogs from going too crazy.

Watch for Republicans to screech that using reconciliation is unprecedented, so we can spank them without mercy. The GOP used the same tool on social-policy bills such as welfare reform, student loans, children’s insurance, and digital TV conversion. Republicans are terrified at the prospect of the other team aiming this incredibly dangerous weapon right back at them – it only allows for 20 hours of debate, and it can’t be filibustered or clogged up with irrelevant amendments, so all the usual Republican implements of obstruction are out of bounds – but, what can I say? Turnabout is fair play.

Weirdly, Ben Nelson – famous opponent of reconciliation – said recently that health care should be done in two parts, the cost-cutting bit first and the extension of coverge later. That actually sounds a lot like what would happen if they chose the reconciliation option – one bill with the budget-y stuff and another with the non-budget stuff. Is he crazy like a fox, or just plain crazy?

Watch for anything the Senate parliamentarian, Frumin, says or does. This will probably be a futile exercise: he will almost surely keep his cards close to his vest, and even if he gives health reform sponsors his early opinions on key provisions, he can still change his mind out on the floor if the nature of the relevant provision changes.

Watch for any Senator speaking out on the notion of overruling the parliamentarian, because like filibusters, rulings by the parliamentarian also require 60 votes to override. Actually, for anybody to antogonize the parlimentarian by speaking out on this issue would be incredibly rash. But as we learned in the last several days, there are some pretty stupid Senators.

In the end, keep in mind – if Obama decides he wants to public option, there is nothing anyone can do – Republican or Blue Dog Democrat – to stop it from passing via reconciliation. We know he prefers the public option (as does most of America), and he knows that his presidency will not survive the passage of a BAD bill. And remember also – the Republicans must block the public option at every step along the way: the Democrats only need to get lucky once, either in the first Senate bill, or the conference bill, or via reconciliation.