The public option: how many of us remember when and why it died? [View all]

[pnwmom]

Last edited Sun Mar 23, 2014, 03:51 PM - Edit history (2)

When President Obama came into office, he immediately began work on two major fronts: an economic stimulus and an overhaul of health insurance.

At that time, we had a more liberal House and a more conservative Senate. The Senate, influenced by Ted Kennedy even in his last days, was the first to pass a bill. But the best bill the Dems could get passed with the necessary 60-vote super-majority was an ACA with no public option.

But that was okay, because the next step was for the more liberal House to vote on its own version with a public option. And then the two Houses, both at that time controlled by Democrats, were expected to work together in committee and reach a compromise; which, because the Dems were in charge, was expected to resemble the House bill -- with a public option. This was the plan when Barack Obama was running for President, and the pieces were falling into place.

But before that could happen, Kennedy died of brain cancer; and with him, the Democrats’ super-majority. And MA had a law that didn’t allow the Democratic governor to appoint an immediate replacement. Instead, an election was called for several months later, and Scott Brown, R, was elected to replace Kennedy.

That was when the public option died. It was too late for the House to strengthen its negotiating position by passing a more liberal bill, with a public option. It was too late for the House to fix ANY of the other problems that had already been identified in the Senate bill. The only possible way to get ANY bill passed was for the House to simply pass the exact version of the ACA that had already been approved in the Senate. The one that Ted Kennedy had midwifed.

Because by then the Republicans controlled the Senate through the filibuster and they wanted to bury the bill, not fix it.

So, in the House, Nancy Pelosi had to persuade dozens of liberal Representatives to vote for the Senate’s version of the bill, a version they never would have voted for otherwise. That’s how we finally got the ACA passed – a bill that, despite all its flaws, has already insured millions of Americans who didn’t have insurance before.

So it isn’t reasonable or fair to blame the President for the fact that he promised support for the public option and then ultimately pushed for an ACA that lacked one. The only way for him to have succeeded with the public option depended on keeping Senator Ted Kennedy, and the super-majority, alive. And that was too much even for President Obama.

http://en.wikipedia.org/wiki/Affordable_Care_Act

House


House vote by congressional district.
Democratic yea (219)
Democratic nay (34)
Republican nay (178)
No representative seated (4)


President Obama signing the Patient Protection and Affordable Care Act on March 23, 2010.
The election of Scott Brown meant Democrats could no longer break a filibuster in the Senate. In response, White House Chief of Staff Rahm Emanuel argued that Democrats should scale back for a less ambitious bill; House Speaker Nancy Pelosi pushed back, dismissing Emanuel's scaled-down approach as "Kiddie Care."[107][108] Obama also remained insistent on comprehensive reform, and the news that Anthem Blue Cross in California intended to raise premium rates for its patients by as much as 39% gave him a new line of argument to reassure nervous Democrats after Scott Brown's win.[107][108] On February 22, President Obama laid out a "Senate-leaning" proposal to consolidate the bills.[109] He held a meeting with leaders of both parties on February 25. With Democrats having lost a filibuster-proof supermajority in the Senate but having already passed the Senate bill with 60 votes on December 24, the most viable option for the proponents of comprehensive reform was for the House to abandon its own health reform bill, the Affordable Health Care for America Act, and pass the Senate's bill, the Patient Protection and Affordable Care Act, instead.

Various health policy experts encouraged the House to pass the Senate version of the bill.[110] However, House Democrats were not happy with the content of the Senate bill and had expected to be able to negotiate changes in a House-Senate conference before passing a final bill.[106] With that option off the table, given that any bill which emerged from conference that differed from the Senate bill would have to be passed in the Senate over another Republican filibuster, most House Democrats agreed to pass the Senate bill on condition that it be amended by a subsequent bill.[106] They drafted the Health Care and Education Reconciliation Act, which could be passed via the reconciliation process.[107][111][112]
Unlike rules under regular order, as per the Congressional Budget Act of 1974, reconciliation cannot be subject to a filibuster. However, the process is limited to budget changes, which is why the procedure was never able to be used to pass a comprehensive reform bill like the ACA in the first place; such a bill would have inherently non-budgetary regulations.[113][114] Whereas the already passed Senate bill could not have been put through reconciliation, most of House Democrats' demands were budgetary: "these changes—higher subsidy levels, different kinds of taxes to pay for them, nixing the Nebraska Medicaid deal—mainly involve taxes and spending. In other words, they're exactly the kinds of policies that are well - suited for reconciliation."[111]

The remaining obstacle was a pivotal group of pro-life Democrats led by Bart Stupak who were initially reluctant to support the bill. The group found the possibility of federal funding for abortion substantive enough to warrant opposition. The Senate bill had not included language that satisfied their abortion concerns, but they could not include additional such language in the reconciliation bill as it would be outside the scope of the process with its budgetary limits. Instead, President Obama issued Executive Order 13535, reaffirming the principles in the Hyde Amendment.[115] This concession won the support of Stupak and members of his group and assured passage of the bill.[112][116] The House passed the Senate bill with a 219–212 vote on March 21, 2010, with 34 Democrats and all 178 Republicans voting against it.[117] The following day, Republicans introduced legislation to repeal the bill.[118] Obama signed the ACA into law on March 23, 2010.[119] The amendment bill, The Health Care and Education Reconciliation Act, was also passed by the House on March 21, by the Senate via reconciliation on March 25, and was signed by President Obama on March 30.