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How the Senate Finance Committee Got Ron Wyden's Vote

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If you'd asked me six months ago which Democrat on the Senate Finance Committee would prove the toughest vote on health-care reform, I'd have had a couple answers for you. Blanche Lincoln, maybe. Or Tom Carper. Or Kent Conrad.

I would not have said Ron Wyden.

But it was Wyden's support that eluded the Senate Finance Committee and the White House in the final days. The reasons were twofold: First, it's always easier to bargain with a dealmaker than a policy wonk. Wyden wanted something real, and maybe even a bit radical, added to the bill. He wanted not only all employers, but all individuals, given access to the exchanges. He wanted to give individuals the option to move beyond the employer-based system, but that wasn't very popular, given that preserving the employer-based system was among the central premises of health-care reform.

Second, he was mishandled. His amendment wasn't scored until the last minute, and then at 1 in the morning on the final night of the mark-up, Sen. Kent Conrad waved his blackberry in the air and told Wyden his amendment had never really been scored at all. It's a bit hard to say what happened there, but it looked, and felt, like a dirty trick to Wyden's camp.

Securing Wyden's support for the bill thus proved a bit trickier than was initially anticipated. Part of the deal emerged in today's hearing, when Baucus and Wyden read from a "colloquy" before the vote. Never heard of a "colloquy?" You're not alone. It's a bit of an odd tradition: "a pre-scripted floor dialogue between the chairman of a committee and another congressman. The dialogue seeks to clarify the intent behind certain provisions for purposes of legislative history." Here's what Baucus and Wyden agreed to:

SENATOR WYDEN: As you know, Mr. chairman, I have long been working on fundamental health reform that would provide expanded choice to all Americans, including employees who have group coverage at their workplace. Today, almost half of the workers who are fortunate enough to have employer-sponsored health care don’t have any choice of health plans. I believe that providing workers choice – just like we have as members of Congress -- will both improve the quality of health plans and lower costs by encouraging health insurers to compete for consumers’ business. Choice and competition are fundamental to any comprehensive health reform.

I offered an amendment during the markup that would have ensured every American would be guaranteed a choice of health plans. Unfortunately, it was clear that my proposal would not have been approved by the committee, so I withdrew the amendment. Since then, our staffs have been working to come up with a workable choice proposal that will enable employees to shop for the coverage that most efficiently meets their needs and ensure that workers who are not offered affordable coverage by their employer would have the ability to shop for coverage in their local insurance exchange. It also would provide states with the opportunity to go even further in promoting choice and competition if they choose to provide their citizens with that option. I hope that you will join me in working to include this idea as health reform moves forward.

CHAIRMAN BAUCUS: Thank you, Senator Wyden, for your tireless work over the past years in health reform and, most of all, promoting choice for American workers and their families. I too believe in choice, and I believe the most recent version of your proposal could help achieve our mutual goals of ensuring affordable coverage for all Americans and injecting competition into the health-care system. We need to be sure that the proposal achieves our goals without unexpected consequences, but I believe it is a promising approach that could be included in the health reform bill that the Senate takes up. I look forward to working with you on this proposal.

The agreement that's pointing towards is this: Baucus and Wyden are, in theory, working together to get a compromise version of Wyden's amendment into the merged bill that will come out of the HELP/Finance negotiations. The details of that amendment aren't nailed down yet, but Baucus's cooperation, at least for the purposes of the Congressional Record, is.

For more from Wyden, check out Jon Cohn's interview.

Photo credit: By Alex Brandon — Associated Press

By Ezra Klein  |  October 13, 2009; 4:20 PM ET
Categories:  Health Reform  
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Next: Will Joe Lieberman Vote Against Health-Care Reform?

Comments

It helps that Snowe affirmed support for Wyden's plan to strengthen the exchanges. I'm also hopeful that Rockfeller was wooed by being promised some version of the public option would be put into the merged bill which would make it far more likely that a public option would come out of committee.

Posted by: Rhoda | October 13, 2009 4:37 PM | Report abuse

Wyden just simply gets health care. I think at the end of the day, I'd have reacted the same way he has-- its a crappy bill, I'd hold out support as long as possible, but at the end of the day, there are some clear benefits of the bill that you can't actually oppose the whole thing. Its clearly better than the status quo.

But he gets the importance of the consumer in driving down costs and increasingly quality-- he's a refreshing voice among Dems who believe that centralized government authority is the only option.

He gets that the public option wasn't worth the distraction its been.

He gets that we really don't have an insurance marketplace today-- but a much less efficient system that relies on few decision-makers among HR benefits people.

He gets that people really are concerned about their own health care costs, that nothing in these bills really address those concerns, and there will be consequences down the road for Democrats who have ignored the true concerns of Americans-- not whether there's a public option, but whether the increasing portion of premiums that they're paying stop rising 8-15% a year.

You'd be hard-pressed to name a Senator who's more qualified on health care, and there are only a handful of Congressman with similar knowledge and experience. Its a shame he's been marginalized in the process-- we'd all have been much better off with him in the leadership role.

Posted by: wisewon | October 13, 2009 4:40 PM | Report abuse

Question, Ezra. You said they were working to add a version of Wyden's amendment to the combined Finance/HELP bill. I was under the impression that during the merging process, Senate rules precluded adding new provisions, and limited the process to strictly combining the two bills; I was expecting Wyden's next opportunity to be on the Senate floor.

Is it really a possibility that this and other provisions could be added at this stage, before the bill reaches the floor?

Posted by: GhaleonEB | October 13, 2009 4:42 PM | Report abuse

Good reportage Ezra. I think not many people realize the complete scope of current nation-wide costs and the implications. We've had, just as one should expect on careful reflection, a kind of Health Care Cost Bubble, due to easy credit over decades.

http://findingourdream.blogspot.com/2009/10/great-american-health-care-bubble-or.html

Posted by: HalHorvath | October 13, 2009 4:47 PM | Report abuse

i don't understand why we can't have the exchanges for all as Wyden proposes but not destroy the employer system. Why can employers not buy and sell their employees premium from the exchange? Put everyone on there (all 300+ million of us) and thus give the greatest potential bargaining power (even greater than Medicare) but allow private insurers to process claims (what they do most often now anyway).

For example employer A has 500 employees.

150 of them like Aetna and it works for them

150 like United and it works for them.

150 like BCBS and it works for them.

50 like Cigna and it works for them.

Then have the exchange be the billing system for them and bill back to the employer the premium for them as per the rates on the exchange for the plan that they choose.

Employers keep their employees happy with a wide array of choices and still allow their employees to be THEIR employees (a great fear of big business) and negotiating power is magnified tenfold thus decreasing costs.

I don't see who loses here. You've then taken the drawbacks of the employer system (lack of choice, inflexibility) and made them strengths.

Posted by: visionbrkr | October 13, 2009 4:59 PM | Report abuse

I still think that,they should have got the economy back up and everyone working before handing this farce of a healthbill to a country that has its citizens out of work.the gov does not care about you and me! because they wasted so much time on this crap,they let 3 thousand people run out of unemployment benifits,our gov't is a loose cannon that needs to be reined in.

Posted by: Lwebb121 | October 13, 2009 5:13 PM | Report abuse

I am finding it tough to trust anyone in washington,they make bad decisions every day that effect us all one way or another,and this healthcare deal is more of the same.records will be kept on what democrat voted for and who voted aginst.those that vote aginst might get lucky enough to keep their seats.

Posted by: Lwebb121 | October 13, 2009 5:22 PM | Report abuse

Step by Step. Thanks to Senator Wyden for holding firm. The current system is unsustainable. Don't let the perfect be the enemy of the good.

Single payer Government Insurance with a public option. Perfection.

Posted by: thebobbob | October 13, 2009 5:25 PM | Report abuse

So let me get this straight.Their logic is, vote for this bad bill because it's a little better then the status quo ?Well why don't you put it online and let the American people decide ?I guess the town hall meetings told you nothing.Say by by to reelection.And rightfully so.

Posted by: votingrevolution | October 13, 2009 5:33 PM | Report abuse

Wyden is just another spineless democrat. All talk but when it comes time to vote he caved in.

Posted by: Woodstocknative | October 13, 2009 5:47 PM | Report abuse

I have a question for every America.

What is best for the country?

Is it better to have a large portion of our population lacking in health care coverage?

OR

Is it better for the health care insurance industry to pick and choose whom they will cover and what claims they will pay, that the insurance industry will decide to what extent of health care a person receives, if any at all?

What serves our society best?

It is our civic duty, one citizen to another, to ensure that all citizens have sufficient health care, even if only to enable citizens to be productive members of society.

Or is that asking too much of ourselves?

Posted by: abbydelabbey | October 13, 2009 6:39 PM | Report abuse

I don't understand why it is so WRONG for each individual to CHOOSE what insurance plan they want to purchase.

I can pick and choose my auto, life, home, flood, long-term care etc, BUT I AM STUCK WITH A CHEAP WORTHLESS EXPENSIVE CRAPOLA plan that my EMPLOYER picked because he could save money -

I want choice -- I WANT CHOICE.

WHY DOES NOT ONE PERSON IN CONGRESS GET THAT>>>>>>>

Posted by: kare1 | October 13, 2009 7:20 PM | Report abuse

Nowhere visible in this 'debate' have been sufficient facts to make a really informed decision. What we DO know is, the people that run insurance companies have pretty 'healthy' income levels. AIG, a LARGE insurance group, no, make that VERY LARGE, well, what's that, yes, they also sell...health insurance. Must be a pretty lucrative business, then, and that's kind of one of the sticking points of the whole issue, at least with me. Not only do these companies end up soaking their policyholders for extra money, they turn some of it right around, and shoot it at their stockholders. Publicly traded companies. Your healthcare payment roughly goes to maintain the health of their corporate entity.

These people have some pretty substantial lobbies to promote their cause in Congress. They say there's 46 million people in the United States that don't yet have this magical coverage, another way to read that is that there's 46 million people that don't yet pay a supplemental medical/hospital tax. Because that's where we're headed with this. You(consumer-person), WILL pay X amount to support Hospital Y, as well as employees(Group Z), Insurance companies and employees(Group ZA), along with all the billing specialists, telemarketers, advertisers, lobbyists, executives, and everyone else rolling around up there. Why? Because in addition to all the other statutes, laws, rules, and regulations that govern various goings-on in this country, there's also the Golden Rule: He that has the gold, makes the rules, and if you were king, wouldn't you be pushing for laws that made it so you could squeeze people(legally) for MORE? Money is power, power corrupts, and I think the wonderful world of medicine is less-than-honest. And yes, they DO own the place.

Posted by: walkerbert | October 13, 2009 8:52 PM | Report abuse

The committee got Wyden's vote because its plan is closer to what he wants than the status quo. I don't see any public committment on Baucus' part, except maybe to be more sensitive of Wyden's feelings in the future.

Wyden's plan is the cool new model airplane that everyone wants to see fly. But no negotiated rate system is ever going to have the efficiency of an administered system when it comes to health care. Doctors are simply too bullheaded.

Posted by: bmull | October 13, 2009 10:26 PM | Report abuse

The absolutists on both sides are disappointed.

wisewon - I thought your take on this was really interesting.

I find it odd that a key objection of Republicans in Committee was that they believe the bill doesn't bend the cost curve in favor of the consumer enough.

They proposed amendments like individual tax breaks and tort reform (which might as well be on the table) but they never did propose an alternative comprehensive plan that addresses the fundamentals of coverage + cost control across the board.

Wisewon said, "He (Wyden) gets that we really don't have an insurance marketplace today-- but a much less efficient system that relies on few decision-makers among HR benefits people."

That has the ring of truth.

I've been thinking about this overly simplified comparison:

FedEx and UPS compete fairly with a fee based public option called the US post Office.

Those who want to can send a greeting card by FedEx for, say, $13.00 and know that it will get there overnight.

Those who don't can send a holiday card anywhere in the States in about 3 days for 45 cents.

It's an open market solution. The PO is authorized but not run by the government or supported by tax dollars, private enterprise makes a profit by offering competitive service, anyone can mail a letter and the public gets a choice of providers.


Posted by: JohnQuimby | October 14, 2009 1:09 AM | Report abuse

Wyden is right to try to end the employer system. But I don't think a hybrid model would work. Group insurance is all about the pool being insured. With everyone in the exchanges, that pool would be huge. But with employees being able to choose whether or not to be part of their employer's insured pool, that insurer would have to constantly try to ascertain how that pool's risk profile needs to be priced.

With small employers there is already often a premium penalty paid when they end up with more than an average number of sick employees and a premium benefit if they happen to have a low risk workforce. So there would likely be an abandonment of the employer system for the exchanges when the former occurs while the later simply allows for an adverse selection advantage, which always results in an adverse selection cost accruing to someone else.

A possible barrier to flight to the exchanges when an employer's risk pool turn bad could be if the exchanges turn out to be high priced insurance because of the unwillingness of politicians to use adequate coercion to stop adverse selection in that market. As of now the penalties in the legislation are delayed and cheap. It may be far more advantageous for healthy people to pay the fine and pay for what little health care they use and pocket the savings over the cost of being insured. After all, if they come to need a lot of health care in the future they can always enter the system without any cost due to pre-existing conditions. Of course this is less like insurance, which is a contract for risk assumption, than it is like allowing one side to see the cards of their opponents before betting.

Posted by: jskdn | October 14, 2009 2:49 PM | Report abuse

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