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Is it time to break up?

I should say, at the outset, that I'm not a fan of this idea. But there's no denying that breaking the health-care bill into different pieces is receiving serious consideration. Nothing is decided, but according to House aides, there would be at least four bills: one containing tax credits to help people up to 400 percent of poverty purchase insurance and insurance regulations; a second focusing on changes to Medicare, everything from pilot programs to the closing of the doughnut hole; a third including the Medicaid expansion; and a fourth with miscellanea like the health-care workforce and wellness and prevention programs and IT. Funding would be scattered across the bills in order to satisfy pay-go requirements.

The argument for this is simple: The Senate bill is too compromised to survive. Passing health-care reform is still a necessity. But passing that health-care reform -- which includes Sen. Ben Nelson's Nebraska deal -- is too dangerous. As DCCC Chair Chris Van Hollen told Greg Sargent, "The Senate bill has been branded in a way that understandably makes it unacceptable in its current form to many voters, especially independents.”

The appeal of breaking the bill into parts is that it's a clear push of the reset button. It's easy, some House aides think, to message on one piece at a time. Being for or against health-care reform is a a much vaguer proposition -- and thus much easier to demonize -- than being for or against tax credits, or for or against a Medicaid expansion. Crucially, one House aide said, it also makes it easier for the members to understand. It's a depressing thought, but that doesn't make it untrue.

But the downsides are serious. For one thing, House aides appeared to be considering letting go of the exchanges. That takes out arguably the most important element of these reforms, and leaves us with something much closer to a pure health-care expansion. On a policy level, that would be a shame. For another, this means four new bills have to be written, cleared out of committees, and all the rest. It's a lot of time and a lot of opportunity for things to go wrong, or for Congress to simply tire of this issue. And time is not on the side of reform. If Scott Brown's election should have taught Democrats anything, it's that.

By Ezra Klein  |  January 22, 2010; 2:49 PM ET
Categories:  Health Reform  
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Next: Rep. John Dingell: 'The fact of the matter is we don't have time to be angry.'


good luck to all of us with this one.
that is all i can say.

thank goodness, it is the weekend

Posted by: jkaren | January 22, 2010 5:07 PM | Report abuse

Wait - those little chunks would all then have to go back through the SENATE too. WTF House. Ain't gonna happen.

Hello House Dems: remember the election in MA a while back that you are all freaking out over? The one that lost the 60th vote? What a bunch of morons. They cannot be serious.

Posted by: jeirvine | January 22, 2010 5:08 PM | Report abuse

Jesus Christ, this is going to fail miserably, unless done through reconciliation, and even then I'm very doubtful. How can House Dems not see this? Or do they just hate the Senate so much that they don't care? Cause I'm sorta with them on that, except now I'm really starting to hate the House too...

Posted by: Chris_O | January 22, 2010 5:10 PM | Report abuse

soon there will be as many variations on health care as there are bach fugues.

best advice regarding future health care.
try really hard to stay healthy.

Posted by: jkaren | January 22, 2010 5:15 PM | Report abuse

How can the exchanges be "the most important element" of reform when the three largest exchanges (FEHBP, CalPERS, and Mass Connector) have all failed to control health expenditures?

Posted by: bmull | January 22, 2010 5:20 PM | Report abuse

Didn't the Democrats want to pivot to "jobs, jobs, jobs", in the wake of Scott Brown and the further deterioration of the nation's economy?

Posted by: lancediverson | January 22, 2010 5:25 PM | Report abuse

Sure, House. Let's do that. I'm sure you'll vote it out of committee just minutes before Robert Byrd becomes incapacitated, giving you 58 votes in the Senate.

And after spending a year so far, do they really think that this can get done before summer? Then everybody switches into "campaign mode," and nothing gets done. And to think I spent good money electing these clowns. Might as well have shoved it up my @$$ for all the good it's doing.

Posted by: JEinATL | January 22, 2010 5:26 PM | Report abuse

bmull, there are other numerous factors to health care costs in addition to the exchanges. Doctors want to be paid more, same with hospitals, drugs are going up, and medical equipment now costs more. What the exchanges do is reduce the costs of marketing insurance. My thought is that without the exchanges, the health expenditures would have been even higher.

Posted by: jkallen9 | January 22, 2010 5:35 PM | Report abuse

@bmull: you are spot on. And it takes a 4.5% assessment on premium to fund the MA Connector, which further drives up the cost of health insurance in MA.

Posted by: Policywonk14 | January 22, 2010 5:36 PM | Report abuse

This idea is idiotic.

Posted by: slag | January 22, 2010 5:50 PM | Report abuse

& marketing cost are 20 to 25% of the cost. Think I prefer 4.5%.

Posted by: jkallen9 | January 22, 2010 5:51 PM | Report abuse

This is the stupidest idea I've ever heard of. Have the Democrats learned nothing from the last year of GOP obstructionism? Zero Republican Senators are going to vote for any of these bills and you'd probably lose one or more of Lincoln, Lieberman, Nelson, and Landrieu too. So you'd go through this big charade of passing these bills in the House only to see them get filibustered to death in the Senate. What's the point? Just pass the Senate bill through the House and start fixing it by reconciliation.

Posted by: redwards95 | January 22, 2010 6:21 PM | Report abuse

This idea is really idiotic. These people cannot seriously be this stupid.

How do you think the Medicare cuts and/or the tax increases necessary for the subsidies will get 60 votes in the Senate?

Heck, let's say the community rating is in one bill. How do you get 60 votes for a 2:1 -- or even a 3:1 -- age rating? How do you limit and/or eliminate the smoker rating? Can't you see the Republicans offering amendments allowing insurers to vary premiums by beer consumption, fast-food consumption, bungy jumping, etc., and how do you think such a bill will ever get 60 votes in the Senate?

How many votes do you think the Senate has to require mental health, substance abuse treatment, durable medical equipment, and other benefits used by a very small percentage of the U.S. population to be covered and at a minimum 60-70 percent actuarial value level?

The idea that this bill will become more popular -- not less -- is ludicrous. All a piece-by-piece legislation will do is illuminate piece-by-piece how much money you are taking out of one person's pockets and putting into someone else's pockets.

Posted by: moronjim | January 22, 2010 7:39 PM | Report abuse

& marketing cost are 20 to 25% of the cost. Think I prefer 4.5%.

Posted by: jkallen9 | January 22, 2010 5:51 PM | Report abuse

please stop with the lies.

Check here for the truth.

Sure they could and should do better but at least be honest about what the true numbers are and don't make them up out of thin air or worse yet spew the talking points of the Democratic party.

Loss ratio is around 85% over the last 3 years. Even Daily Kos says so.;-its-already-86

Sensibly the most efficent is large group because of economies of scale down to individual which is more time consuming and thus more expensive to administer. I think if reform ever did happen and individuals got on the exchange those of you that don't have a clue about any of this would realize that the cost to administer to individuals is MUCH greater than you think. HAHA. 4.5%. Ya sure.

Posted by: visionbrkr | January 22, 2010 10:26 PM | Report abuse

I think if reform ever did happen and individuals got on the exchange those of you that don't have a clue about any of this would realize that the cost to administer to individuals is MUCH greater than you think. HAHA. 4.5%. Ya sure.

Posted by: visionbrkr | January 22, 2010 10:26 PM

Exactly right -- especially if a bunch of federal government employees are hired to staff the Exchange, career bureaucrats or newbies who know exactly zip about insurance -- which is the scenario most likely to happen. (see below)

jkallen9, do you really think the Exchange will not incur a lot of marketing expenses to publicize itself? Wasn't the MA Connector running ads during Red Sox games?

Section 3510(i) (starting on p. 150) of the engrossed Senate bill states that the government will hire "Navigators" to conduct public education about the Exchange plans and the premium subsidies. Of course, those who actually know what they're doing (insurers and insurance agents) cannot be Navigators, because it's important to hire people that know nothing.

Posted by: Policywonky | January 22, 2010 10:57 PM | Report abuse

This has just turned into a cynical attempt to save your political hides. No longer are you actually concerned with providing any real reform - now it is merely a wish to pass anything so you can't be hammered over the head about having failed.

The American people are not wonks who are going to be deceived that just because you pass something called "Health Care Reform" that you actually achieved anything. We don't believe that something is better than nothing. Ask the Tea Party, or, or NOW - the voices range across the spectrum.

Unemployment shows no signs of abating. This Congress and President have the air with lies about focusing on the economy in 2010, 1 year late already.

The time is now - you failed at health care, don't fail to act on the economy.

Posted by: NelsonMuntz | January 23, 2010 12:52 AM | Report abuse

" ...second focusing on changes to Medicare, everything from pilot programs to the closing of the doughnut hole..."

There's no point in talking about closing the hole in Medicare part D without pemitting Medicare to negotiate for prices. Medicare has already run all sorts of pilot programs only to have Congress cave in when it came time to implement them system wide.

IMHO, if the Democrats want to gain some credibility, they should just enact what they already know will save money *now* and quit all the mumbo jumbo about savings down the road.

Posted by: Athena_news | January 23, 2010 8:27 AM | Report abuse

I've considered myself a liberal Democrat up to this point. But I will certainly campaign against my former party this fall if the House does not at least pass the Senate bill. I could even imagine voting Republican if the Republicans turn around before the election and support a health care bill that offers essential reforms, such as prohibitions against discrimination based on pre-existing conditions. We cannot have a political party in Congress that is unable to pass its own legislation with a 256-178 majority.

Posted by: opinionpieces | January 24, 2010 2:46 PM | Report abuse

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