Investing in community leaders is essential
Applications to the 2024 Restuccia Health Justice Fellowship are now open!
In Massachusetts, baseball and politics are both blood sports. On Tuesday, as the election results came in on who would fill the seat of the late Senator Kennedy, Red Sox fans who are also health reformers got that old unpleasant feeling they had back to 1986 when the ball went through the legs of Sox first baseman Bill Buckner to give the New York Mets a victory in Game 6 and, ultimately, the World Series.
The latest twist in the health reform saga is so improbable that if you submitted the plotline of to-date as a work of fiction, it would be dismissed as too unbelievable.
After the passage of groundbreaking health care reform legislation in Massachusetts helps spark a renewed drive for national reform, the Senator who championed the cause of health care for all throughout is career is struck with terminal cancer. He is temporarily replaced by a friend and former staffer, who gives the Senate Democrats a crucial 60th vote to advance reform, while a longer-term replacement is selected in a special election –a process pursuant to a law that was passed in 2004 to prevent a then-Republican governor from appointing a Republican to replace the other Senator from Massachusetts, who was then running for President. Starting to sound familiar? But, then, a virtually unknown Republican state senator (who voted for Massachusetts reform) triumphs in the special election process created to safeguard the seat for Democrats, giving Republicans a 41st vote in the Senate and potentially undermining passage of the very reform his predecessor fought for.
Really, you can’t make stuff like this up.
The question now is whether the upset victory of State Senator Scott Brown over Massachusetts Attorney General Martha Coakley (whose name has become, in some quarters, as unpronounceable as Lord Voldemort) will cause health reform to go the way of the 1986 Red Sox, or the 2004 team, with reformers playing the band of rag-tag Sox that saw an 0-3 record as just four wins short of the Pennant. (And were right.)
Were we there yet? To understand what the Brown election does and doesn’t mean for the chances of passing health reform, it is useful to pause to assess where the political process stood on the eve of Tuesday’s election.
Last week, House and Senate leaders and the Obama administration had nearly concluded negotiations over merging the two chambers’ bills. Although not all the details of that agreement are available, most observers believe that in addition to a publicly reported compromise on the tax-treatment of health benefits, the proposal would also close the Medicare Part D prescription drug “doughnut hole,” improve premium and cost-sharing subsidies for low- and moderate-income people, provide stricter federal oversight of insurance Exchanges, and alter the special Medicaid deal given to the state of Nebraska.
The content of this deal had not yet been presented to members of either chamber and one issue that remained problematic was the language prohibiting federal funding from being used to pay for abortions. Anywhere from 3 to 15 House members who had voted yes on the original House bill were expected to vote no on the House-Senate merger because they did not accept the Senate language on segregating federal funds. This meant that the House leadership needed to turn as many as a dozen votes that had been no the first time into yes on the final bill.
What the election meant (and didn’t mean) Many pundits and politicians are spinning the Massachusetts election as a referendum on national health care reform, but that greatly oversimplifies what is a complex and not-at-all clear correlation. While it is true that Scott Brown won and that a majority of Massachusetts voters have a negative view of national reform, it does not follow that Brown won because of health care reform.
First, health care reform closely in line with the federal bills is already up and running in Massachusetts, so the benefits of passing federal reform were less clear to Massachusetts voters. Indeed, Sen. Brown voted for health reform in Massachusetts in 2006 and did not repudiate his support during the election. Why would he?: Mass health reform enjoys public approval of more than 70 percent.
Instead, he attacked the taxes and health spending cuts that finance federal reform, asking why Massachusetts voters should pay more taxes to finance the cost of covering health insurance for people in other states. Brown ignored, and Coakley failed to make the case, that national reform would actually help Massachusetts (a case I made to Jon Cohn at The Treatment last week.)
To listen to the talking heads, you’d think voters picked Brown as an anti-health-reform message. But, in fact, the opposite is true: Polls show that the majority of Massachusetts voters who care about health care cast their ballot for Attorney General Coakley.
Obstacle course Although the legislative path must be altered, the Brown victory does not prevent Congress from concluding its work along the lines that were negotiated by leadership just prior to election. Instead of the House amending the Senate bill and sending it back for concurrence, the House can simply pass the Senate bill as is and then send over a package of amendments that can be incorporated via budget reconciliation, a process that requires only a simple majority in the Senate, rather than 60 votes.
That being the case, why have so many—including some prominent House progressives—suggested that the Brown election heralds the death of comprehensive health reform?
The short answer is: the elections’ psychological impact. The Democrats, having recently lost two governorships and with a number of prominent lawmakers facing uncertain electoral prospects in 2010 and now losing what was expected to be an easy race for them, are spooked. To get over the finish line, House leaders must reassure nervous members of their caucus, hold defections to a minimum and still move as many as a dozen members from the No to the Yes column. At the same time, the House and Senate need to finalize agreement on a package of reforms that can meet the technical requirements of a budget reconciliation bill.
Reversing the Curse While all of this is difficult, it is by no means impossible. And failing to pass major reform legislation (as Five Thirty-Eight and The Treatment have pointed out) is unlikely to improve the electoral prospects of Democrats. Failure also means the continuation of the status quo in health care, with rising premiums forcing more people to go without care or lose coverage entirely, higher rates of medical debt and personal bankruptcy, unchecked increases in federal health spending and an eroding base of paying customers for doctors, hospitals and drug makers (not to mention health insurers who nonetheless continue to oppose reform).
In fact, the only way to blunt political attacks on health care is to actually pass and implement the best possible reform so that voters can see for themselves that the attacks on the bill are baseless and begin to recognize the benefits.
In addition, the alternatives that have been floated—passing an entire bill through budget reconciliation or starting over in negotiation with Republicans—are, as ideas go, also rans for two reasons: Both are time-consuming propositions at a moment when most members are anxious to move on to other issues, and they offer no certainty of either substantive or political success. With this in mind, a strong grassroots movement to shore up support for reform has helped to stem the initial post-election panic that seemed to first take hold.
While it’s too early to say for certain that the House and Senate will be able to conclude their negotiations with a package that will win the support of 218 House members, it is far too early to count reform out. Remember, “the curse” was ultimately reversed.
–Michael Miller, director of strategic policy