Who Runs Gov

We’re coming down to the wire on the House’s vote on health care, and it’s still not totally clear how the Blue Dogs will vote. Right now, Rep. Nancy Pelosi is trying to sure up every vote she can in anticipation of a weekend vote on the bill. Waiting any longer, the thinking goes, will only give the Blue Dogs and other Democrats on the fence more time to decide they don’t support the legislation.

Right now, the hot issue is whether the bill will lead to government-funded abortions. Currently, the legislation would allow plans offered through new insurance exchanges to cover abortion services as long as firewalls prevented federal subsidies from covering the cost. A compromise measure by Blue Dog Rep. Brad Ellsworth (D-Ind.) would “require federal health officials operating the public insurance plan created in the House bill to hire a private contractor to pay abortion providers.” This has so far not satisfied Democrats who oppose abortion.

The other big problem is the question of covering immigrants. Rep. Gerald E. Connolly (D-Va.) told The Washington Post that in order to support the bill, he needed to be able to reassure his constituents that people “who are here illegally cannot avail themselves of the infrastructure that we’re creating.” Leaders may tighten the language on illegal immigrants so that it’s as tight as the Senate language.

The Blue Dogs had a couple of conditions for signing on to the health care bill. The big one, you probably remember, was convincing House Speaker Nancy Pelosi that public option rates should not be tied to Medicare. But there’s another, less-covered piece that Blue Dogs wanted. The measure would create the Institute of Health to put together recommendations for reducing costs in areas with high Medicare spending. It would also reward places where costs are lowest.

Blue Dogger Dave Loebsack (D-Iowa) said in a statement that “this agreement rewards states like Iowa who have put patients and their care first.” The loser will be urban hospitals, which are usually in districts of more liberal representatives.

As you can imagine, this isn’t sitting well with health executives in places like New York, who argue that their services cost more because they are serving a poorer population with a greater range of health care risks. “Unless we deal with the problems of poverty in underserved areas, health care will be expensive in urban areas,” Dr. Kenneth L. Davis, chief executive at Mount Sinai Medical Center in New York, told the New York Times.

Many more rural districts treat less people and slightly more affluent populations, which New Yorkers say accounts for the differences in spending. Another words, this measure helps places where Blue Dogs hail from, like the west and midwest.

This idea isn’t in the Senate bill, and it’s unclear whether it will be added to the final legislation. But it’s definitely something to watch.

House Speaker Nancy Pelosi wants to make sure Blue Dogs vote for health-care reform.

With what seemed like half the House crowded behind her at the podium, Pelosi announced the bill that will be debated on the House floor would include a public option, but a version more acceptable to the moderate Democrats. The full text of the bill is here.

Why? Pelosi needed their votes.

As our Greg Sargent first reported, Pelosi had barely 200 of the 218 votes she’d need for a more “robust” public option.

That “robust” public option was what progressives would have preferred . It would have paid doctors and hospitals based on Medicare reimbursement rates, which are the lowest in the industry. Instead, Pelosi chose to include a public option in which the government would have to negotiate rates with doctors and hospitals, which means they’ll end up paying them more than with the “robust” option.

It’s the outcome Blue Dogs wanted, especially those from rural areas. They said Medicare, which pays hospitals based on cost-of-living in their area, was already reimbursing doctors and hospitals far too little, and they worried that rural hospitals would not survive if the public option paid at Medicare rates.

This will make it harder for moderate Democrats to vote against the bill, and Pelosi needs only a handful of the 56 Blue Dogs on board to get a bill through the House.

Yesterday, our very own blogger Greg Sargent reported that House leaders don’t think they can pass a health care bill with a robust public option. As Beth explained, that means that they don’t think they can pass a bill with reimbursement rates similar to Medicare. This is a big deal to some doctors and hospitals, who say Medicare pays too little. It’s also been a major point of contention for Blue Dogs from poorer or more rural districts, where doctors rely heavily on clients with government-funded health care.

But Chris Bowers at Open Left says that according to a source, House Dems are closer than it seems to passing a robust public option. He reports that many of the other “lean no” votes are actually “lean yes” votes. He also writes that “if the whip count was conducted differently, then the Progressives could probably get over the top.”

Specifically, he said that whip counters should ask whether Medicare +5% public option is a deal breaker, not whether they’ll support a bill with those rates. This has bloggers on the left excited. Today, they will be organizing an effort to try and pin down what every House member (including Blue Dogs) would respond to the question.

We’ll check in at the end of the day and let you know what our beloved Blue Dogs have to say (if they say anything at all).

House Speaker Nancy Pelosi has promised the House version of the health-care bill will include a “public option,” a government health insurance plan that would compete with existing private plans.  But she’s still trying to figure out what that public plan will look like.

That’s because the two sides of her party can’t agree. Progressive Democrats want a “robust” public option that would be similar to Medicare, but the conservative Democrats, many of them Blue Dogs, want a public plan that pays doctors and hospitals more than Medicare does.

According to the New York Times, Pelosi told lawmakers Thursday that she had more than 200 votes for the “robust” option, but is finding it difficult to reach the 218 she needs. that was a day before House Democratic Caucus Chairman John B. Larson (D-Conn.) polled Dems to see who would support a robust public option. “The results,” the Times reported, “were not definitive because many members were missing and some supported the bill but called for changes.”

On Sunday, Sen. John McCain (R-Ariz.) predicted the House bill would be a cinch to pass. “I think that Blue Dogs bark but never bite, so I don’t think they have a problem over in the House side,” the former Republican presidential nominee said on the talk show Face the Nation.

Meanwhile big news from the Senate . . . Majority Leader Harry Reid (D-Nev.) chose to put a public option in the Senate bill.  As our colleague Greg Sargent reported, Reid plans a compromise in the form of an “opt-out” clause, allowing individual states to choose not to offer the public plan.

Pop quiz - what’s the best way to win friends and influence people? Sweeten the pot so they get something out of it too. It’s Negotiating 101, and House Speaker Nancy Pelosi seems ready to play hard.

According to the New York Times, Pelosi and 13 House Democrats signed a deal to increase Medicare payments in their states. This move paves the way to convince these Dems to support a public insurance plan that uses Medicare rates as a basis for paying doctors and hospitals. It’s the plan liberal Democrats want.

The move is part of the new bullish push to pass health care legislation with a public option. Just yesterday, Sen. Harry Reid met with President Obama to let him know that he was going to try to pass a bill with an opt-out public option. It’s a bit of a gamble - our good friend Olympia Snowe has said she will oppose the legislation, and it’s not clear that any other Republican will sign on.

But Reid is moving forward anyway, which means he thinks he has the votes. For her part, Pelosi is so confident that she’s told her members to be ready to vote for a bill with a public option before Nov. 11.

Unsurprisingly, House Republican leader John A. Boehner (R-Ohio) warns that the celebration is premature. “This talk of the Democrats’ having 218 votes is nonsense,” Boehner told the New York Times.

Preliminary budget numbers price the House health-care bill at a cheap $871 billion today. House Speaker Nancy Pelosi is smiling, but where does this leave our Blue Dogs?

It would seem that the fiscally-conservative Blue Dogs would be more inclined to vote for the cheaper bill. After all, the price-cuts were designed to overcome their concerns that the bill was too costly.

Not so, reports the Post’s Lori Montgomery.

She explains that much of the bill’s cost savings come from creating a strong public health insurance plan that would cut costs by reimbursing doctors and hospitals at Medicare’s rates, the lowest reimbursement rates around. With its Walmart-like size, the argument goes, the public plan would force private insurers to follow suit. They’d lower their reimbursement rates to compete, thereby driving overall health costs down.

The problem is Medicare rates are based on the cost of living, which means health providers in rural areas get paid far less than the national average.  Blue Dogs from rural areas are not happy, Montgomery says:

A new insurance plan that paid such low rates would be devastating to their communities financially, these Democrats say. Instead, they argue that any public plan should negotiate rates directly with providers, as private plans do.

Blue Dog Leader Stephanie Herseth Sandlin weighed in, saying, “A number of Blue Dogs would have a hard time accepting a public option with Medicare rates.”

So what do you think?  Are these Blue Dogs justified in wanting more money for rural doctors and hospitals? Or are they looking for excuses not to vote for health reform?

Rep. Nancy Pelosi knows how to play the politics game. According to Talking Points Memo, she and her leadership are working to create a bill that is less expensive than the final Senate bill (leaked estimates say the bill is already about $100 billion cheaper) but also contains a public option.

The goal, sources say, is to create a bill that moderate Democrats can willingly sign on to because it will be the fiscally-responsible choice. Will they succeed? It’s difficult to say, because cost estimates are changing constantly.

In the mean time, Obama has invited a couple of Blue Dogs over to the White House for a friendly game of pick-up basketball. The roster includes: Rep. Michael Arcuri (D-N.Y.), Rep. John Boccieri (D-Ohio), Rep. Brad Ellsworth (D-Ind.), Rep. Jeff Flake (R-Ariz.), Rep. Baron Hill (D-Ind.), Rep. Jay Inslee (D-Wash.), Rep. Frank Kratovil (D-Md.), Rep. Rick Larsen (D-Wash.), Rep. Patrick Murphy (D-Pa.), Rep. John Shimkus (R-Ill.) and Rep. Heath Shuler (D-N.C.). There’s no evidence that the winner will get to set health care policy, though in Washington, anything goes.

Help us keep track of where Blue Dogs stand by contributing to our Reform Tracker.

As the health care debate moves to the floors of both houses of Congress, we’re looking hard at the group most likely to throw their weight around in the House: Blue Dog Democrats.

These fiscally-conservative Democrats are all over the map when it comes to health care. Some support the more progressive policies of their Democratic brethren, others join the GOP in saying the current reform plans are too expensive, and many have avoided the question altogether. Theirs are the votes Democratic leaders need to push a health plan through the House.

Our reporters have been trying to pin down where these lawmakers stand on health-care issues in our Reform Tracker.

Out of 56 Blue Dogs, we’re counting 20 who have said they’d vote for a public option, including California Reps. Jane Harman (D) and Loretta Sanchez (D) and Arizona Rep. Gabrielle Giffords (D). But some have only said they’d vote for it if the bill is not too costly.

That’s compared with 13 who have said they don’t support a public plan, many of those from conservative states, or facing tough re-election battles in 2010 .

The rest are undecided or avoiding the question. It seems Blue Dog leaders especially have been going out of their way to avoid committing to particular health care positions.

We’re also asking the Dogs about ideas that made waves with moderate Democrats in the Senate, including non-profit health insurance cooperatives.  So far, two Dogs have said they’d support a similar idea if it were proposed.

Help us keep track of where Blue Dogs stand by contributing to our Reform Tracker.

Sen. Harry Reid’s (D-Nev.) office would not confirm reports that Snowe would not join the Democratic leadership to hammer out a final health care bill. But spokesman Jim Manley told us that the Democrats “want to keep her [Snowe’s] vote” and said that his office has “to see how things play out” next week.

That statement came when we called to ask them about a story in The Huffington Post, which reported that Sen. Snowe will not be meeting with the Senate’s Democratic leadership to decide how to merge the chamber’s competing versions of the health care bills.

You know who will be at that meeting? A team of White House officials that includes Obama’s chief of staff Rahm Emanuel, budget director Peter R. Orszag, Health and Human Services Secretary Kathleen Sebelius and Health Care Policy Coordinator Nancy-Ann DeParle. They will be meeting with the Senate leadership regularly over the next several weeks to help shape the final legislation.

Meanwhile, back in Maine, some of the most conservative members in Snowe’s home state think the power Snowe has accumulated has gone to her head. They have taken to sending bags of salt to her Maine offices. “Olympia Snowe has sold out the country. Having been banished to our world after Aslan chased her out of Narnia, Snowe is intent on corrupting this place too. So we should melt her,” an organizer explained to a news reporter.

And finally, to round out the news - in case you missed it, Sen. Snowe earned a spot on GQ Magazine’s 50 Most Powerful Washingtonians. Quite an honor, though we weren’t surprised.

People just can’t stop talking about Sen. Olympia Snowe. That includes resident news funnyman John Stewart, who said of the Senator “the blazer said staunch Republican, but the skirt hinted she might be bipartisan curious.”

Watch the whole clip (it’s worth it!) here:

Olympia Snowe was inundated with media coverage yesterday, after she was the lone Republican to support passing health-reform legislation out of the Finance Committee.  The Boston Globe has a good rundown of Snowe’s journey to “yes,” while Dana Milbank reveals what she gained along the way.

As the lady of the hour, she lost no time in using the attention to push her signature health-care idea: the “trigger” option.  The “trigger,” you may remember, is a variation on the public option that Snowe often calls a “safety net.”  Under the trigger, publicly-run insurance would go into effect (or be “triggered”) only if private insurers failed to lower prices by themselves. 

Snowe pitched her plan on Good Morning America, and to the Associated Press.

Snowe made it clear that her support yesterday didn’t guarantee a yes vote once the bill is melded with another committee’s version and debated by the full Senate. So Democrats have to keep wooing.

Speaking of wooing Snowe, Sen. Bill Nelson, a moderate Democrat from Florida, said this weekend that he preferred a trigger option to other plans floating around Capitol Hill.

Many are predicting an all-out intra-party war between the moderate and progressive ends of the Democratic Party. The key to that debate: Blue Dogs, a coalition of fiscally-conservative Democrats in the House. That’s where the debate is headed, and where this blog will follow.

Snowe was the only Republican to vote “aye” to send the Senate Finance Committee’s health-care proposal to the full Senate. 

Final tally: 14-9 in favor of the bill, making Senate Finance the fifth and final congressional committee to report out a health-reform bill. Baucus beamed.

It’s an historic moment. This is the farthest health-care reform has made it down the legislative path since Theodore Roosevelt.

Now Senate Majority Leader Harry Reid (D-Nev.) will merge Finance’s proposals with the Senate Health, Education, Labor and Pensions Comittee bill, and the whole Senate will debate and vote on health-care reform.

In the same speech where Snowe declared that she would support the Senate Finance legislation, she gave some clues about what it will take for her to vote yes to the final health care bill. In a word, affordability. “All Americans should have access [to health care] and we should absolutely know that they are affordable,” she said a couple of minutes ago.

Though the Finance bill limits the penalties for people who don’t buy health insurance, Snowe wants to make sure the final measure assures that everyone can afford insurance.

She quoted poet and fellow Maine resident Henry Wadsworth Longfellow, saying “great is the art of the beginning, but greater is the art of the ending.”

Well, it’s almost official. Snowe just made it clear that she is going to vote “yes” to send the Finance Committee’s proposed health-reform legislation to the full Senate.

During round two of the Finance Committee debates, Snowe called out-of-control health-care costs “a death spiral,” and compared America’s situation to the Titanic. “The difference is the captain did not know there was an iceberg, but we do,” she said. 

But it came with plenty of caveats.  Snowe once again insisted that health insurance be made truly affordable, and she railed against the “arbitrary deadlines” for passing legislation set by the Democrats. “People do have concerns about what we will do with reform, but they want us to continue working, and that is what my goal to report this bill out of committee to day represents,” she concluded.

WhoRunsGov reporters describe Chairman Baucus’s reaction as “giddy.”

Snowe, like Lincoln, emphasized that her vote today does not ensure her vote once the bill sees the Senate floor.  She quoted (fellow Mainer) Henry Wadsworth Longfellow, saying, “Great is the art of the beginning, but greater is the art of the ending.”

In other words, we’ve still got a ways to go.