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A week of twists and turns in health-reform debate

The same day that Al Franken was sworn in as Minnesota’s junior senator, U.S. Senate Majority Leader Harry Reid visibly started rethinking the need to make a health-reform bill palatable to Republicans in a filibuster-proof Senate.

The same day that Democrat Al Franken was sworn in as Minnesota’s junior senator, U.S. Senate Majority Leader Harry Reid visibly started rethinking the need to make a health-reform bill palatable to Republicans in a filibuster-proof Senate.

Reid, D-Nev., reportedly sent a note to Finance Committee Chairman Max Baucus of Montana to drop a proposal to tax employer-based health insurance benefits and to push on with a public option, a plan opposed by Republicans. That was Tuesday.

But by Thursday, Roll Call reports, Reid met privately with four Republicans on the Finance Committee to “assure them he was committed to a bipartisan deal.” Later, he told reporters that he “could envision a nonprofit medical cooperative plan of some sort being acceptable substitute for a government-run insurance option.”

“We’re going to have some type of public option — call it co-op, call it whatever you want,” Reid said. “We’re trying to work something out and have not drawn any lines in the sand.”

In the House, new objections from the Blue Dog Coalition — a group of fiscally conservative Democrats including Minnesota’s Collin Peterson — are expected to delay the legislation, according to Roll Call:   

“Forty Blue Dogs signed a two-page letter communicating a series of demands ranging from more aid to rural areas to more cost-cutting to protections for small businesses.

But the fiercest opposition is to a public plan option based on existing Medicare reimbursement rates.”

No need to play nice?
But with a filibuster-proof Senate, Democrats no longer necessarily need to play nice, various news media pointed out this week. Tough talk might even result in bipartisan cooperation on health reform, according to The Treatment blog at the New Republic.

“The more that Republicans believe Democrats are willing to pass reform on their own — either by maintaining enough party discipline to break a filibuster or by trying to use the budget reconciliation process, in which legislation can pass with a simple majority vote — the more likely Republicans are to compromise. It’s possible Reid’s show of pique could actually strengthen Baucus’s hand for dealing with [Iowa Republican Charles] Grassley, while also strengthening the hand of those on the right — be they individual lawmakers or special interest groups — who would prefer a modestly unacceptable bill to one they really hate.”

Still up in the air is how to pay for health-care reform, and observers are worried about Congress being able to reach consensus and pass a bill by Aug. 7, when a month-long recess begins.

This week, Vice President Joe Biden announced that hospitals had agreed to contribute $155 billion to health reform, joining a list of industries making concessions. But what are the expectations behind those concessions?

Hidden costs of concessions
The New York Times looks at the hidden costs, noting the bottom line of retailer Wal-Mart, which said last week that it would support an employer mandate for big companies to provide insurance for workers. “In exchange, Wal-Mart said it wanted a guarantee that the bill would not ‘create barriers to hiring entry-level employees’ —  in effect, code words to insist that lawmakers abandon the idea of requiring employers to pay part of the cost for workers covered by Medicaid, the government insurance plan for the poor.”

The tradeoffs are of concern to Congress, including the chairman of the Senate’s health committee, Sen. Christopher Dodd, D-Conn., and Sen. Olympia Snowe, R-Maine, considered a critical swing vote. 

“I’m delighted to hear that people are stepping up to help reduce costs,” Dodd says in the Times story, “but I want to know what the ask is, and the ask sometimes can exceed the value of your cost savings.”

Snowe has not signed on to any of the White House deals. “It’s one thing for the president to reach that agreement, but it’s another thing for Congress to reach that agreement,” she says. “We have yet to evaluate what are the specifics and particulars. So it’s uncertain. It could be helpful. I just don’t know.”

Obama and public option
Though President Obama was overseas this week, he tried to reassure advocates of a public option that he’s still in their camp with what Slate calls an “out-of-the-blue two sentence statement”: “As I’ve said before, one of the best ways to bring down costs, provide more choices, and assure quality is a public option that will force the insurance companies to compete and keep them honest.”

Slate asks, “Why does the president have to issue a statement from several time zones away reiterating something he’s already said? Because his supporters worry that in order to achieve comprehensive health care reform, and to win support from some Republicans, Obama will trade away his support for a public option. Alternatively, they worry that he will redefine public option beyond recognition.”

The Washington Post offers some perspective on the week’s developments: “No single development appeared likely to kill Obama’s signature domestic agenda item, but the relentless barrage of challenges that seemed to hit hourly served to demonstrate why no president since Lyndon B. Johnson has been able to enact large-scale health legislation.”

Michigan plowing a path to reform
Meanwhile, some legislators in Michigan aren’t waiting for national health reform to try to stop practices that deny insurance coverage and charge more for chronic health problems, the Detroit Free Press reports.

State Sen. Tom George, R-Kalamazoo, a sponsor of Republican legislation, thinks chances of passage this year are “fair to good.”

The Free Press says George’s plan “would require businesses — including self-insured enterprises such as General Motors Corp. and Chrysler Group LLC, now exempt from state regulations — to pay to expand health care for poor people.”

Though any tax increases are opposed by the Detroit Regional Chamber and similar groups, Michigan stands to lose federal matching money if it doesn’t require businesses to help pay for the programs, George said.

“Why wouldn’t we want the government-run General Motors and Chrysler to help us with this problem?” he tells the Free Press. “It’s aimed at their former employees.”

Time magazine sums up what’s ahead for the nation: “The next few weeks will bring some hard decisions for everyone involved in the health reform debate. But the bottom line will come down to one crucial question: Is it riskier to push for health reform — or to be seen as having stopped it?”  

Casey Selix, a news editor and staff writer for, can be reached at cselix[at]minnpost[dot]com.