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Lobbying for votes on health-care reform

Dan Eggen
Washington Post Staff Writer
Thursday, March 18, 2010; 1:00 PM

The Post's Dan Eggen takes your questions about what undecided members of Congress want from the White House or private industry in return for their vote on health-care reform.

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Dan Eggen: Greetings everyone. Ready to chat about CBO scores, Cornhusker kickbacks and anything else on your mind.

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Arlington, Va.: How many congressmen think they'll have enough leverage over passing the health reform bill to demand sweeteners? While they're doing this, do they worry that these "sweeteners" on such an important bill will appear as bribes to much of the public?

Dan Eggen: This is merely speculation on my part, but based both on the reporting I've seen and common sense, I think the day of sweeteners are done. The Dems have no desire to add more "Cornhusker kickbacks" or other targeted breaks; in fact, the plan calls for removing a slate of those measures as part of the reconciliation bill.

If anything the tide may be shifting the other way--it appears that labor had to give more on their end of the excise tax on "Cadillac plans," which they already hate.

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Indianapolis: Seems to me that the Democrats in the House from swing districts have to weigh whether or not a YES on the health care vote will sink them or the label of "do nothing" will sink them if the health care bill fails. The GOP will use either one depending on how the Dems vote. Which one is worse for the Dems?

Dan Eggen: That is indeed the calculation that the remaining holdouts need to make. The White House and Dem leaders are pushing them in part on the argument that nothing succeeds like success, and that they'll get hit even harder in the fall if they don't have anything to show for all the noisy fights in Washington. They also point to evidence from polling that Americans tend to like many of the features contained in the legislation (no more getting dropped for pre-existing conditions, no lifetime caps, etc.) but have been turned off by the ugly sausage-making process.

Republicans, of course, say the opposite--that a vote for HCR will doom the Democrats to even more losses in the fall. (Some liberal wags question the sincerity of this friendly advice of course!)

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Reston, VA: Here's what I don't understand: Why didn't HCR go to committee to work out the differences like other bills do?

If the House and Senate can't agree on the final form of the bill, shouldn't that make the House worried that the Senate won't make the changes they want in reconciliation?

Dan Eggen: Because the GOP is preventing that from happening by using their 41 votes in the Senate to filibuster any HCR compromise bill. (Dems need 60 to overcome this blocking maneuver; this was the game-changing importance of Republican Sen. Scott Brown's win in Massachusetts in January.)

Thus the Democrats are going to Plan B: using the process known as reconciliation to push the changes through with a simple majority vote.

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Madison, Wis.: Hello, Could you explain how the HCR bill is supposed to cost around $1 trillion over a decade, but the deficit is also going to be cut? Is this because the $1 trillion is paid for by increasing taxes/cutting benefits elsewhere, and the deficit savings come on top of this? Thanks.

Dan Eggen: Yes, it's fairly straightforward math. Cuts in costs for Medicare Advantage (the private sector program), Medicaid, and the revenues raised through the excise tax and other measures result in the CBO prediction (just released today) of $138 billion in deficit savings over the next decadea and $1.2 trillion in deficit reduction in the decade after that.

BTW, proponents argue that the real savings will be even higher because of various reforms aimed at improving efficiency and bending the curve on medical costs. CBO, however, does not give credit for those kinds of changes since presumably they are too hard to predict.

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Washington, DC: Doesn't Obama's cancellation of his Asia trip show the severity and down to the wire politicking of the health care issue?

Dan Eggen: You are referring to the breaking news that President Obama has postponed his Asia trip until June, allowing him to be in town for the crucial vote expected Sunday in the House and then the wrangling to come in the Senate.

I think the simplest answer to your question is: Yes. This is a nailbiter, and Democratic leaders were very nervous about Obama leaving the country in the midst of it. The White House had already postponed the trip by 3 days but apparently concluded it was important for the president to be here.

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Love those WP editors!: So the news is that the health care reform package gets priced at $940 billion dollars (just under one TRILLION dollars), and the Washington Post website runs a headline about the health bill reducing the deficit by $138 billion? Well, I wouldn't buy a used car from you guys!

Dan Eggen: The overall pricetag on the bill hasn't changed much since last summer (Obama made keeping it under $1 trillion a requirement). The big question has always been whether it reduces the deficit and, if so, by how much.

I'm not quite sure why those concerned about the deficit would complain when the neutral arbiter in these things (the CBO) issues its decree and reporters make note of it.

To continue with your car analogy: The Democratic argument is that, yes, you're buying a more expensive car than the old gas guzzler you have now, but it will save you money in gas and upkeep in the long run. A crude comparison, yes, but I think that's one way to look at their point of view. But hey, I'm not selling the car!

I assume you join Republicans and many others who doubt that the CBO numbers are accurate, which is a perfectly valid debate. The problem is that both sides rely on CBO for every financial decision they make, so today's numbers are a powerful talking point for the Democrats.

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Chicago: Please help me out here. The health bill will provide health coverage to 30 million uninsured people, or to put it a different way, 30 million voters. Are the Dems too timid to bluntly make this point, or are the R's incapable of doing the math?

Dan Eggen: The Democrats have been hammering this point for months, but they've still not gotten traction in the polls. In part, this may simply be because the ugly debate has overshadowed everything else.

But to be blunt there is also a demographic point here: Many of those who will benefit are not as likely to vote. Plus the Democrats have had a hard time selling their plan to seniors, many of whom fear the impact that reform might have on Medicare, which already takes care of their health care coverage.

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Buffalo: DO THEY HAVE THE VOTES?

Dan Eggen: Not yet. But they're close. The good-for-Democrats CBO scores may move things along further; we'll see.

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Belfast, Maine: When I looked at the Post's scorecard this morning, which seems to have vanished by the way, my congressman Mike Michaud was listed as undecided. Will the CBO report convince him to get with the program?

washingtonpost.com: Graphic -- Who's in play: House health-care vote

Dan Eggen: There's the link for you. I'm not familiar with the details of Rep. Michaud's objections. But if he is among those who have expressed concern about cost, then the CBO numbers could sway him, it's hard to tell.

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Utica, N.Y.: How many of the undecided reps are like my congressman Mike Arcuri. He voted AYE the first time around and will have to answer for that in November. He now "tends NO." Seems to me he has managed to offend every part of his constituency with these contrary positions.

Dan Eggen: This is the argument of the Democratic leadership, that looking like you're waffling does you no good at the polls. Republicans would argue that it would simply mean Rep. Arcuri had come to his senses (though I'll venture a guess that they'll still field a GOP challenger to try to unseat him in the fall!)

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Rome NY: What is the fate of the anti-trust exemption for insurers? I've lost track of it in the debate and certainly hope that if everyone must buy insurance under HCR, we at least can count on competitive market forces directing prices.

Dan Eggen: I believe it passed the House but future is uncertain in the Senate (I could write that about a lot of things!).

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St. Paul, Minn.: Hi Dan -- Thanks for taking questions today. Rep. Kucinich, in explaining his change of heart, said that if HCR didn't pass, the Obama presidency would be "destroyed." Maybe it's just me, but isn't that just a little bit over the top? If it doesn't pass, then what does Obama do with the remaining three years of his "destroyed" term? And most importantly, do you think this "doomsday" scenario will have any impact on other wavering members of the House?

Dan Eggen: The White House argues that they have had many successes, including the stimulus, jobs bills, children's health insurance legislation etc. But the fact remains that HCR is Obama's #1 priority, and if it's defeated, his presidency will be deeply wounded. That is how politics works in Washington--momentum, perception and all the rest have a huge impact on what can get done. (Just look what happened when, as the joke goes, the Democrats became a 59-vote minority in the Senate.)

I don't know if this enters into the calculations of wavering members or not.

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Alexandria, VA: What is the best "deal" that any member of Congress has gotten over the healthcare issue?

Dan Eggen: I'm not sure how to rank this, but certainly the most widely known--and reviled--was the aforementioned "Cornhusker Kickback," which singled out Nebraska for preferential treatment under a requirment to expand Medicaid coverage. The measure was included in the Senate bill to mollify centrist Sen. Ben Nelson (D), but Nelson and pretty much disowned the provision after it was publicized. That deal and some others would be eliminated under the reconciliation package.

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Alexandria, VA: So the Congresional Budget Office projects that there will a trillion dollar savings in health care costs over the next 20 years. So, how can those who voted for Medicare Part D a few years ago that projected to increase the deficit, now vote against Health Care Reform based on "fiscal responsiblity"?

Dan Eggen: The mood is certainly different now, due in part to an economic meltdown which has decimated federal revenues and driven the deficit into stratosphere. But yes, Democrats complain that Republicans are being hypocritical since they backed many policies (including Medicare Part D and the Bush tax cuts) with no revenue offsets.

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Arlington, VA: As one of the Senators asked during President Obama's recent White House roundtable meeeting on health care, why can't we start over with reform and take it in steps and with legislation that I as a consumer (and voter) understand? I have not heard a good answer to that simple question. Thank you.

Dan Eggen: I think the WH answer is that they've already been working on it for more than a year, and the proposal itself is based on years of previous research and debate. (Sen. Baucus began holding hearings in his committee in at least 2008 if not earlier, if I recall correctly.) The plan is very similar to one proposed by Republicans in the early 1990s; it also shares strong similarities to the plan adopted by Massachusetts under then-Gov. Mitt Romney (R).

Obama also likes to frequently point out that presidents since Teddy Roosevelt have tried to get universal (or, in this case, near-universal) coverage passed.

All of that is a long-winded way of saying: The Democrats view the "start over" argument as a GOP stalling tactic rather than a serious request.

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Dan Eggen: OK folks, I'm afraid that's all I have time for. Hopefully we can do this again soon.

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