THE TREATMENT DECEMBER 22, 2009
Over at Politico, public option advocate (and sometimes Treatment contributor) Jacob Hacker has some suggestions for how to improve the Senate bill, assuming it passes. And most of those suggestions involve making it look more like its House counterpart:
The gaping hole left by the removal of the public option must be filled, at least partially before the final bill is passed and more fully every year thereafter.
Several critical provisions in the House bill would help to fill this hole. The House bill offers Americans living at 250 percent of poverty or below (about $55,000 for a family of four) far greater affordability protections than does the Senate bill, and it expands Medicaid to individuals with incomes of roughly $16,000. Both provisions are central to ensuring health care is affordable and available to all Americans, not simply those with means. Both are also central to making morally and politically acceptable the requirement that Americans have coverage.
The House bill also has far stronger employer responsibility requirements than does the Senate bill. Although many of these will be hard to incorporate into the final legislation, House leaders and the president should insist on making the employer requirements apply to part-time workers and on strengthening insurance regulations on large employment-based plans.
Finally, and perhaps most important, Congress must ensure that the federal government does not leave reform dependent on the capacity and will of state governments. The best way to do this is to move away from the near-exclusive emphasis on state regulation in the Senate bill toward the stronger federal regulations in the House bill.
Yesterday Kent Conrad, echoing Joe Lieberman and Ben Nelson, warned that the House shouldn't demand too many changes in conference or whatever informal negotiation takes its place. But, at least in principle, the House has the exact same right to shape this bill as the Senate does. And particularly when it comes to guaranteeing people financial protection, the House bill is simply better on the merits.
Update: Representative Raul Grijalva tells The Plum Line's Greg Sargent that fellow House liberals might push to speed up the Senate's implementation timetable, so that the exchanges started up in 2013 rather than 2014. That's a terrific idea--if anything, the exchanges should launch even earlier--and precisely the sort of compromise the House might actually be able to win. More on this soon...