THE TREATMENT SEPTEMBER 1, 2009
Given Mike Enzi’s departure from the bipartisan talks and the imminent collapse of the Gang of Six, it looks like there’s just one Republican Senator still willing to negotiate seriously with the Democrats—Olympia Snowe. Even if the leadership decides to take a more partisan route for the bill, Snowe is sometimes more liberal than the right flank of the Democratic Party, and her vote could still be critical to reform’s survival. But what does she really want out of the current bill? And is she in a place where she can still see eye-to-eye with the Democratic leadership?
Over the past few days, I’ve spoken with close observers of the debate, both on and off the Hill, to get a better sense of Snowe’s positions on the key issues that will shape the final Finance Committee bill. Here’s the quick rundown on where Snowe appears to stand, based on my reporting so far:
—Supports the public plan—but only as a fall-back option. Snowe has essentially maintained the same position that she came to months ago: a government-run insurance plan that would be a fall-back option, only if the reforms to the private insurance industry did not provide adequate savings. This is the "trigger" option has largely fallen to the wayside in the midst of the hysteria over the public plan and the popularity of Kent Conrad’s co-op plan. Snowe is continuing to lobby her colleagues to support what she calls a "safety net plan" to avoid the politically combustible association with the liberals’ “public plan.”
—May agree to scale back insurance subsidies, but allows room for negotiation. The Finance Committee has already indicated that they plan to scale back the subsidies to help low-income individuals to buy insurance, providing help to those earning up to 300% above the poverty line, as opposed to the 400% that’s in the HELP/House bills. Snowe argues that most of the uninsured fall below the 300% mark, though—according to multiple sources—she believes there are some “unique problems” that those in the 300-400% range face. She is going to continue deliberating ways to help these individuals in negotiations. But it’s not clear what those mechanisms might be if Finance isn’t willing to budge from the lower figure--and if Snowe’s not willing to fight to push it higher:
—Wants financing for the bill to come from within the health care system. Snowe apparently wants to finance the bill from “within the health care system,” according to one source, and expects much of the savings to come from industry groups and cost-savings measures within the system. But for meaningful reform to happen, more money will probably have to be put on the table--and the means for doing so might not be to Snowe’s liking. Back in May, she spoke out against putting a cap on the tax exclusion of employer-sponsored benefits, opposing a significant potential revenue stream for the bill. Altogether, it’s still unclear whether she will support taxing individuals—either within or outside the system—to pay for the bill.
—Supports a reduction of the minimum benefits that all insurance policies would have to provide. The “actuarial standard” basically means the percentage of medical bills that insurance would have to cover. The HELP bill set this at 75%, while Snowe seems inclined to support something closer to 65%. According to my sources, it’s partly because Snowe thinks this is less of a priority for the public—they don’t understand this provision very well and are more concerned about, say, the high cost of insurance premiums. And plans that provide fewer benefits are bound to cost less.
—Willing to consider having larger businesses participate in the Health Insurance Exchange. Right now, only small businesses would be eligible to participate in the exchange, which could limit its cost-saving potential. Snowe is interested in exploring whether businesses with more than 50 employees could participate--a move that could ultimately strengthen the exchanges by attracting a larger, and more medically diverse, group of people.
—Wants to protect older people from undue price discrimination by insurance companies. Right now, insurance companies in certain states charge exorbitantly higher premiums for older patients—the HELP/House bill stipulate that they can only vary by a factor of 2, but Enzi wanted to push it to 5. On this issue, Snowe appears to be on the more liberal end of the spectrum, though she doesn’t expect the rating to remain as low as 2.
—Opposes reconciliation because of the detrimental impact it would have on reform. It’s no surprise that Snowe opposes reconciliation, but her apparent rationale is telling: it’s not just because of its political significance, but also because it could only be applied to part of the current bill. Snowe shares the fears of some members of the liberal, pro-reform camp that doing this could significantly curtail the impact of reform.
Altogether, these positions put Snowe to the right of many if not most Democrats. But not that far to the right. In other words, she appears to be negotiating in good faith—and her interest in passing reform seems genuine. That sets her apart from the rest of the Republican Caucus—and makes her somebody with whom Democrats can, and should, keep talking.