Obama's victory changes the world

By Gideon Rachman

Published: March 23 2010 02:00 | Last updated: March 23 2010 02:00

President Barack Obama has leapt out of his political sick-bed, ripped out his feeding tubes and is ready to dance a jig around the Oval office. The Congressional approval of healthcare reform has reinvigorated the Obama presidency in a way that has implications not just for Americans, but for the world.

By pushing through a social reform that eluded generations of presidents from Teddy Roosevelt to Bill Clinton, Mr Obama can now point to a genuinely historic achievement. He has turned around his image as a weak president who cannot get things done - just when it was getting dangerously close to becoming a self-fulfilling prophecy.

Over the past year, the optimistic glow that surrounded Mr Obama when he took the oath of office has faded away. In its place came new and less flattering images: Obama the talker, not the doer; Obama the naive president, who was getting pushed around by the world's tough guys; Obama, the hate figure for the American right, who lost one of the safest Democratic seats in the Senate in Massachusetts.

The president's apparent inability to get healthcare reform passed sapped his credibility, not just in America but around the world. Foreigners were uninterested by the rules of Senate procedure: all they saw was a popular president, with a massive majority, who seemed unable to get his major domestic policy through.

Deadlock over healthcare set a disturbing pattern, which then replicated itself in the Obama administration's dealings with the rest of the world. In his first year in office, Mr Obama fell into the habit of declaring grand goals and then failing to deliver.

The president announced that he would reinvigorate the Middle East peace process and demanded a halt to new Israeli settlements on Palestinian land. But there were no peace talks and Benjamin Netanyahu, the Israeli prime minister, basically ignored him on settlements. On the night that he was elected, Mr Obama made a "planet in peril" one of his top priorities - but the Copenhagen talks on climate-change ended in fiasco, with the US diplomatically out-manoeuvred by China.

The Obama administration said that it would not tolerate the development of an Iranian bomb - yet the Iranian nuclear programme continued apace and the Americans have so far proved unable to rally the world behind fresh sanctions. When it came to the war in Afghanistan, the Obama administration agonised in public for months - and then announced a new troop surge that even the president seemed unconvinced by.

Increasingly Mr Obama was portrayed overseas as weak, indecisive and ineffective. That is now likely to change - at least for a while - in the wake of the passage of healthcare reform. As a result, Mr Obama now has a chance to re-launch his presidency, abroad as well as at home.

Of course, there is no direct connection between the renewal of Mr Obama's domestic political momentum and his chances of success in foreign policy. But there is an indirect connection. Put crudely, the passage of healthcare reform makes Mr Obama look like a winner rather than a loser. It also shows that he is tenacious and that his stubbornness can pay dividends.

Healthcare looked like a lost battle - but it turned out just to be a long battle. Foreign leaders who have written off Mr Obama's chances of succeeding on the big international issues - Afghanistan, the Middle East, climate change, Iran - will now have to consider the possibility that the president's persistence might ultimately deliver success. That increases the likelihood that leaders who are wavering will listen and try to work with him.

It may also make foreign leaders who are inclined to thumb their nose at the president think twice. This is not a great week for Mr Netanyahu to arrive in Washington - where he is scheduled to speak to the annual conference of the American Israel Public Affairs Committee (Aipac). If healthcare reform had collapsed in Congress, the Israeli prime minister might have been emboldened to try to rally US opposition to the Obama administration's Middle East policies. But now that the president has a following wind, confronting him looks riskier.

Success over healthcare may also encourage fickle pundits (I include myself amongst them) to take a more balanced view of Mr Obama's first year in office. The administration did, after all, avert the threat of a complete meltdown of the banking industry. The US economy is now growing at an annualised rate of almost 6 per cent a year - much faster than any comparable western economy.

American conservatives are right that healthcare reform has nudged the US a bit closer towards European ideas of social solidarity - and a bit further away from America's own tradition of rugged individualism. The social and economic costs and benefits of such a move can be debated. But there is likely to be an indirect foreign-policy pay-off for the US.

By committing his nation to providing healthcare for nearly everyone, Mr Obama will undermine the Michael Moore vision of America as a country where big business ruthlessly exploits the downtrodden poor. This is a cartoon version of the US that is wildly popular in Europe and around the world. It will be harder to propagate in the wake of the passage of Mr Obama's healthcare reforms.

gideon.rachman@ft.com

Nancy Pelosi Now Has The 216 Votes That She Needs To Pass Helath Care Reform

CNN Breaking News‏

From:	CNN Breaking News (BreakingNews@mail.cnn.com)
Sent:	Sun 3/21/10 1:29 PM
To:	textbreakingnews@ema3lsv06.turner.com

-- House Democrats have 216 votes needed to pass health care reform, chairman of House Democratic Caucus tells CNN.

The Final Shape Of The Health Care Reform Bill

Health Care: Changes Planned to Senate Bill by House Democrats
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By Kristin Jensen and Nicole Gaouette

March 20 (Bloomberg) -- House Democrats are aiming to approve tomorrow the biggest changes to the U.S. health-care system in more than four decades, extending coverage to tens of millions of uninsured Americans and attempting to curb rising medical costs.

Insurers would no longer be able to reject new customers with pre-existing medical conditions; new restrictions would be placed on their ability to set premiums. Patients would have greater access to preventive care and young adults would be able to stay on their parents’ insurance until the age of 26.

No Republicans support the 10-year, $940 billion legislation, forcing the Democrats to finish their work with a budget process called reconciliation. Using the procedure, House Democratic leaders are pushing for approval of a Senate bill passed in December along with a series of changes in a reconciliation bill. The Senate will then take up the reconciliation bill as well.

President Barack Obama has made an overhaul of the U.S. health-care system his top domestic priority and is helping House Speaker Nancy Pelosi round up the final support she needs ahead of a vote slated for March 21. The House is insisting on the reconciliation bill, released March 18, because many members don’t like the Senate version.

The following outlines some of the biggest changes:

INDIVIDUAL MANDATE: The Senate bill requires all Americans to get health insurance or pay a penalty. Under the reconciliation bill, individuals who don’t purchase insurance would be subject to a fine of $325 in 2015 and $695 in 2016, compared with $495 and $750 in the original Senate bill. Individuals may be subject to a charge equal to as much as 2.5 percent of their income in 2016, if the total is greater than the flat payment, a change from 2 percent in the Senate version.

EXPANDING COVERAGE: With changes made by the reconciliation bill, 32 million uninsured Americans will be covered by a health plan, the Congressional Budget Office said yesterday. That means that 92 percent of all residents, or 95 percent excluding illegal immigrants, would have insurance in 2019, the nonpartisan agency said.

About 15 percent of U.S. residents, or some 46 million, lacked insurance in 2008, according to the U.S. Census Bureau.

HELPING SENIORS AFFORD MEDICINES: The reconciliation bill builds on the Senate measure to help close a gap, known as the doughnut hole, in coverage for prescription drugs for patients in the Medicare program for the elderly. Part of it is funded by the government and part by the pharmaceutical industry, which in June agreed to spend as much as $80 billion over 10 years.

TAXES: Already in the Senate bill, a higher Medicare payroll tax will be assessed on individuals who make more than $200,000 a year or families with annual income of more than $250,000. The reconciliation bill includes an additional 3.8 percent Medicare tax on unearned income such as dividends on these high earners.

The reconciliation bill would also scale back the Senate’s planned tax on so-called Cadillac, high-end insurance plans. Labor unions said the levy would affect too many workers; the reconciliation bill reduces the revenue from the tax by 80 percent by raising the thresholds at which it would apply. The measure also delays the tax until 2018.

INDUSTRY FEES: The reconciliation bill converts $20 billion in fees that the Senate planned to raise from medical device makers such as Natick, Massachusetts-based Boston Scientific Corp. into a 2.9 percent excise tax on certain devices. The revenue would be the same, with a delay on the tax until 2013.

The pharmaceutical industry, which includes New York-based Pfizer Inc., would be subject to fees starting in 2011. Lawmakers replaced a $2.3 billion annual tax in the Senate bill with a levy that would gradually increase from $2.5 billion in 2011 to $4.2 billion in 2018. Beginning in 2019, the fee would drop to $2.8 billion annually and hold steady thereafter.

Insurers such as Indianapolis-based WellPoint Inc. would face varying fees over the life of the reconciliation bill, as compared with a flat $6.7 billion annual levy in the Senate bill. The industry would pay $58.8 billion in fees over the period from 2014 to 2018; levies would be adjusted for premium growth afterward.

EMPLOYER MANDATE: Under the Senate bill, if an employer with more than 50 employees doesn’t offer coverage and has just one employee who qualifies for a new tax credit, the company must pay a fee for every full-time employee on its roster. The reconciliation bill raises the penalty to $2,000 from $750, though it subtracts the first 30 employees from the calculation.

ABORTION FUNDING: The reconciliation bill doesn’t address the issue of abortion and therefore may lead to the defection of some anti-abortion Democrats in the House who say the Senate bill doesn’t do enough to ensure federal funds aren’t used for the procedure. Top congressional Democrats say the legislation already preserves the ban on federal funding.

STUDENT-LOAN REVAMP: The reconciliation bill adds a House- passed measure to revamp the college student-loan program. The plan would end subsidies to lenders such as SLM Corp., commonly known as Sallie Mae, and instead have all students borrow directly from the federal government.

Democrats plan to use the bulk of the anticipated savings to expand Pell college tuition grants. The savings also proved critical to meeting the requirement that any health-care reconciliation bill save at least $2 billion over the first five years, the CBO analysis shows.

What’s Next

The House first needs to pass the Senate bill and the reconciliation changes. The Senate bill would become law as soon as Obama signs it. The Senate would have to pass the reconciliation bill as well before it can become law.

Republicans are vowing to use every procedural tactic they can to block the reconciliation bill and they may challenge its provisions. If the Senate parliamentarian rules with Republicans on a challenge, Democrats might have to vote on a changed bill, which would kick it back to the House again.

The No. 2 Senate Democrat, Dick Durbin of Illinois, yesterday said the Senate aims to finish its work by March 26. That’s the day lawmakers are scheduled to leave for a two-week recess.

To contact the reporters on this story: Kristin Jensen in Washing

The Ferocious Battle To Pass Health Care Reform

Health Care Whip Count Live Updates: Will Reform Bill Have The Votes?
The Huffington Post | Sam Stein First Posted: 03-19-10 10:30 AM | Updated: 03-20-10 12:33 AM

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Ahead of this weekend's vote on health care reform, Democratic leaders in the House of Representatives have been engaged in fierce behind-the-scenes lobbying of undecided lawmakers whose support will be crucial to final passage of the bill.

The magic number that House Speaker Nancy Pelosi (D-Calif.) and other top Democrats are working toward is 216. On Thursday and Friday her prospects brightened as several fence-sitting lawmakers came out in favor of the bill. Still, there are holdouts and they will be the focus of the Democratic arm-twisting between now and Sunday's vote.

Check here for the Huffington Post's breaking updates of the health care whip count in Congress.

6:45 PM ET -- Momentum on Democrats' side for health care vote. House Speaker Nancy Pelosi (D-Calif.) is apparently optimistic about Sunday's vote.

"It's looking good," she said smiling to reporters on Capitol Hill.

Indeed, if all of the remaining undecided Democrats were to vote as they did when health care reform first passed the House in November, the final legislation would pass on Sunday with a handful of votes to spare.

"It's over," declared Larry Sabato, the director of the University of Virginia's Center for Politics. The bill "will pass [the] House."

Story continues below

--RYAN GRIM & NICO PITNEY

6:30 PM ET -- Vicki Kennedy whipped Stephen Lynch to no avail. Rep. Stephen Lynch (D-Mass.) one of the few Democrats opposing the bill because it doesn't go far enough, said Friday that he got a call two or three days ago from Ted Kennedy's widow Vicki Kennedy.

"She said Ted had worked at this for quite some time and invoked his name," Lynch told reporters. He regretfully told her he would be opposing the bill, he said. Senate Majority Leader Steny Hoyer (D-Md.) pushed Lynch again today on the House floor. Lynch said he told Hoyer not to waste time on him. He's a firm no.

Rep. Bill Delahunt of Massachusetts said that if Lynch says he's voting no, he's voting no. "He's a man of integrity," said Delahunt.

--RYAN GRIM

6:15 PM ET -- Two more for the "yes" column. Rep. Gary Peters (D-Mich.) and Rep. Scott Murphy (D-NY) will both vote for the bill.

"The vast majority of Americans believe that health care reform is needed. I agree, and after thoroughly reviewing the details of the proposal, I believe it will be far better than the status quo that allows skyrocketing costs to cripple families and small businesses and cause people to lose their care," Peters said, according to the Detroit News. The newspaper reported that Peters was "the last of Michigan's 15 House members to reveal how he'll vote" this weekend.

As for Murphy: "This bill is fundamentally different than the bill we voted on last November," Murphy said, "[it] is not perfect," but he added that he feels "much better" about it, according to the Albany Times Union.

6:00 PM ET -- Cao opens the door after closing it. Hours after he seemed to firmly close the door on supporting health care reform, the one Republican to back the legislation opened the door once more to ultimately voting "yes."

Rep. Joseph Cao (R-La.), who said he was a "firm no" during an interview with CNN on Friday -- citing "insufficient" restrictions on abortion in the legislation being considered -- told the National Review later in the day that he "hopes to reconsider" his position

Cao's hope is that House Speaker Nancy Pelosi can guarantee -- "with certainty" -- that the abortion language will be altered in a separate piece of legislation. Though he also suggested that he is still determining whether he's comfortable with the current language as is.

All of which points to Cao likely crossing the aisle on Sunday provided that he is not the one determining vote. There is no reason for the GOP to demand that he vote "no" (and irk his largely Democratic constituents) if the bill is going to pass anyways. But if he is the difference between passage and failure, the pressure from his Republican colleagues will likely be too tremendous to dismiss.

--SAM STEIN

5:45 PM ET -- The Georgia twosome split their votes. Two Georgia Democratic congressmen are voting in opposite ways on health care reform, local news affiliates report. Neither vote changes the party's calculus in passing the legislation.

Rep. Sanford Bishop (D-Georgia), who voted "yes" during the first go-round, will remain in that camp come Sunday, he announced on Friday.

"I'm in a situation where I'm damned if I do and damned if I don't," Bishop said. "And if I'm damned under those circumstances, I want to be damned on [the] side of angels and on the side of right."

Meanwhile, another Blue Dog Democrat, Rep. John Barrow, announced that he will vote "no" on the bill -- the same position he took during the first vote.

--SAM STEIN

5:30 PM ET -- Can you hear me now? White House Press Secretary Robert Gibbs just e-mailed reporters word that "since Monday, the President has held 64 meetings or phone calls with Members of Congress on health insurance reform."

Accompanying the email is a photo of Obama making a phone call from the presidential motorcade while on the way to George Mason University to deliver a speech on health care on Friday.


The imagery is persuasive: a president looking cool, calm, business-like as he works the phones. But it also raises the question: what exactly took Obama so long to start the personal diplomacy -- a charge that several lawmakers have leveled at the president. (Sens. Blanche Lincoln (D-Ark.) and Joseph Lieberman (I-Conn.) both claim to have never heard from the White House about their opposition to a public option for insurance coverage.)

--SAM STEIN

5:15 PM ET -- Florida Dem now a "yes." The Orlando Sentinel reports that Rep. Suzanne Kosmas (D-Fla.) will support the bill. Kosmas was among the group of nearly 40 Democrats who voted against the health care bill last fall.

"I'm going to vote for health care reform," she told the Orlando newspaper. "I know this is not a perfect bill. But in the scheme of things, it provides the best options and the best opportunities for my constituents."

--MICHAEL FALCONE


5:10 PM ET -- Indiana Democrat gets behind the bill. Rep. Brad Ellsworth (D-Ind.) will support health care reform, a spokesman for his office told the Huffington Post on Friday. The Indiana Democrat, despite having supported the bill when it was first considered by the House, was weighing opposition to the legislation because of disagreements with its abortion language. He had been a part of Rep. Bart Stupak's (D-Mich.) noted Gang of 12 holdouts.

But after some party pressure -- and undoubtedly with his forthcoming Senate campaign weighing on his mind -- he decided to remain in the "yes" column.

Here is an excerpt from Ellsworth's statement:

"Like most Americans I was frustrated by this process throughout. Unfortunately many in both parties made snap judgments on whether or not they would support this bill based on politics, not policy. I was sent here to look at all sides of the argument in a thoughtful manner and I knew that the status quo was no longer acceptable. I needed to answer only one question when deciding whether to support this reform: will this bill benefit Hoosiers? Put simply, in my core I know it does."

"There is no issue more important or more personal to every single Hoosier than our health and well-being. My job is to look beyond all the political games, study the bill carefully, and do my best to make the right decision for Indiana."

"After months of meetings and conversations with thousands of Hoosiers, health care experts and pro-life advocates, I am confident supporting health care reform is the right decision for Hoosiers."

4:40 PM ET -- Obama meeting with Dems for last-minute arm-twisting. President Obama will travel to Capitol Hill on Saturday to met with House Democratic lawmakers prior to Sunday's vote.

The meeting, was supposed to have taken place at the White House but was moved to Capitol Hill to accommodate the large number of expected attendees. White House spokesman Reid Cherlin sent the following to reporters just minutes ago;

"Tomorrow's meeting with the House Democratic caucus will be held at 3:00pm in the Cannon Caucus Room."

The president held a similar pre-vote gathering with House Democrats when they first voted on health care legislation back in November.

--SAM STEIN

4:37 PM ET -- Ohio's Kilroy is on board Rep. Mary Jo Kilroy (D-Ohio), who voted for the health care bill last time but was on the fence approaching the second go-round, announced on Friday that she remains supportive of the bill.

"I will vote for the health insurance reform bill that will put our families and small businesses in charge of their health care choices," said the Ohio Democrat. "As many of my constituents know, I live with multiple sclerosis. I understand what millions of Americans with preexisting conditions face, including my constituent who suffers from Parkinson's disease and who was physically harassed by opponents of health insurance reform just this week in front of my office."

Kilroy, who hails from a swing district in Ohio said that the bill was "by no means perfect." But, she added, "it is a big step in the right direction and will save lives. I will not stop fighting for central Ohioans after this vote."

4:25 PM ET -- Pennsylvania Blue Dog isn't convinced. Rep. Jason Altmire (D-Penn.) will oppose the final version of health care reform in the House, a Democratic source tells the Huffington Post. The congressman, a fiscally conservative Blue Dog, was concerned about the bill's cost and its language on abortion.

Altimre did not vote for the bill during the first go-round. So his "no" vote doesn't hurt the party as much as a defection. But the Pennsylvania Democrat had been courted heavily by party leadership, including the White House, for weeks as the vote approached. He was, apparently, unpersuaded.

--SAM STEIN

4:00 PM ET -- Another "yes" flip. Rep. Allen Boyd (D-Fla.) is a yes, after voting no the last time around, the Tallahassee Democrat is reporting. Boyd's flip is a big pick-up for Pelosi. More from the newspaper:

[Boyd] said he studied the revised bill and the Congressional Budget Office report on its costs and benefits. He said "it's not perfect" but that the package meets the four criteria he set forth in a series of 16 meetings across the 2nd Congressional District last summer.
Boyd's flip puts pressure on Suzanne Kosmas (D-Fla.) to follow suit, as Boyd is the Blue Dog Dean of Florida, so to speak. However, if Boyd's vote gives Democrats the number they need, Kosmas could be given a pass. Boyd's seat is much safer than Kosmas, who is a top pick up opportunity for Republicans. She told reporters in the Capitol Friday afternoon that she will make a decision "shortly."

--RYAN GRIM

2:50 PM ET -- Perriello is a "yes." Rep. Tom Perriello (D-Va) announced on CNN Friday afternoon that he would vote for the health care bill. More on his decision from the Lynchburg News and Advance on the conditions for his vote in favor of the bill.

2:20 PM ET -- Heath Shuler not budging. North Carolina Democrat Heath Shuler says he is a definite 'no' vote. "I have not waffled one instant. That's coming from people who would like me to waffle," he said, referring to rumors he was reconsidering his position.

--RYAN GRIM

2:18 PM ET: Ohio Democrat still not on board. House Democratic leadership and outside groups have not yet been able to convince Rep. Zack Space (D-Ohio) to get on board health care reform, two Democratic sources working on health care tell the Huffington Post.

Space, who previously supported the legislation, announced back in January that he would oppose the Senate's version of reform. Since then, he has been the subject of an intense lobbying campaign, including a discussion with the president on Wednesday.

The arm-twisting, however, has not appeared to pay off. At least not yet, as the union source described the congressman as "being a problem still." Another Democratic official relayed that the White House was in continued conversation with the Ohio Democrat.

AFL-CIO President Richard Trumka is expected to personally call Space about his position with other union leaders following suit. Local officials are also launching a heightened lobbying effort on Space as well.

Earlier in the day, two of Space's Ohio Democratic colleagues, Reps. Charlie Wilson and John Boccieri, announced that they will support the House's health care reform legislation.

--SAM STEIN

2:00 PM ET: Connecticut Dem adds his support. Rep. Joe Courtney (D-Conn.) announced on CNN on Friday afternoon that he would vote in favor of the bill this weekend.

1:45 PM ET: Bobby Rush holding out. President Obama called Rep. Bobby Rush (R-Il) Friday morning to lobby him on health care, Rush told reporters. Rush told the president that a primary objection of his to supporting the bill was the removal of a provision that would extend outpatient discounts on medication to inpatient settings, which would benefit public hospitals.

"It just mysteriously disappeared," Rush said of the previously-agreed-to provision. He said he was told that Big Pharma objected to it.

Rush said he's switched his position from "leaning undecided to very undecided." (Obama assured Rush he was working to fix the language).

--RYAN GRIM

1:30 PM ET: Pro-life Democrat getting on board. Rep. Henry Cuellar of Texas said he was largely persuaded by arguments that the Senate bill does, in fact, prevent federal funds from paying for abortion.

"I'm almost there," he told reporters on Friday, saying he was swayed by a legal analysis by health care scholar -- and HuffPost blogger -- Timothy Jost. The fact that Rep. Dale Kildee (D-Mich.), Catholic hospitals and nuns backed it also helped convince him.

As a Blue Dog, he said, the CBO numbers were "very impressive."

He said the White House called him the day before yesterday, but he has yet to return the call.

"If I have to talk to him, I'll talk to him," he said. "Whether he's popular or not in my district I won't get into."

--RYAN GRIM

1:15 PM ET: Ohio Democrat leaning toward a "yes" vote? The Toledo Blade reports that Rep. Marcy Kaptur (D-Ohio) has indicated she may be thinking about supporting the health care bill.

"I am leaning toward voting for the bill if we can properly deal with the abortion issue and we are fast about that task," Kaptur, an anti-abortion Democrat who voted "yes" on the bill in November, told the Blade.

1:00 PM ET: Defazio may have company. Caucus Chair John Larson (D-Conn.) tells HuffPost that Rep. Jay Inslee (D-WA) and Rep. Ron Kind (D-Wisc.) and others -- along with Defazio -- objected to the stripping out of language related to Medicare disparities in the health care bill.

"Several members have expressed concerns," Larson said. We're continuing to meet on that and if we can't fix it because of parliamentary procedure, we believe that there are ways to fix it in other legislation."

Would they buck the party over this?

"I can't speak for them," Larson told HuffPost, "but I know they know how significant and important this historic moment is."

--RYAN GRIM


12:25 PM ET: Nevada Dem lends her support. Rep. Dina Titus (D-Nev.) released a statement on Friday saying that she would support the health care bill even though it "is not perfect."

"For nearly a year, I have talked with the people of District Three about the need for health care reform," Titus said in the statement. "I have heard horror stories from small business owners who had to lay off workers because of rising health care costs and families that could not get insurance because of a pre-existing condition. While the legislation the House will vote on this weekend is not perfect, it makes critical reforms that provide common sense rules of the road that will give families and small businesses more control over their health care -- not government bureaucrats or insurance company CEOs."

The HuffPost's Ryan Grim reports that House Speaker Nancy Pelosi lobbied Titus hard on the House floor on Thursday, standing over her as the Nevada congresswoman stayed seated. Pelosi repeatedly put her hand on Titus's hand while making her case.

In her statement, Titus pledged to "continue to push for additional reforms" where the legislation -- in her view -- falls short.

UPDATE: A spokesman for Titus, Andrew Stoddard, tells HuffPost that Titus had wanted to speak at a caucus meeting prior to the vote during which she spoke to Pelosi, but the meeting ended while she was still waiting in line. The Speaker approached Titus on the floor, said Stoddard, not to pressure her to vote yes but to ask what she had wanted to say during the meeting. Titus raised questions about the education reform language that had been added to the bill and Pelosi assured her that her concerns would be taken under consideration.

"She wasn't responding to pressure from anyone in Washington," Stoddard said of her subsequent decision to vote yes.

--RYAN GRIM and MICHAEL FALCONE

11:55 AM ET: Obama's pitch -- special interests vs. the American public. In a rousing speech before a crowd at a northern Virginia university on Friday, President Obama sent a forceful message to wavering lawmakers.

"I don't know how passing health care will play politically, but i know its right," Obama said.

Then, addressing the cheering crowd at George Mason University, he asked for their help:

"If you believe that its right, then you've got to help me finish this fight," asking them to call lawmakers and apply some pressure of their own.

"We are going to get this done, we are going to make history, we are going to fix health care in America with your help," Obama said as he ended his remarks.

--MICHAEL FALCONE

11:30 AM ET: Pelosi weighs in on Defazio's objections. At her press briefing Friday morning, House Speaker Nancy Pelosi (D-Calif.) was asked about Rep. Peter Defazio's objections to the removal of the Medicare disparity fix from the final bill. "We're working on that language," said Pelosi. "I feel comfortable about where we are heading." She said she supports the language that was in the House bill and is working toward restoring it as much as possible.

"We have reached agreement before," she said of the dicey political issue. Defazio said his state receives the fifth lowest Medicare reimbursement rate - some $5,000 per recipient compared to Miami's $16,000.

--RYAN GRIM

11:20 AM ET: The White House's Take. White House spokesman Reid Cherlin said it was a "big day" just before President Obama began his remarks at George Mason University in Virginia where he traveled on Friday to make a final push for the health care bill.

11:05 AM ET: Unions cracking down on health care "no" votes. As the Huffington Post has reported, labor unions have been threatening tough consequences for Democratic lawmakers who do not get behind the health care bill, and here's proof: The PlumLine's Greg Sargent reports on Friday that the powerful Service Employees International Union has informed Rep. Michael Arcuri (D-NY) that it is "pulling support for him" over the congressman's refusal to support the bill.

SEIU spokesman Matt Nerzig told Sargent that Jerry Dennis, the president of SEIU local 200 in New York called Arcuri and "told him it'll be very difficult to support him come next election if he's not on this bill," Nerzig said. "The search for alternatives has already begun." In other words, Arcuri can expect that the union will be looking for a primary challenger to run against him.

Politico's Ben Smith reports that the Working Families Party in New York is already "actively recruiting" a candidate to run against Arcuri.

--MICHAEL FALCONE

10:45 AM ET: Liberal Dem angry, threatening 'no' vote. Rep. Peter Defazio (D-Ore.) tells HuffPost's Ryan Grim that he currently opposes the health care bill because House leaders removed a measure addressing the geographic imbalance of Medicare spending. Defazio is furious and claims he will oppose the health care bill unless the fix is put it back in (he said he's also angry about stripping the public option). A word of caution though: Defazio often makes noise like this before votes, so he's not a definite 'no' until his vote is cast -- but he was certainly animated.

"Unless they put that back in, I can't support it," Defazio said, referring to the medicare disparity fix. "This is under active discussion. They just decided yesterday morning they're stripping this out. The senate budget committee staff deliberated for 20 minutes and it was out and our leadership was going to accept that. But a number of us involved in the quality health care coalition said that's unacceptable and we're not going to support the bill unless you fix this."

When asked what if the fix violates the Byrd Rule, Defazio responded: "If you can't find language that works you can overrule the parliamentarian...he's just an employee."

--RYAN GRIM

10:25 AM ET: Prospects improving for Democrats. Three more Democratic lawmakers -- including to two undecided and one former "no" vote -- have announced, or are expected to announce, on Friday that they would support the latest version of health care reform in the House.

Rep. Eliot Engel (D-N.Y.) said on MSNBC that after changes to the legislation he was now "satisfied that [it] has moved a great deal towards the House bill in terms of compensating [New York] and doing the right thing for health care." (The New York Democrat had backed health care reform when it was first considered by the House back in November but had been coy about supporting it since then.)

Engel was never thought of as a serious threat for defection. But two other lawmakers whose votes were considered up for grabs are now expected to vote "yes" on reform. Rep. Charlie Wilson (D-Ohio), who supported the bill the first go around, will back it again when the vote comes -- as expected -- on Sunday.

"This bill is not perfect, but it is a strong step forward," Wilson said. "I have seen the CBO score and the reconciliation changes for myself. This bill will not add a dime to the deficit. I am confident that the Senate bill will be amended by the reconciliation language and that special deals for certain states, like Nebraska, have been taken out, that affordability for middle class families has been improved and that the harmful excise tax on high cost health plans has been adjusted. For these reasons and for the benefits that this bill will bring to my constituents, I will support the Senate bill with the announced reconciliation changes."

The big get for Democrats, however, is Rep. John Boccieri (D-Ohio). The freshman Democrat had been a member of a group of lawmakers who were threatening to abandon the bill over concerns with its language about abortion financing. Hailing from a district that was won by John McCain during the 2008 election, his seat is considered vulnerable in 2010. But the congressman, who was lobbied heavily on the floor by House leadership on Thursday, announced he was a "yes" vote, despite having opposed the bill the first time around.

"There are to many politicians who are worried about their future instead of the future of the families standing behind me," Boccieri said, with Ohio families draping him in front of the nation's Capitol. "A lot of people ware telling me this decisions could cost me my job... I want my mom to know I am standing up today and doing what I believe in."

--SAM STEIN

Six Votes Needed To Pass Health Care Reform

Democrats About Six Votes Short on Health Care, Officials Say
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By Julianna Goldman and Roger Runningen

March 19 (Bloomberg) -- Democrats need about six more votes from House members to pass a U.S. health-care overhaul, Obama administration officials said today.

White House and Democratic leaders aim to collect those votes from a pool of about 14 to 15 undecided lawmakers to get to the 216 votes needed to pass the measure, according to the officials, who spoke on condition of anonymity.

Obama has met or called about three dozen lawmakers in the last five days and has cleared his schedule today for more last- minute appeals, including a campaign-style rally in nearby Fairfax, Virginia.

Obama postponed a five-day foreign trip to Indonesia and Australia to remain at the White House this weekend to ensure passage of a $940 billion bill that is of “paramount importance” to his presidency, spokesman Robert Gibbs told reporters yesterday.

Health Care Reform Bill In Final Form-Vote Sunday Possible

CBO Score On Health Care Bill Released: Boosts Democrats' Hopes Of Passing Reform
First Posted: 03-18-10 09:20 AM | Updated: 03-18-10 11:42 AM

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Comprehensive health care reform will cost the federal government $940 billion over a ten-year period, but will increase revenue and cut other costs by a greater amount, leading to a reduction of $130 billion in the federal deficit over the same period, according to an analysis by the Congressional Budget Office, a Democratic source tells HuffPost. It will cut the deficit by $1.2 trillion over the next ten years.

The source said it also extends Medicare's solvency by at least 9 years and reduces the rate of its growth by 1.4 percent, while closing the doughnut hole for seniors, meaning there will no longer be a gap in coverage of medication. The CBO also estimated it would extend coverage to 32 million additional people.

The CBO score is the last piece House Speaker Nancy Pelosi (D-Calif.) was waiting on before putting the puzzle together on the House floor. A contingent of Blue Dogs has been holding out support, insisting that the bill be fully paid for and not increase the deficit. The numbers give a major boost to Pelosi and her leadership team, which can now begin the whip count in earnest and can specifically point to the cost savings.

With the CBO score released, the Democratic whip team has a specific, thoroughly-analyzed bill to show to undeclared members who can no longer claim they are "waiting to see the language." Pelosi has very little room for error and needs to move nearly every undecided voter to a solid "yes."

Since the House last passed legislation in November, three Democrats who opposed it -- John Tanner and Bart Gordon of Tennessee and Brian Baird of Washington -- have since announced their retirements, relieving them of some political pressure to oppose the bill. Pelosi may end up drawing on those exiting members for a cushion of support.

The reconciliation package that the CBO analyzed makes slight changes to the underlying bill. Subsidies for the uninsured to purchase insurance are increased and more funding is dedicated to community health centers. The excise tax on insurance premiums is scaled back so that it hits few families. The bill also demands a higher commitment from drugmakers, aiming to close the so-called "doughnut hole" -- the time that seniors must pay full price for medication. The pharmaceutical lobby has signed off on the increased commitment and will be running ads in Democratic districts in support of reform.

The reconciliation package, because of budget rules that limit its policy scope, does not deal with two contentious social issues: abortion or immigration. Anti-choice Democrats are threatening to kill the entire project over the abortion language in the Senate bill and Congressional Hispanic Caucus members are rebelling because of its draconian immigration provisions. The Senate language bars federal funds from paying for abortion, but doesn't go far enough, according to some Democrats. Undocumented workers would be barred from purchasing insurance -- even with their own money -- from private companies which operate within exchanges set up by reform.

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The reconciliation package is headed for a Rules Committee vote on Thursday with a vote in the full House to follow. But before the House votes, it will require the commitment of 50-plus members of the Senate to agree to pass the identical bill. A Democratic Senator told HuffPost Tuesday night that Senate leadership had yet to begin whipping support for the bill because the language hadn't been finalized. Now it's been finalized.

The reform effort was jolted forward Wednesday morning, when Rep. Dennis Kucinich (D-Ohio), who was a firm no as of last week, announced that he would back the bill.

"This is a defining moment for whether or not we'll have any opportunity to move off square one on the issue of health care. And so even though I don't like the bill, I've made a decision to support it in the hopes that we can move towards a more comprehensive approach once this legislation is done," he said. "If I can vote for this bill, there's not many people who shouldn't be able to support it."

Anti-choice Democrats have begun to back away from their certain opposition over the last several days. Rep. Jim Oberstar (D-Minn.) has pledged to back the bill and Rep. Marcy Kaptur (D-Ohio), who opposes abortion rights, said on Tuesday evening that she is still considering voting for it. "That is one of the factors," she said of the Senate's abortion restrictions. "It is not the only factor."

It's not clear, though, what Kaptur's concern is. At one point Tuesday, she said that she didn't like the Senate language because it went too far beyond existing restrictions on federal funding of abortion. "The abortion issue is an issue for me in that I don't want to go beyond existing law," she said. "I view what was done in the Senate as going beyond existing law."

But at other times, she said that the Senate bill did not adequately ensure that federal money would not be spent on abortion and also cited federally-funded community health centers as a potential way such money could pay for abortions. HuffPost pointed out to her that such centers do not perform abortions. "Read the language," she insisted.

HuffPost asked Kaptur what the difference is between a federal subsidy of a private COBRA health care plan that covers abortion and a federal subsidy of a private plan under the proposed health care reform. In both cases, a consumer uses a mix of personal and federal money to purchase a private plan.

"Those are private choices [made by COBRA consumers] and the private plans that are out there, for instance federal health plans that we have: We've handled that separately. They can purchase it separately. They can purchase it separately. Keep the line as firm in the sand as you can and that makes me more comfortable," she said.

HuffPost noted that Kaptur had essentially just described the provisions of the Senate bill, which requires consumers to write separate, personal checks for abortion coverage. "I don't think what I've read in the Senate language is that," she said.

Kaptur, a social liberal, has a number of other concerns she said, including the absence of a public option. "When you take out the public option, when you take out the ability to negotiate prescription drugs, when you take out McCarran-Ferguson, when you take out the provision that I authored in the House in Title I to create regional, not-for-profit purchasing pools, where you can have hundreds of thousands of people aggregate and negotiate together on behalf of whatever their insurance plans are, you take the guts of that out."

UPDATE: The CBO score is here.

THe House May Pass The $875 Billion HEalth Care Reform Bill Without Voting On It

Health-Care Reform 2010

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House may try to pass Senate health-care bill without voting on it

Rep. Betty McCollum (D-Minn.), left, talks to House Budget Chairman John M. Spratt Jr. (D-S.C.), center, and committee staff director Thomas Kahn, before the hearing to mark up a draft reconciliation bill for health-care reform. (Melina Mara/The Washington Post)
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By Lori Montgomery and Paul Kane

Washington Post Staff Writers
Tuesday, March 16, 2010

After laying the groundwork for a decisive vote this week on the Senate's health-care bill, House Speaker Nancy Pelosi suggested Monday that she might attempt to pass the measure without having members vote on it.

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Instead, Pelosi (D-Calif.) would rely on a procedural sleight of hand: The House would vote on a more popular package of fixes to the Senate bill; under the House rule for that vote, passage would signify that lawmakers "deem" the health-care bill to be passed.

The tactic -- known as a "self-executing rule" or a "deem and pass" -- has been commonly used, although never to pass legislation as momentous as the $875 billion health-care bill. It is one of three options that Pelosi said she is considering for a late-week House vote, but she added that she prefers it because it would politically protect lawmakers who are reluctant to publicly support the measure.

"It's more insider and process-oriented than most people want to know," the speaker said in a roundtable discussion with bloggers Monday. "But I like it," she said, "because people don't have to vote on the Senate bill."

Republicans quickly condemned the strategy, framing it as an effort to avoid responsibility for passing the legislation, and some suggested that Pelosi's plan would be unconstitutional.

"It's very painful and troubling to see the gymnastics through which they are going to avoid accountability,"Rep. David Dreier (Calif.), the senior Republican on the House Rules Committee, told reporters. "And I hope very much that, at the end of the day, that if we are going to have a vote, we will have a clean up-or-down vote that will allow the American people to see who is supporting this Senate bill and who is not supporting this Senate bill."

House leaders have worked for days to round up support for the legislation, but the Senate measure has drawn fierce opposition from a broad spectrum of members. Antiabortion Democrats say it would permit federal funding for abortion, liberals oppose its tax on high-cost insurance plans, and Republicans say the measure overreaches and is too expensive.

Some senior lawmakers have acknowledged in recent days that Democrats lack the votes for passage. Pelosi, however, predicted Monday that she would deliver.

"When we have a bill, then we will let you know about the votes. But when we bring the bill to the floor, we will have the votes," she told reporters.

Pelosi said Monday that House Democrats have yet to decide how to approach the vote. But she added that any strategy involving a separate vote on the Senate bill "isn't too popular," and aides said the leadership is likely to bow to the wishes of its rank and file.

As Pelosi and other congressional leaders pressed wavering lawmakers, President Obamahighlighted how close the result may be as he focused his attention Monday on Rep. Dennis Kucinich (D-Ohio), who has been a stalwart no vote on health-care reform.

Kucinich, an uncompromising liberal, has rejected any measure without a government-run insurance plan. Obama invited Kucinich to join him aboard Air Force One for a trip to suburban Cleveland, where the president made a plea for reform, the third such pitch in eight days.

As he addressed a crowd of more than 1,400, Obama repeatedly called on lawmakers to summon the "courage to pass the far-reaching package." He painted the existing insurance system as a nightmare for millions of American who cannot afford quality coverage.

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• Reversal of fortunes may be at hand for Democrats
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The president lashed out at Republican critics who have argued that the health-care initiative would undermine Medicare, and he argued that the measure would end "the worst practices" of insurance companies.

"I don't know about the politics, but I know what's the right thing to do," he said, nearly shouting as the crowd cheered. "And so I'm calling on Congress to pass these reforms -- and I'm going to sign them into law. I want some courage. I want us to do the right thing."

Asked whether he was reconsidering his position, Kucinich demurred. But Sen. Sherrod Brown (D-Ohio) said Kucinich is coming under intense pressure from Ohioans who want Congress to act, and from his colleagues in Washington.

"All of us -- the governor, the congressional delegation, the president -- are making clear to Dennis that we won't have another chance for a decade if this doesn't happen," Brown said.

Persuading liberals such as Kucinich to support the Senate bill is critical to the Democratic strategy, which has been rewritten since January, when Democrats lost their supermajority in the Senate. The Senate Democratic caucus, reduced to 59 seats, lost its ability to override Republican filibusters and soon abandoned plans to pass a revised version of the health-care bill that would reflect a compromise with House leaders.

As House leaders looked for a path that could get the Senate legislation through the chamber and onto Obama's desk, conservatives warned that Pelosi's use of deem-and-pass in this way would run afoul of the Constitution. They pointed to a 1998 Supreme Court ruling that said each house of Congress must approve the exact same text of a bill before it can become law. A self-executing rule sidesteps that requirement, former federal appellate judge Michael McConnell argued in a Wall Street Journal op-ed.

Democrats were also struggling Monday to put the finishing touches on the package of fixes. Under reconciliation rules, it is protected from filibusters and could pass the Senate with only 50 votes, but can include only provisions that would affect the budget.

Democratic leaders learned over the weekend that they may not be able to include a number of favored items, including some Republican proposals to stem fraud in federal health-care programs and a plan to weaken a new board that would be empowered to cut Medicare payments.

Rep. Chris Van Hollen (Md.), the Democratic leader tasked with protecting politically vulnerable incumbents, said Republicans would twist the nature of the health-care vote, no matter how the leadership proceeds. He defended the deem-and-pass strategy as a way "to make it clear we're amending the Senate bill."

Without that approach, Van Hollen warned, "people are going to try to create the impression that the Senate bill is the final product, and it's not."

Undecided Democrats appeared unconcerned by the flap. Rep. Bart Gordon (D-Tenn.), a retiring lawmaker who opposed the original House bill and is undecided on the new package, mocked Republican criticism of the process. Ultimately, he said, voters will hold lawmakers responsible for any changes in law.

"I don't think anybody's going to say that we didn't vote for the bill," he said.

The US Senate Gets Ready To Make History

Healthcare reform draws nearer

By Edward Luce in Washington

Published: December 10 2009 23:26 | Last updated: December 10 2009 23:26

Barack Obama’s healthcare reform, the signature policy of his presidency, looks likely to clear its most formidable obstacle by Christmas.

Within the next few days, the non-partisan Congressional Budget Office will give its fiscal “scoring” of the compromise reached on Tuesday between five moderate and five liberal Democratic senators.

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If the CBO were to pronounce the package at least deficit-neutral – a big if, given the body’s ­Jesuitical approach to bud get accounting – the way would probably be cleared for a rapid vote in the Senate. Since the House of Representatives has already passed its own 1,990-page bill, only a seismic intervention could stop it from reaching Mr Obama’s desk within the ensuing weeks.

On Thursday, aides to Harry Reid, the Senate majority leader, said they believed the latest formulation would attract the 60 votes needed to prevent Republicans from being able to block it.

In addition, the fact Mr Reid is engaging the interest of two Republicans, Olympia Snowe and Susan Collins, both senators for Maine, has provided added confidence that they may be able to afford to lose one Democratic vote in the upper chamber.

“We put together a bill that we believe has the best chance to overcome a Republican filibuster,” said Jim Manley, an aide to the Senate majority leader.

But he added: “Mary Landrieu and Blan che Lincoln [centrist Democratic senators from Louisiana and Arkansas] are saying they’re not going to agree to anything until we hear back from the CBO.”

The smart money in Washington is now betting that the arduous and often unseemly legislative process is within spitting distance of a conclusion.

Len Nichols, a fellow at the centrist New America Foundation and probably one of the most experienced analysts of the Byzantine process, said: “In my judgment, the co-operation of the moderate and liberal Democrats and the fact that Snowe and Collins are in the conversation signals a real likelihood this will get through the Senate by Christmas and be on the president’s desk before his State of the Union address [in late January].”

Should the bill get the go-ahead from the CBO, Mr Reid is likely to push for a Senate vote as rapidly as possible, assuming he has garnered the 60 votes by then. After that, the bill would either have to be merged with the House version or else could even bypass the bicameral reconciliation process and go for a direct vote in the lower chamber – an unusual route but one that could circumvent the process.

Nancy Pelosi, the House speaker, who has insisted on a public insurance option, the measure that has attracted the most argument, on Thursday played down the differences between the two bills.

“We are waiting on the actions of the US Senate and hopefully we will be able to send it very, very soon to the president’s desk,” she said on Thursday.

The latest Senate compromise formed a new “Medicare buy-in” to allow people aged 55-64 to buy the healthcare coverage currently available only to senior citizens. It came at the expense of the public option.

Some liberals would fight to the finish to retain the public option, a watered-down version of which was passed in the House bill. But most Democrats are falling in line with the thinking of Rahm Emanuel, Mr Obama’s pugilistic chief-of-staff, who said: “The only non-negotiable principle here is success.”

Washington insiders bel ieve a historic healthcare act would give Mr Obama and the Democratic party a boost ahead of next year’s mid-term elections. But polls, which show mixed support for healthcare reform, suggest the reality may not be so simple.

“All the revenue-raising measures – the taxes and fees – come up-front, while the benefits don’t kick in until 2013 and 2014,” says Robert Blendon, the leading healthcare pollster. “There would be an initial surge in support for this historic achievement, followed by quite a big backlash as the costs seep through.”

American Health Care Insurers Will Play Their Same Dirty Tricks After Health Care Reform

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Health-Care Reform 2009
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Discrimination by Insurers Likely Even With Reform, Experts Say
Economic Pressure Could Give Rise to New Biases Against Prior Conditions


Sens. Charles Schumer with Max Baucus prepare the mark up of the Senate Finance Committee's version of health care reform, which calls for mechanisms to dissuade insurers from limiting coverage based on prior conditions. (By Melina Mara -- The Washington Post)
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By David S. Hilzenrath
Washington Post Staff Writer
Sunday, October 4, 2009
Any health-care overhaul that Congress and President Obama enact is likely to have as its centerpiece a fundamental reform: Insurers would not be allowed to reject individuals or charge them higher premiums based on their medical history.

But simply banning medical discrimination would not necessarily remove it from the equation, economists and health-care analysts say.

If insurers are prohibited from openly rejecting people with preexisting conditions, they could try to cherry-pick through more subtle means. For example, offering free health club memberships tends to attract people who can use the equipment, says Paul Precht, director of policy at the Medicare Rights Center.

Being uncooperative on insurance claims can chase away the chronically ill. For people who have few medical bills, it is less of a factor, said Karen Pollitz, research professor at the Georgetown University Health Policy Institute.

And to avoid patients with costly, complicated medical conditions, health plans could include in their networks relatively few doctors who specialize in treating those conditions, said Mark V. Pauly, professor of health-care management at the University of Pennsylvania's Wharton School.

By itself, a ban on discrimination would not eliminate the economic pressure to discriminate.

"It would probably increase the incentive for cherry-picking," Pauly said. "I'm strongly motivated to try to avoid you if I'm not allowed to charge you extra."

Cognizant of the threat, lawmakers are trying to neutralize it. For example, the bill advanced by Senate Finance Committee Chairman Max Baucus (D-Mont.) calls for creation of complex mechanisms to essentially raise or lower compensation to insurers, depending on whether they attract disproportionately sick or healthy populations.

The bill assumes the problem would be greatest during the first few years; after that, part of the machinery to compensate for variations would go away.



A straightforward way to reduce gamesmanship is to standardize benefit packages, Precht wrote in a July report. One issue lawmakers must resolve is how much latitude to leave insurers over what they cover and how.

Unless lawmakers tackle the problem effectively, a reformed health-care system could continue to reward insurers for avoiding rather than treating illness. It also could perpetuate existing economic penalties for health plans that do a better job of covering the sickest patients. They tend to attract costlier members, which can force them to raise premiums, fueling a cycle that can make it harder for the severely ill to get affordable coverage.

"In a competitive market, a good-guy insurer is a patsy," Pollitz said. "The race is to the bottom."

America's Health Insurance Plans, a lobbying group for health insurers, has endorsed the idea of guaranteeing individuals access to coverage regardless of their medical history -- if that guarantee is part of a larger plan to help the uninsured pay for coverage and bring everyone into the insurance market.

At a more nuts-and-bolts level, AHIP has been trying to shape the legislation in ways that could help insurers attract the healthy and avoid the sick, though it has given other reasons for advancing those positions. In a recent letter to Baucus, AHIP President Karen Ignagni said benefit packages "should give consumers flexible options to meet diverse needs."

There are myriad ways health plans can attract healthier members, from the messages they advertise to the overall level of coverage they provide and the smallest enticements they add to their benefits packages.

Anthem Blue Cross markets a line of insurance called Tonik that is explicitly aimed at young adults. "You're young. You're healthy. You're in shape," the Tonik Web site says, addressing its target market. Tonik policies bear such names as "Part-Time Daredevil" and "Thrill-Seeker." The latter is for people who "live life on the edge, and happily go over it," says the Web site, whose graphics and color scheme bring to mind an ad for the Apple iPod.

At the other end of the age spectrum, ads for private health plans serving senior citizens on Medicare seldom feature people who are sick, said Tricia Neuman, who has studied the ads for the Kaiser Family Foundation. Many of the plans have offered benefits such as health club memberships, help buying eyeglasses, and preventive dental care, which may be more likely to sway healthy seniors than seniors who have severe and complex medical needs.

Some private Medicare plans have offered relatively inexpensive enticements while requiring members to pay more out of pocket than they would under conventional Medicare for major expenses, said the Medicare Rights Center's Precht. In 2008, a quarter of the private Medicare plans charged members more out of pocket for Part B medications, which include chemotherapy drugs for cancer patients, according to a March study for the AARP Public Policy Institute.



The government has been cracking down on those practices. As a Medicare official put it in a March 2008 letter to health insurers, charging beneficiaries more out of pocket than conventional Medicare for Part B drugs, dialysis and time spent in skilled nursing facilities "may be considered discriminatory."

In response to questions about the risk of continued cherry-picking under his legislation, Baucus provided a statement that "the difference in the market will be like night and day" compared with today's "wild West." But he also offered a qualification.

"These regulations are the first step to a market where consumers can be confident in the coverage they purchase," he said.