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The debate over health insurance reform will continue, due to the votes of three Democratic Senators
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In order for United States Senate Majority Leader Harry Reid (D-NV) to file cloture on the motion to proceed with H.R. 3590, the newly dubbed Patient Protection and Affordable Care Act, it was necessary for him to persuade 60 of 100 Senators to vote in favor of continuing the discussion of a 2,074 page document which has become one of the most contentious bills to come out of the United States House of Representatives in decades. With 40 Republicans united in opposition to advancing the bill, which was estimated by the Congressional Budget Office to cost at least $848 billion over a ten year period, and the vast majority of Democrats and two Independents supporting further debate, it was imperative that Majority Leader Reid convince the few uncertain Senators to vote for the motion to pass. Among those hesitant to vote for cloture were Senators Mary Landrieu (D-LA), Blanche Lincoln (D-AR) and Ben Nelson (D-NE), moderate liberals who expressed reservations about the merits of the bill, specifically the “public option” which they believed amounted to the creation of a federally run health insurance provider with potentially several hundred million subscribers.
Due to their reputations as political moderates, Senators Landrieu, Lincoln, and Nelson have been courted by the Democratic and Republican parties to oppose or support measures and, given that Republicans have staunchly opposed most policy proposals presented by the Barack Obama administration, Speaker of the House of Representatives Nancy Pelosi and Senate Majority Leader Reid, it has become vital for Majority Leader Reid to have the undivided support of the 58 Democratic members of the Senate in order to pass legislation.
Senator Nelson refused to wholeheartedly endorse the bill, but voted in support of the cloture motion due to his desire for reform within the health insurance industry.
"When I saw the bill, I said it can be improved and the debate should begin," Senator Nelson said. "A public option is a big government Washington-run health insurance operation. It will under-reimburse doctors and hospitals and will undermine private coverage that 200 million Americans have. It isn't necessary to do that."
The Nebraska Senator said he was hopeful “we'll make the process work so it can get bipartisan support" and identified the public option as the primary issue of contention and the Senator from Arkansas expressed similar sentiments, stating “my decision to vote on the motion to proceed is not my last, nor only, chance to have an impact on health-care reform." Louisiana’s lone Democratic Senator implied she voted with Majority Leader Reid for a different reason.
"I am not going to be defensive," Senator Landrieu declared. "It's not a $100 million fix. It's a $300 million fix."
The “fix” referred to by the Senator was the inclusion of section 2006 of the Patient Protection and Affordable Care Act, which amended section 1905 of the Social Security Act and provided for a “special adjustment to Federal Medical Assistance Percentages (FMAP) determination for certain states recovering from a major disaster.” Section 2006 defined the term “disaster-recovery FMAP adjustment State” narrowly, particularly in the clause “at any time during the preceding 7 fiscal years,” within which time the President of the United States had to declare the State a major disaster under section 401 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act and determine as a result of such disaster that every county or parish in the State warranted individual and public assistance or public assistance from the Federal Government. If a state qualified under section 2006, then FMAP would be adjusted accordingly. The only state to qualify under the section was Louisiana.
Despite the accession, Senator Landrieu alleged that she was uncertain whether she would support a Senate vote to send the bill to President Obama for execution.
"My vote today should in no way be construed by the supporters of this current framework as an indication of how I might vote as this debate comes to an end," she said. “I am opposed to a new government-administered health-care plan [and] I will not vote in favor of the proposal as it is written.”
This gesture on the part of House Democrats to appease Senator Landrieu was not novel to the political world. Federal, state, and local governments have historically made efforts to persuade noncommittal officials to vote in favor of or against legislation by offering them financial incentives to pursue such course of action. The incentive offered to Senator Landrieu was far from the most egregious offered in recent years – for example, allocations of federal funds in economic recovery legislation and Iraq war bills were far more questionable than providing increased Medicaid assistance to a state struggling to provide health insurance for many of its residents. Despite the concession, the majority of Louisiana residents remain opposed to the current version of the Patient Protection and Affordable Care Act, which should factor heavily into Senator Landrieu’s decision when the bill is considered for a final vote.
Due to the significant cost of the bill, particularly during a severe economic recession, the uncertainty about the state of the health insurance industry if the federal government controlled the industry due to a gradual increase in market share as a result of the availability of a “public option,” and the inclusion of a provision to provide public funding for abortions under limited circumstances, a majority of the American public opposes the bill in its current form. According to the conservative-leaning Rasmussen Reports, 38% of Americans favor the health plan proposed by President Obama and congressional Democrats and 56% are in opposition, while the Gallup poll, relied upon by the more liberal New York Times, showed that 41% of Americans believe health care legislation would make the U.S. health care system better and 40% believe the legislation would make the system worse.
The vast majority of Americans agree that some reform of the health insurance industry would benefit the country, particularly if the reform decreased the cost of purchasing insurance. According to an ABC News/Washington Post poll, 78% of Americans are dissatisfied with the cost of health insurance, with 54% feeling very “dissatisfied.” These estimates include insured Americans, 86% of which rate their coverage positively.
Although the cost of insurance has become a concern for many, the possibility that proposed legislation would reduce the availability of medical professionals or the quality of care alarmed more than 60% of those polled. In order to maintain current physician-per-patient ratios with at least 30 million more insured individuals, it would be necessary to increase the number of physicians by 5-10%. This is highly unlikely, particularly when considering the strong probability that medical professionals will receive less compensation while treating more patients, a less-than-enticing situation.
Senators Landrieu, Lincoln, and Nelson will face mounting pressure from Democrats and Republicans during the next few months. They will grapple with acting in the best interests of their constituents, which they believe includes passing legislation without a federally run health insurance program, or their political party, whose leaders demand such a program remain the centerpiece of the bill. Due to the significance of the Patient Protection and Affordable Care Act on the future of health care in the United States of America, a nation widely considered to have the best health care industry in the world, the political careers of these three individuals will likely be defined by the votes the cast.
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