Six Health Care Holdouts in the Senate

THE debate over public option, a “government run health plan to compete with private insurers” has always been a major threat to the Senate passage of the universal health care bill, even before the legislation came to fruition in the House. As early as last campaign cycle, several Senators expressed their opposition to Barack Obama’s vision universal health care, because they view the public option aspect as an invasive over-extension of government control; an unnecessary reform during economic crisis.

Since the House passed the health care bill with a public option included, the attempts at negotiating an agreement are abound. Over the past week, a “gang of 10” Senators – a combination of liberal and conservative Democrats – brokered a compromise after a week of negotiations behind closed doors, and presented it to the body today. Called a “broad agreement” by heath care spearhead Senator Harry Reid (D-NV), the deal expands Medicare buy-in and essentially eliminates an immediate public option offer.

Bending the health care legislation was prompted by 6 Democratic Senators, whom despite the urgings of the President and their party, maintained their opposition to the public option:

Evan Bayh, D-Indiana

Senator Bayh

Evan Bayh (D-IN) comes from a state hard hit by the recession. As a legislator, he has a history of concern about debt. Recently, he voted against raising the national deficit , so it is unsurprising that he has voiced more concern about the cost of health care than anything else.

Bayh’s constituents, however, support health care reform, and more specifically, the public option, by a healthy margin of 52% to 42%.  Editorials written on the topic have been scathing.  One constituent muses that it must be “great to be Bayh” who has an excellent health care plan provided by Congress.  Another accuses him of talking debt while ignoring the war and health care.  Most damning is the speculation that Bayh is accepting money from the health care lobby and cow-towing to special interests.  Dan Young, from Indianapolis writes:

Senator Bayh with Secretary Clinton, a harbinger in the fight for universal health care.

“While hundreds of thousands of Hoosiers are without work and health insurance, Susan Bayh is making millions serving on the boards of several huge corporations, including WellPoint. The influence of this cash flow on Sen. Bayh’s voting record is obvious… He is willing to sabotage the democratic process in the Senate because he can’t overlook the millions of dollars he has taken from the insurance industry…”

Records, however, indicate that Bayh has not accepted as much money from insurance and health care providers as other hold outs in the Senate (including Ben Nelson and Joe Leiberman). Since 2005 he has not accepted “millions” of dollars from these industries. The number is closer to $700,00.

On Tuesday, Bayh sided with Republicans and Senator Ben Nelson (below)

Blanche Lincoln, D-Arkansas

Senator Lincoln is vocally opposed to America’s Affordable Health Choices Act of 2009, stating she refuses to vote for a proposal that includes a public-option: “I just don’t think it’s fair in these economic times to put at risk taxpayers and the treasury, which if in fact the premiums don’t cover the program that’s what’s probably going to happen.”  Lincoln is instead championing both reduced costs in the Senate’s health care bill and more help for small businesses in the bill.  Up for re-election next year, Lincoln is stratteling the line between party goals and a constituent majority opinion.

Senator Lincoln

In Washington, Lincoln is stuck between the proverbial rock and a hard place: Republicans are upset because she cast a procedural vote in favor of a floor health care debate, and Democrats are disappointed in her public rejection of the proposed health care legislation.  The tension is exceptionally strained, with Republicans attacking her for receiving campaign contributions from insurance companies – the 5th highest industry to fund her political career – in hopes for a leg-up in the 2010 elections.

Back home in Arkansas, Lincoln’s stance is being projected as a major threat to her future in the Senate.  Polls show the majority of Arkansans will not vote for Lincoln next year if she supports universal health care.  The Senator maintains that, despite what critics on all sides are saying, she will fight to change the bill to best serve her constituents.   Along with Senator Mary Landrieu (below), she helped negotiate the Medicare buy-in this past week.

Joe Lieberman, I-Connecticut

Joe Lieberman (I-CT) is possibly the legislator that has been attacked the most by pro-reformers. He has received more than $2.6 million dollars from the health and insurance industries since the start of his career. His state, Connecticut, is also a hub of the insurance industry in general, as it accounts for 64,000 jobs as of June 2009, according to the state’s labor department.

Senator Lieberman

Connecticut voters, however, approve of the health care bill by a 5 point margin (47% to 42%). As a result, Lieberman has had to address questions about his motivations directly. “Insurers aren’t my biggest concern — I sued them once when I was attorney general, and I’m not afraid to end anti-trust exemptions,” he said in October. “I am really worried about what this could do to the deficit.” These words have not satisfied his critics.  On November 5th, 9 health care supporters stormed his Wshington office shouting phrases like “represent Connecticut, not AETNA!”

Thus, Lieberman has had to back up his words with legislative action. On December 1st, the Senator’s webite touted his new amendment to the health care bill, which “revoke health insurers’ and medical malpractice insurers’ existing exemption from federal antitrust laws that prohibit anti-competitive conduct such as price fixing, bid rigging, and market allocations.” This past Friday, in a “tri-partisan effort,” Lieberman along with Republican Susan Collins and Democrat Arlen Spector introduced an amendment to the bill intended to work as a cost-containment measure.  Here are the bill’s five main provisions:

  1. Create a website to report the quality of physician performance.
  2. Strengthen reporting requirements for insurance companies regarding the denial of claims.
  3. Increase penalties for hospitals with high incidents of post-treatment infection.
  4. Give HHS more authority to implement a pilot program that would bundle Medicare payments to hospitals and physicians and allow them to implement the program more broadly without needing additional Congressional approval.
  5. Do a large-scale evaluation of government health care programs to deduce their value and consider cost cutting measures.

These measures do not radically change the bill, but the fact that it was presented by a Republican and an Independent signals that it may bring more people to the negotiating table.

Ben Nelson, D-Nebraska

Senator Nelson

Ben Nelson (D-NE) comes from a state where 85% of citizens have health care.  Thus, Nelson has made it quite clear that he has to sell the bill in a different way. He has been touting “The Lost Message of health care reform, or rather, the part of it that benefits those that already have health care insurance. Despite his critiques of the Democratic plan, he has been optimistic about health care reform, saying he believes this bill will be passed by next year.

Nelson can afford such optimism. His state supports the public option 46% to 44%.  He has represented his constituents’ traditional lean toward conservatism by vocally opposing funds for abortion.  He also supports the Rural Community Hospital Demonstration Expansion Act, to benefit hospitals that must serve large, sparsely populated areas like his state.  Nebraskans have expressed concern that Nelson may be in the pocket of insurance companies and the health industry, who have contributed over $2 million to his war chest over the years. However, he supports a “trigger” activated public option, which reflects the slight majority of support a government run health isurance provider enjoys in his state. Nelson has also been unafraid of criticizing Republicans for their handling of this attempt at reform. In September he said that Republicans need to demonstrate “the same willingness to compromise that they’re asking from the [Democratic] majority.”

Nelson’s resistance comes from his anti-abortion stance, a hot-button issue in Nebraska, where anti-abortion protests were held this summer in front of the office of Dr. LeRoy Carhart. On Tuesday, Senator Nelson attempted to duplicate House legislation that would ban abortion coverage for women who receive federal subsidies to purchase private insurance.  Co-sponsored by Senator Orrin Hatch (R-UT), the abortion amendment failed to pass in the Senate today.  Many are now speculating whether Nelson will defect on his final vote.

Mary Landrieu, D-Louisiana

Senator Landrieu

Senator Landrieu is no stranger to pushy political strategy in the Senate.  Representing a state still financially wrecked by Hurricane Katrina, Landrieu parlayed her clutch public option vote Democratic vote to leverage $100 million for her state.  The money is intended to fill a giant hole left in Louisiana’s Federal Medicade Assistance Percentage (FMAP), which Governor Jindal emphasized as critical for the health of Louisiana’s uninsured and Medicade recipients.  To balance the states’ needs for Medicare, disaster relief, and a public option, Landrieu surprisingly shifted to the center in this debate.

FMAP is calculated using a formula based on individual state income.  An obscure stipulation requires insurance reimbursements and federal recovery assistance, both sources heavily relied on to rebuild after Hurricanes Katrina and Rita in 2005, to be counted as “income.”  After calling to reform FMAP, Governor Jindal appealed to SenatorLandrieu to address the problem on the federal level.  Senator Landrieu then held out on the procedural vote to bring the health care legislation to the floor until Senator Reid, universal health care spearhead, tacked an amendment allocating $100 million to counties and parishes in Louisiana.

Senator Landrieu surveying damage from Hurricane Katrina in 2005

Reactions on both sides are mixed.  Already dubbed “the Louisiana Purchase,” Senator Landrieu’s stratigery is a bulldog move during an already feisty and highly historic debate.  In a state where nearly 23% of the population is uninsured, Louisiana is bordering on a health care crisis.  A substantial chunk of Landrieu’s campaign and PAC donations come from emergency and disaster responders, not HMOs and insurance agencies.  Still, Landrieu continues to be “skeptical” to the public option, despite her positive reactions to “extremely helpful” centrist hold-out negotiation meetings this past weekend.
Here is Mary Landrieu discussing her tendency to not vote for public option, along with the devistation of Katrina, back in August:

Senator Landrieu helped broker the public option compromise and wants Congressional Budget Office (CBO) projections on the Medicare buy-in before proceeding further.


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