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Photo of President Barack Obama delivering a health care address to a joint session of Congress at the US Capitol Sept. 9, 2009 | Photo by WhiteHouse on Flickr
Although it was highly anticlimactic and awfully frustrating for all parties involved, this week signified a historic move on the health care reform bill.
So what exactly happened? Well, the US Senate voted 60-40 -- not in favor of passing a specific bill --- but in favor of ending debate and stopping further filibustering on a specific set of amendments to the health care reform bill known as the Patient Protection and Affordable Care Act [full bill and amendments can be found here (.pdf)]
Yes, anticlimactic, but a huge leap at the same time.
The Senate essentially only voted for "cloture" -- to end debate on the bill. Were the debate to continue, Republicans (or Independent Senator Lieberman from Connecticut or Democrat Senator Nelson from Nebraska) would have more chances at filibustering the bill and thereby blocking debate, discussion, and process.
Republicans have already filibustered the health care bill a few times, which not only stalls debate, but which allows for a full 30 hour debate after the filibuster ends. And Lieberman and Nelson have threatened to filibuster if certain demands were not met. The bill would only have needed a majority vote (51 votes in the Senate) to continue passing through these various processes in moving a bill forward. Increasingly, however, the filibuster has been used to stop discussion, and the only way to overcome the filibuster is to have a supermajority, or pull together 60 votes, in the 100 person Senate. There are 58 Democrat Senators, 2 Independents (Sanders and Lieberman) and 40 Republicans.
Every single Republican Senator was committed to voting against moving the bill process forward (in other words, every Republican senator was in favor of continuing to filibuster the bill). In order to make the 60 votes (again, to stop a filibuster), Democrats caved to Senator Lieberman (Independent) and Senator Nelson (Democrat) and others who were threatening to filibuster the bill. As a result, the bill was watered down greatly.
The public option -- widely and consistently popular among the American public -- was a measure to allow individuals buying health insurance to choose not only from various private health insurance plans, but also from a government run plan, paid for by peoples' premiums, and not taxpayer funded. [More on the public option as previously covered at LAist can be found here and here].
The public option would have increased choice and competitiveness for consumers, by providing an alternative (and a benchmark) to private plans on the market. The market arguably has no incentive for affordability, efficiency, and non-discrimination. Recently however, the public option was swiftly stripped away in order to please a few Senators so that they would not filibuster the bill from moving on in the process. Then a Medicare buy-in was presented, allowing those aged 55 and over to buy into Medicare, a hugely popular government-run health insurance program for those 65 and over. That was then stripped out -- for the same reason.
It seems that the process around this hugely popular health care bill is being watched by more Americans than ever before -- and their colors are showing. Americans are fuming at the undemocratic process of filibustering and the worsening habit of our legislators to withdraw from actual legislating. There's a growing movement of folks who are passionate about slowly but surely increasing transparency and democracy in this process in the future (of note, the filibuster is not in the Constitution, it was introduced as a Senate action later and has shot up in use mostly be Republicans, since the 2006 mid-term elections). Some of the success in improving the democratic process will come from voting out obstructionist elected officials. And some will arise from greater awareness and pressure from the public about undemocratic procedural issues (the ones we never learned about in our high school American government classes).
So, what's the next step for this bill? There is one more procedural step like this (in which it is expected that there will continue to be a 60/40 vote split and the bill will continue to move forward). This step is expected to occur today, and a final vote on the Senate version of this bill is planned for tomorrow morning, the day before Christmas (further obstructions notwithstanding). Then Congress goes on break until January, when the Senate and the House versions of the bill are reconciled in "conference" to create one solid bill.
The Senate and House bills differ in many areas, most fundamentally in four areas. The House bill contains the "public option" while the Senate bill was stripped of it in order to gain the 60 votes it needed to move forward on the bill. The Senate bill contains an individual mandate -- meaning that those who do not qualify for public programs like Medicaid must pay for their own health insurance on the private market or face penalties (many consider this mandate unfair if there is no public option and no competition to prices of private health insurance plans). The House bill mainly funds healthcare reform with a tax on the wealthiest Americans, while the Senate bill mainly does so by taxing higher-end "cadillac" health insurance plans. And the House and Senate bills have different restrictions on abortion coverage (though both have restrictions on it).
But what the heck is in the bill that the Senate finally voted to stop Senators from filibustering? There's a nice overview of what is contained and what is missing from the Senate bill.
This article from the New York Times is an interesting read. It highlights the events and bizarre actions around this week's vote, including Republican Senator Coburn's encouragement of praying so that perhaps one of the Democrats would not be able to make it for the vote (presumably Senator Byrd, who is elderly and frail now). Other Republicans lamented the late-night 1am EST vote (although the resolution to go to war in Iraq, Medicare Part D, and a slew of other crucial votes occurred even later in the night and were pushed forth by Republicans). Still other Republicans claimed that this bill was not really legitimate unless 75 or 80 Senators voted for it (a super super super majority when you consider that there are only 100 Senators).
For a precise look at how absolutely twisted our democratic system can be, read Ezra Klein's "The Death of the Public Option". It's a short piece that goes through the public option from its birth until Christmas time this year. Unsurprisingly, it sounds quite different from Schoolhouse Rock's "How a Bill Becomes a Law":
For Americans, the process from here until passage of the bill continues to require much scrutiny. The Kaiser Family Foundation has a comparison of the House and Senate proposals. There's a chance to pressure our elected officials to improve the bill's affordability, strengthen the insurance regulations (like those precluding companies from discriminating against people with "pre-existing conditions"), keep the abortion coverage issue at the status quo instead of restricting it further, and improve access for legal and undocumented immigrants (especially important in California). There's much to fix, much to reflect on about American democracy, and many notes taken on obnoxious elected officials whose seats need to be replaced in the coming elections, but onwards we move on the path of how this bill becomes a law.
