Blue Dogs' Bark Worse Than Bite
Published July 29, 2009 @ 11:39PM PT

The House is back on track. The Energy and Commerce Committee began marking up HR 3200 again this afternoon and will likely finish in the next few days. At that point, all three committees will be done, their staff will work on reconciling discrepancies between the committee mark-ups, and when the House returns in September, a historic full health care reform bill will open for debate on the House floor. All it took was a deal with the Blue Dogs – self-proclaimed fiscally conservative Democrats who effectively shut down Energy and Commerce until their demands were met.
The fact that the deal was struck is a positive – the process can roll on. But most folks are worried first and foremost about what progressives in the House had to give up.
Surprisingly, not a whole heckuva lot. Irate progressive Democrats are already calling this “a sop to the insurance industry,” but the insurance reforms and regulations are intact. For those concerned that the disproportionate weight of the Blue Dogs and their pro-business tendencies would cause the House bill to be watered down, not much water was added. Probably the biggest change – and the one least expected – was that originally the federal government was going to entirely pick up the tab for increasing Medicaid eligibility to all adults at or under 133% of the federal poverty line, as well as all of the cost for increased reimbursement, particularly for primary care, of the most anemic rates in Medicaid. Now states will be asked to pay for 7% of the costs, at lest on the eligibility piece. They’ll whine. A lot. But this still leaves the federal government paying for 93% of the cost.
What now seems like ages ago, the Blue Dogs aggressively suggested they only wanted to see a public health insurance option with a “trigger” – a five year “head start” for private insurance to take advantage of all the new customers and subsidies in the Health Exchange, with a public option kicking in to keep them honest only if private insurance fails to make health insurance affordable on its own (the sound you hear is me laughing so I don’t cry.) They haven’t mentioned that in a while. Instead, they held firm for a public option that does not use Medicare rates at all, but negotiates reimbursement with its providers. It's a change. But the House public option was always going to transition away from Medicare rates and towards negotiate with providers after three years. The Senate HELP committee likewise uses provider rates from the get-go. The negotiation with the Blue Dogs just anticipated (and resolved) a likely sticking point for reconciliation between the House and Senate bills. The compromise also allows for states to set up their own co-ops. The co-ops won’t replace the public option-- they’ll just be an additional choice. No big whoop.
The element I was most nervous about was the cut in subsidies for those towards the high end of eligible income -- $43,000 for an individual and $88,000 for a family of four. But the premiums for this income level will be 12% of their income instead of the original 11%. Talk about tinkering around the edges.
As their main bragging point, the Blue Dogs pushed for small business exemption on the employer mandate to go up to payrolls with $500,000 (instead of $250,000). Really, this is moving money around – robbing Peter (subsidies on individuals) and Patrick (Medicaid money from the states) to pay Paul (small businesses). But not really paying Paul that much.
Finally, the total package will be shaved by $100 billion. I’m by nature irked by cutting money just to say you cut money, rather than actually cutting in order to make a bill better. But in this case, I just don’t see that the bill has lost anything. Negotiating with the Senate is likely to change the reform legislation by an order of magnitude more than anything we’ve seen from negotiating with the Blue Dogs, for all of their barking.
That’s why I agree with the dominant sentiment – this was about stalling for time. It’s basically impossible for a House vote before the recess at this point (so Henry Waxman and House leadership agreeing to delay a vote until September is a “no duh”). Hopefully, the Senate Finance Committee – who has an extra week before recess – has a reasonable chance of getting their act together (defined solely as finally producing a draft bill, in this case). As Jon Cohn writes, “[Blue Dogs] want to wait and see what the Senate produces. If they have to take what they consider a hard vote--to raise somebody's taxes, to change the way Medicare pays for medical services, whatever--they don't want to stick their necks out any more than is absolutely necessary.”
That’s why the Blue Dogs bit off so little of what makes HR 3200 work. Once the vote was delayed, the rest was gravy anyway.
(Photo credit: eepie on Flickr.)
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Comments (23)
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Tim has been an online organizer and blogger on health care policy for the Obama for America campaign (during the primaries) and currently for the Committee of Interns and Residents/SEIU Healthcare, a labor union for intern and resident doctors. Views expressed here are Tim's, and don't represent the positions of CIR or SEIU.
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Tim, thanks for deciphering all this for us. Could never keep up otherwise.
Posted by Danny Moldovan on 07/30/2009 @ 12:17AM PT
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Blue Dog/Career Politician -- same thing.
In U.S. politics, decision-making often results in outcomes that conflict with the preferences of the general public. For example, many special interests and pork barrel projects are not the desire of the overall democracy. However, it makes sense for politicians, especially blue dogs, to support these projects. It may make them feel powerful and important or even make them feel as if they have something to say or contribute. It can also benefit them financially by opening the door to future wealth as lobbyists. The project may be of interest to the blue dog's local constituency increasing district votes or campaign contributions. The blue dog pays little or no cost to gain these benefits, as he or she is spending public money.
Blue dogs are the ultimate career politicians. And on this issue of health care reform their input is largely irrelevant. They are mostly meddlers, poking their snouts in the president's business to see if there is anything in it for them.
Posted by Martin Bring on 07/30/2009 @ 02:18PM PT
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It is difficult for the plain American folks to understand what the heck is going on here. I support the President and definitely want this health care fixed. I have a sister who has no coverage (a disaster waiting to happen). I have a daughter who had breast cancer who will never finish paying her medical bills. and another daughter with asthma who needs medication and trips to the emergency room often. I can't care about me. Most American mothers are probably like that. I watch the blogs and belong to the USA Can group. Everybody seems to be unhappy with this health care mess. It is quite confusing. When I hear the President I feel much better. He is always positive. He says; "We will get this done." I get so mad at my insurance premiums which seem to go up and up. Everytime our state gives teachers a pay raise, the insurance company takes it. I can't understand why teachers don't fight this tooth and nail. But, what we have been seeing for years is what the entire country is faced with. They need to find a way to stop the medical professionals from charging so much and doing exams that aren't warranted. There are too many greedy people. As for the blue dogs. They own the medical clinics or sure are making a profit at the expense of all of us. It is hard to believe when the rest of us are out there doing community service they are keeping us from having health care and making up stories. They need a few more jobs.
Posted by Lynn Morris on 07/31/2009 @ 08:30AM PT
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God forbid people actually want to read and understand something before they vote on it! *gasp*
This whole health care bill is ridiculous. The people have been mislead on the prevelence of the problem by exaggerated and skewed statistics. And there's all sorts of crazy stuff that is snuck into this bill that violates people's personal freedom.
I applaud the blue dog democrats for slowing this down, and I hope they continue to stand their ground.
Posted by Abby J. on 07/31/2009 @ 10:08AM PT
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Hi Abby--
Well, since the Blue Dog Democrats have already stood down and are no longer slowing the process down (you know, the actual text of the post above), you may wish to retract your applause.
Let's combat one thing right here: The House bill dropped 6 weeks ago. It's slightly longer than the last Harry Potter book. I know many people who finished "The Deathly Hallows" in 2 weeks or less in their free time. None of those people had PAID STAFF whose day job is to read it for them. Now the final bill won't even be debated, let alone voted on, for another 5 weeks.
Folks, if it takes you more than 3 months to even have a staffer summarize the bill for you, you probably shouldn't be in Congress at all.
This "no one's read the bill" stuff is just silliness.
Posted by Timothy Foley on 07/31/2009 @ 10:42AM PT
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The blue dogs made a significant change in the timeline Obama was trying to put the bill under. And they can stand up again in debate. Obama was previously wanting the vote before August recess.
Do you really want this type of attitude when it comes to voting on things?
http://cnsnews.com/public/content/article.aspx?RsrcID=51610&print=on
You're right, let's just vote on stuff and pass it because someone in the same political party as you says "hey, this is a a great idea".
We don't need this bill. And I hope it doesn't pass. This bill isn't really about health care, it's about government control of the people.
Posted by Abby J. on 07/31/2009 @ 11:04AM PT
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To be clear--
1.) They *should* read the bill. I disagree with John Conyers. That's why the man has so many people on staff -- precisely so he knows what he's voting for.
2.) They have had 5 weeks to do read the House bill, and will ultimately have 11. If they can't read it in time, the problem is the person, not the pace.
Posted by Timothy Foley on 07/31/2009 @ 12:12PM PT
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Abby,
Clearly for you it isn't about delaying the legislation, it's about KILLING IT. You said it yourself. You don't want people to have healthcare.
Posted by David English on 07/31/2009 @ 10:58PM PT
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These people already HAVE healthcare options.
Most of the "uninsured" that are talked about are voluntarily uninsured, people in their 20s or early 30s that have opted out.
And for the ones below a certain income, there's Medicaid, which many eligible people just haven't bothered to sign up for.
Last but not least, there are many private programs available to help people without health insurance and who cannot afford to pay. I work at a hospital, and the hospital where I work doesn't turn away anyone, whether it be for a sore throat or a liver transplant. And if you go to an emergency room at any hospital, they'll treat you.
There are also many "charity" hospitals, especially for kids, out there as well. Shriners, St. Lukes, Ronald McDonald, etc.
And yes, I do want to kill this legislation. It's a grossly exaggerated "problem" that we are going to spend trillions on, put us more in debt, and give the government too much control over people's health. I've read portions of the bill, I still need to sit down and read it in its entirety, but the portions I have read, it's scary what they're trying to get in there!
Posted by Abby J. on 08/01/2009 @ 07:38AM PT
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The blue dogs ( God I hate that name being an animal lover) should be neutered.
Posted by Jerry Collins on 08/01/2009 @ 09:19AM PT
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The emergency room is NOT healthcare insurance Abby. I know conservatives THINK that, but it's not true. The big bad hospitals send the collection agencies after you and drive you into bankruptcy. If you had a heart and cared, you wouldn't want to see people live like that.
Posted by David English on 08/02/2009 @ 05:52PM PT
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David, access to emergency rooms is only one peice of it, it's not everything.
Like I mentioned above, there are many private programs in place so people can get healthcare without health insurance or having to pay money. "Real" healthcare: followup visits, ongoing treatment, etc.
Posted by Abby J. on 08/03/2009 @ 11:28AM PT
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Yesterday morning on Fox & Friends they were interviewing a couple from England about their lousy European health care. This isn’t about European’s or Canadian’s. It’s about our health care. I used to work in health care and am ashamed of what is called quality health care in this area. My father had good insurance, went to what I thought was THE best health care facility in the tri-cities for a three day stay that turned into a ten month long nightmare. His care was rationed. He was bleeding to death and the nurse who was taking care of him was practicing medicine as a physician without a physician’s license. He was going into shock. Their excuse was the room temperature could have caused him to bleed to death. The status quo could sure learn a few things on compassionate, efficient, safe and concerned about the patient’s care from Remote Area Medical http://www.ramusa.org . We could start some free preventative care by having the state and local health departments require hospitals and emergency rooms to clean up their act and stop spreading MRSA into our communities. I would like to know where Rick Boucher and Tim Kaine have been knowing the quality of care here in comparison to what’s being sold by the snake oil merchants. I know where Bredesen stands unless Bill O’Reilly was fibbing again, which was not surprising after seeing his concern for the people of East Tennessee over the past several years of contacting him and hearing nothing except to be passed on to the agency I started with five years ago. I was told by Randi Blair of the East Tennessee Facility Licensing board the health care my father got was “horrifying” yet perfectly within the parameters of what the state of Tennessee and the health care system calls “the acceptable standards of health care”. The status quo is doing more harm than good. If you care to see what is really their high quality health care just copy/paste http://www.wisecountyissues.com/?p=62 (I warn you ahead of time there are some graphic and shocking photos.) But it is the truth tri-cities.
Buyer beware, get a second opinion and if you get the flu stay out of emergency rooms, you could come out worse off than before you went in.
Posted by Tim Mullins on 07/31/2009 @ 10:14AM PT
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I would be far more cautious - the Medicaid financing discrepancy... and what may subsequently (given the way the Senate is moving) be an abandon ment of commitments to do substantial reform on Medicaid may not just be a major disaster for the poor, but also a deal breaker for passing the bill. Having August for Governors to get pissed off about having to pay more for Medicaid they don't control could well put some Congresspeople in unhappy positions - especially when many states, especially, say, California, couldn't probably afford the 7%.
Posted by NYC Weboy on 07/31/2009 @ 01:06PM PT
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So Tim, what are the subsidies for people in that $43,000 - $88,000 (for a family of four) income? By my calculations, someone who makes $45,000 a year will have to pay $5400 a year for their insurance which is $450 a month.
If I could afford that much money for insurance, I would have it! And is this plan going to force everyone to buy it whether they want it or can afford it or not?
Posted by Kathy Cullison on 07/31/2009 @ 01:25PM PT
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I answered that at length here:
http://healthcare.change.org/blog/view/whats_in_it_for_me_at_45000_a_year
It is not at all a satisfying situation, and it makes it completely preposterous that the Senate Finance Committee wants to cut subsidies all the way down to 300% of poverty -- about $33,000 per individual -- all in the name of being "bipartisan."
Posted by Timothy Foley on 07/31/2009 @ 01:50PM PT
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The House Speaker Pelosi offered a deal to anybody that was going up for re-election. They could vote no on the health bill. She had enough votes to pass it without their votes. This shows she knew the majority of constituents were against the bill. How's that for cooperation with the public that puts into office people that are supposed to listen on how to vote for the majority? Done all the time. Way past due for term limits, to stop allowing legislators for vote for their own pay raises and to let them have only the same health plan as the American People.
Posted by Donna Gosse on 07/31/2009 @ 01:33PM PT
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It is possible to be in the middle class, still living with your parents. My sister has no job that provides coverage. She does not qualify for welfare. But, is simply too old to be on my mother's insurance. America does need health care. It is unreal that so many people fight what they don't understand. They hear rumors and jump on the bandwagon. There are tons of middle class folks like her who strive to make ends meet and who can't afford to buy insurance. I have insurance but, I can't afford to go to the doctor for myself because I'm always paying off a left over medical bill from my daughter. This happens in several families across America.
Posted by Lynn Morris on 08/01/2009 @ 08:43AM PT
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Finally, a simple plan that will not only pay for itself but save money, provide access to every American from birth to death regardless of income or job status, a plan that will actually allow choice of Doctor, hostpital as well as true Doctor-patient autonomy! HR 676 will go to the entire House floor now for debate & vote!! Some aspects of American society don't belong in 'free enterprise' .. such as the penal system, education, war profiteers and HEALTHCARE!
Posted by Jeanie Embry on 08/02/2009 @ 05:10PM PT
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Dear Abbey,
People do not "opt out" of health insurance because they are irresponsible cheap skate risk takers. The fact is they just cannot afford the premiums. And now, with more and more horror stories about the indusry coming out in the open, people are realizing what I realized long ago ( I have no health insurance): if you are in the individual or small group market, the health insurers can collect your money and deny you coverage when you get sick because they pay people millions of dollars each year to find ways to deny you the coverage you paid for.
Look Abbey, pretty soon you will see what all the fuss is about. Either you will make an attempt to see what people are paying for health insurance in the individual and small group markets, you will do a bit of research and see how many people are denied coverage for pre-existing conditions, or you yourself will fall victim to an illness or a job loss and then come face to face with what over 47 million Americans have come to face. I hope you never have to make the choice to go without care because you cannot afford it. But I do hope that you will somehow come to know just what many of your fellow Americans know intimately well.
Those without insurance and receive medical care at the "hospital you work at" are entitled to medical care as well as anyone. The fact that they must resort to charity is a disgrace. Those who do pay on installment sometimes pay at a higher rate than those who have coverage. The uninsured get ripped off every day and they are made to feel ashamed because they don't have coverage. I should know, I have lived the nightmare.
Fortunately, the medical crisis my family has faced during our long years of "uninsurement" have been minor and the total expenses we have paid and continue to pay are under $30,000 (still way below the amount we would have paid in premiums all these years). Living with the realization that you are one major illness away from losing everything you own ain't easy Abbey. Deciding whether you should see the doctor this week or next month because of expenses is a bit easier. Having people like you who have not a clue about the uninsured keep your flap closed makes it all a bit less unbearable.
Posted by Lauren Serven on 08/02/2009 @ 05:53PM PT
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First, learn to spell. It's "Abby", not "Abbey". An "abbey" is a convent.
Second, do some research. There are many young people that don't bother to get health insurance because they weigh the risk and reward. As long as nothing catastrophic happens to them, it's cheaper for them to pay as they go.
Government run health care hasn't worked in other countries, citizens hate it. And it hasn't worked in this country (Massachusetts' government healthcare is a huge failure)! And now we're going to force it on everyone. That's really smart: force people into something that doesn't work, people don't want, and will cost trillions of dollars.
And how is charity any different if it's from a private organization or from the government?
This government plan is a load of crap. Have you read it and seen the stuff in it? It's detrimental, not helpful! Don't you think it's odd that the people trying to pass this bill don't even want to be on it?
This bill isn't fixing anything; instead, it's taking something that needs a coat of paint and putting it through the wood chipper.
Posted by Abby J. on 08/05/2009 @ 02:46PM PT
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Well,Tim,as usual,after all is said and done,more has been said than done,and most of the elected politicians need another month to keep talking.Some of them hope to talk the whole process to death.Some genuinely hope to make the effort better.And some just want to add to their bona fides(pad their resumes)for the time when they pass through the revolving door and go to work for an insurance lobbying firm.Can anyone remember Billy Tauzin,the father of Bush's prescription drug plan,the biggest unfunded entitlement ever enacted, who went directly to the presidency of Big PhARMA?Or Bill Frist,whose family owns Hospital Corporation of America?
Whe Obama changed his mind about mandates,and when he changed the name of the process from healthcare reform to health INSURANCE reform my anxiety alarm red-lined.
The number of people who use "socialized medicine" as a boogey man to scare people is contained within the number of people who receive the benefit of government-run healthcare:Medicare,Veteran's healthcare,and government employee healthcare.This philosophy of "I've got mine,get yours if you can" is not what I would consider compassionate conservatism.More like good ole robber baron greed.
Posted by Lonnie D.Ward on 08/03/2009 @ 06:49AM PT
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Well, health insurance reform is better than nothing. I guess they all have to work together.
Posted by James Turner on 08/28/2009 @ 06:00PM PT
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