The Indispensable Henry Waxman -- Energy and Commerce Votes Out Bill

by Tim Foley

categories: For Profit Insurance, National Health Exchange, Obama and Congress, Single Payer

Published July 31, 2009 @ 11:15PM PT

We began with five committees – two in the Senate and three in the House.  The early money was on Max Baucus’ Senate Finance Committee to mark-up their bill first.  Instead, they’re the only committee without so much as a draft of their proposal.  Everyone else is done.  Although the House did not have a full floor vote before breaking for the August recess, the fact that all committees with jurisdiction have passed a comprehensive health reform bill out of committee to the House floor is a historical accomplishment – all the more so because of the rollercoaster of the past few days.

Form where I’m sitting, this simply wouldn’t have been possible without two critical events in November.  The first was the election of Barack Obama, obviously enough (we wouldn’t be reforming health care right now under John McCain.)  But the second was Rep. Henry Waxman emerging the victor in his committee chairmanship fight with Rep. John Dingell.  For the past two days, Waxman has been the indispensable man.

First, kudos to the staffs of Ways and Means, Energy and Commerce, and Education and Labor for the leap forward in transparency.  Every single one of the committee Web sites allows you to review all materials on HR 3200, including what happened in mark-up.  I know it will become incredibly popular to say no legislator knows what’s in these bills as one of those "everybody knows" talking points.  But folks, I, Random Blogger Dude, know what’s in these bills.  That means it can't be that frakkin' hard.  And now so can you:

• Ways and Means Mark-up and Amendments
• Education and Labor Amendments
• Energy and Commerce Mark-Up and Amendments

The path to get us to a vote in Energy and Commerce was, in a word, treacherous.

First, Chairman Henry Waxman made a deal with 4 of the Blue Dogs on Energy and Commerce who had put the breaks on mark-up.  As you’ll recall, my bottom line on that deal was, “I just don’t see that the bill has lost anything.”  The Congressional Progressive Caucus massively disagreed – with a rally and with a letter signed by 57 Democrats – 7 more than the Blue Dogs have in their whole caucus.  What originally seemed like posturing for future fights – Rep. Lynn Woolsey’s pronouncement, “Many of us were for single-payer system standing up here today, but we have compromised. We have rallied because we want a plan with a meaningful public option, and we can compromise no more” seems like a refrain that you'll start to hear again and again during the full House debate in September – turned out to have real matter to it.

For one thing, there was no actual back and forth compromise to the Blue Dog "compromise."  It was purely giveaways for the sake of advancing the bill.  When the Progressives stood up, they made it clear that those concessions would come at a price.  Despite Rep. Woolsey’s pronouncement, the liberal members of the Democratic Party were very much ready to compromise, leading to an amazing thing – this time, the bill actually got better.  The deal that liberals struck with conservative Democrats doesn’t roll back the Blue Dog provisions, but does gets two big improvements into the bill.  First, a legislative fiat for the public health insurance option to negotiate for the best rates on prescription drugs and hold prescription benefit managers – the middlemen who arrange the deals between the government and Big Pharma – to a much higher standard than the loosey-goosey Medicare Part D program.   Secondly, and far more importantly, a restriction on how much private insurance companies can jack up the rates each year.

This is probably the biggest improvement in the bill since it first dropped weeks ago, and represents a big step forward in consumer protection.  Currently, private insurance can raise premiums as high as they want whenever they want on individuals, leading to a preposterous 30% jump in premiums for Anthem Blue customers in the Bay Area.  They also don’t need to justify such a jump other than by "what the market will bear" – similar to how the number of medical malpractice lawsuits has plummeted in Texas yet malpractice insurance premiums continue to rise.  Now, private insurance plans in the Exchange will be restricted to 150% of the rate of medical inflation for that year.  So if costs go up 4% from 2014-2015, the Humana plan in the Exchange can raise its premiums 6% in 2015.  It cannot raise its premiums 9-15% for the heck of it.  Of course, the insurance company can apply for an exception – there may be some strange reason why it’s necessary – but such an exception has to be approved.  You have to actually make the case.

The last important gain for the Progressive Caucus is less substantive.  It’s mostly symbolic.  But it’s an important symbol given the years of passionate advocacy for an American single-payer, Medicare for All solution to our health care crisis.  A full House floor vote will allow, for the first time in history, an up or down vote on replacing HR 3200 entirely with a single-payer system.

With no disrespect to the long and storied career of Rep. Dingell, it is almost impossible to imagine him navigating the minefield like Waxman has for the past week.  As a sharp contrast to the “let’s all get along now” negotiations of Max Baucus, which have only resulted in endless delays on Senate Finance, Waxman’s negotiating sessions with Mike Ross of the Blue Dogs have been contentious and, at times, explosive.  It is likely part of the reason the Blue Dogs’ demands were so meager is because Waxman lived up to his reputation as a relentless negotiator.  He was reportedly even willing to have the bill bypass his committee and go to the House floor if the Blue Dogs didn’t step down from their most radical demands. Similarly, Waxman was able to quickly get the Progressive Caucus what they needed to move forward, in no small party because, as Ezra Klein wrote of Ted Kennedy, “[he] has, over the years, given people on both sides of the aisle a pretty clear sense of his core values…. when [he] cuts a deal that seems to diverge from his principles, there's an underlying sense of trust that that was the best deal he could get.”  (Ezra explicitly puts Waxman and Sen. Orrin Hatch in the same category).  Finally, Waxman had by far the roughest mark-up.  The public health insurance option is the most contentious issue in health care right now.  Abortion is the most controversial issue in American politics.  Waxman navigated his way through both, and got votes to pass the bill out of committee.

There was not a single easy step in that process.

So in Waxman’s short tenure as chair of Energy and Commerce, he’s managed to get cap-and-trade to a successful vote in the House, and he’s been able to get a comprehensive health care bill out of the committee for the first time in history.  It’s fitting that the best commentary of all came from the man he replaced – Rep. John Dingell:

“Mr. Chairman, you’ve done a superb job.  You have every right to be proud.”