This is the agony of compromise. Sen. Max Baucus was the supposed gang leader of the Senate's Gang of Six, a group of three Democrats and three Republican senators charged with reaching a bipartisan compromise on health care. Today Baucus released his health care proposal, and the Gang of Six appears to have dwindled to a Wolfpack of One. Let's review the loudest gripers:
All of them. Sen. Olympia Snowe was considered the only major Republican with cross-over potential to rescue the Democrats hopes of bipartisanship, but she has reportedly "left the building" on health care reform. That means reform will have to rely exclusively on the votes of Democrats in the Senate. Expect major hand-wringing over a potential filibuster and the procedural straitjacket of budget reconciliation in the next few weeks.
This we knew going in. The Baucus plan has no employer mandate, no public option, and a tax on expensive insurance plans which will be passed along to employees. This makes unions nervous because it means rates go up and as rates go up, some employees might feel tempted to drop coverage altogether. That makes unions very angry, and angry unions are very bad news for...
3) Liberal politicians.
Sen. Jay Rockefeller, a public option hard-liner from West Virginia, is apoplectic about the idea of taxing insurance benefits, which currently enjoy tax-free status. He sees health care costs soaring for coal miners in his state, and has even threatened to not vote for the bill. My gut tells me this has to be an empty threat, but it highlights a growing concern for Democrats -- the erosion of their left-wing support. Update: Sen. Bob Casey is also miffed about the missing public option.
The Baucus bill expands Medicaid coverage to all individuals making less than $14K and all families making less than $29K. This expansion is a crucial step toward universal coverage because, as TIME reports, low-income adults earning under $33K per family make up half the uninsured. Who exactly pays for all that new health care is a tricky question. But since Medicaid costs will be shared by states and the federal government over time, many governors are duly concerned that even as they struggle to hold together budgets after this recession passes, they will be hit with "unfunded mandates"to help cover the poor for generations.
5) The Strong Universal Coverage Folks.
Baucus' plan costs less than $900 billion over 10 years, whereas the House's version costs more than $1 trillion. That's a good thing, right? Well, not exactly. If your first goal in health care reform is to cover all Americans, than you're probably looking for a bill that extends Medicaid over the poverty line (about $10K/yr) and offers robust subsidies up to 3X the poverty line to help individuals and families without employer-provided care to buy their own coverage. I've read a lot of estimates that put that number just north of one trillion dollars. So when a fiscal hawk sees $860 billion, he might breathe a sigh of relief, but anything less than 10 figures will stress out the social welfare crowd.
6) Insurers, Device Makers and Labs
Some good reporting from the Times' prescription blog (and Atlantic Politics) finds insurers, device makers and labs screaming to their lobbyist groups and congresspeople about new cuts. That matters politically because many medical device and technology companies are based in Indiana and Minnesota, home to three Democratic senators: Amy Klobuchar and Al Franken of Minnesota and moderate budget hawk Evan Bayh of Indiana.