Obama fast-tracks healthcare reform

Even as the president urges Senate Democrats to move quickly, a Congressional Budget Office ruling lowers a hurdle that tripped up the Clinton-era reform effort.

Haraz N. Ghanbari/AP
President Barack Obama meets with Senate Democrats to discuss healthcare in the State Dining Room of the White House in Washington on Tuesday.

President Obama, with a strong assist from Congress’s budget watchdog, is moving healthcare reform to the fast track on Capitol Hill – with or without Republican support.

The next two months are a “make or break period” for getting healthcare done, the president told Senate Democrats at a White House meeting on Tuesday. Mr. Obama says he still wants a bipartisan plan, but Republicans worry that Tuesday’s Democrats-only meeting signals a new tack that may leave them behind.

Call it un-HillaryCare. The president’s rush to closure, even before details of the plan are in place, is in sharp contrast to the White House-driven healthcare reform effort in the first two years of the Clinton administration.

Obama is leaving the drafting of the plan largely to Congress, where competing plans are emerging on both sides of the aisle this week. Meanwhile, the White House is making the overall case for reform and generating a sense of inevitability that a plan will clear Congress this year.

At the same time, some elements that sunk the Clinton-era healthcare plan appear less of a factor this time.

In a little-noted but significant development last week, the Congressional Budget Office (CBO), which played a key role in derailing support for the Clinton plan, unveiled the approach it will take in judging the cost of Obama’s healthcare reform.

“This is a political land mine. The CBO ruling, which went pretty much under the radar, is very important in making sure that healthcare reform can be successful,” says Maya MacGuineas, president of the bipartisan Committee for a Responsible Federal Budget in Washington.

The critical element in CBO scoring is what counts as a part of the federal budget. In 1994, the CBO described President Clinton’s proposed health alliances as government activities financed by government funds – a move that supporters say derailed the plan by assigning it unacceptably high costs.

Typically, the CBO scores legislation only after it has been finalized. But in a May 27 issue brief, the CBO took a proactive stance on budgetary treatment of proposals to change the nation’s health insurance system. A federal mandate requiring individuals to have a minimum amount of health insurance would not be counted as a government expense “because the federal government imposes a variety of mandates on private entities whose associated costs are not included in the budget,” said CBO director Douglas Elmendorf in a blog explaining the brief.

“Had the CBO said we will count [the plan] as a tax or government expenditure no matter what, you would have had a huge hurdle to overcome, even insurmountable. Instead, healthcare reform is moving on a really fast track,” says Ms. MacGuineas.

In another boost, the budget procedures for fiscal year 2010 allow the Senate to shield healthcare reform from a Republican filibuster under a process called reconciliation. It means that the plan can pass by a simple majority instead of the 60 votes typically required in the Senate for legislation that the minority party opposes.

“What the CBO said back in 1994 killed the Clinton plan. Last week, CBO came with a ruling that said the opposite,” says Stanley Collender, a budget expert at Qorvis Communications in Washington.

“You add this wonky thing to the fact that healthcare is going to be included in reconciliation, and you can’t avoid coming to the conclusion that healthcare has a pretty good chance this year,” he adds. “Impediments are going by the wayside.”

Until this week, top Senate Republicans said they had assurances that the president wanted a bipartisan solution. They now say they are troubled by reports that Obama at Tuesday’s meeting appeared open to a strong public insurance plan – a move that would scuttle most GOP support.

“If they try to insist that there be a public plan, that’s very counterproductive,” says Sen. Judd Gregg of New Hampshire, the top Republican on the Senate Budget Committee, who released his own health plan his week.

“I don’t think Americans want to put government between themselves and their doctor.”

Senate Finance Committee Chairman Max Baucus (D) of Montana and Sen. Charles Grassley of Iowa, the top Republican on the panel, met privately with Obama a month ago to discuss progress in drafting healthcare reform.

At that meeting, “the president said he’d rather have a bipartisan plan that gets 80 percent of what he wants than a partisan plan that passes by 51 votes,” recalled Senator Grassley Tuesday. He added, “If Democrats come away from the White House set on a partisan measure, it can’t be done.”

“[T]he only way I can bargain in good faith representing Republicans is if we [don’t] have a public option,” he said.

Senators on the finance panel are meeting privately Thursday to discuss prospects for moving forward on a bipartisan plan.

Without reform, healthcare costs are projected to reach 34 percent of gross domestic product and 72 million Americans will be without health coverage by 2040, according to a report released Tuesday by the Council of Economic Advisers to the president.

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