Posted from today's Politico.
The White House opened its last-ditch push for health reform Monday by releasing a $950 billion plan that signaled a new phase of hands-on presidential involvement.
But by day’s end, President Barack Obama was staring down all the same old problems.
Republicans called it a retread of the same bills Americans have panned, even though it included some GOP ideas. “Déjà vu all over again,” said Sen. Judd Gregg (R-N.H.).
Democrats and labor unions didn’t rush to embrace the plan, either, though by Monday night, Democrats were sounding more receptive to it, despite the lack of a public health insurance option. Congressional Democratic aides also complained of being left in the dark by the White House, asking for a preview of the bill Friday, only to be denied by White House aides, according to multiple sources.
And Obama’s plan did nothing to answer the central question facing Democrats: how to get a bill through the Senate — now one vote shy of a filibuster-proof majority — in one of the most toxic environments for incumbents in recent memory. Even with the first presidential plan on the table, there was no guarantee Democrats could pull off health reform this year.
After a year of keeping his distance from the legislative process, Obama plunged in ahead of Thursday’s bipartisan health care summit with a sweeping plan that laid to rest any question about whether he would scale down his ambitions. Following the Massachusetts defeat, Obama floated the idea of a smaller bill, but even skeptics of the comprehensive approach argued the bill was too interrelated to break apart.
By stepping forward now, Obama hoped to set the agenda for the summit — making his own bill the starting point for any discussions and trying to force Republicans to come to the table with a single plan.
“We view this as the opening bid for the health meeting,” said White House Communications Director Dan Pfeiffer. “We took our best shot at bridging the differences. We think this makes some strong steps to improving the final product.”
The renewed presidential involvement was a relief for many congressional Democrats, who had agitated for a more direct approach from Obama. Democrats said that by presenting his first concrete blueprint in the yearlong debate, the president may be able to rebrand health care reform after months of messy legislative negotiations that contributed to a sharp drop in the bill’s popularity. Even though the president’s numbers have dipped, the public views him more favorably than it views Congress.
“Let’s just say it was welcomed,” Sen. Sheldon Whitehouse (D-R.I.) said when asked whether Obama’s involvement was overdue.
But Republicans weren’t impressed with the offer, issuing uniformly negative statements. They called it more of the same drafted-behind-closed-doors policy that Americans dislike and continued to push for Democrats to start with a blank slate — a demand Obama has emphatically rejected.
“Americans want the administration to scrap its massive government scheme in favor of an incremental approach to health care reform,” said Senate Minority Leader Mitch McConnell (R-Ky.). “Unfortunately, the White House still seems unwilling to do the one thing Americans want most. It’s still clinging to a massive bill that Americans have overwhelmingly rejected, again and again, for months.
The White House kept Obama’s plan under wraps until Monday, and knowing this, party leaders in the House agreed last week not to weigh in immediately on the plan once it was unveiled, preferring instead to hear from their rank and file and field whatever concerns members had, leadership aides said.
House Speaker Nancy Pelosi released a statement Monday morning to say the plan “contains positive elements from the House- and Senate-passed bills.” House Majority Leader Steny Hoyer (D-Md.) said, “It could be the basis for a compromise. We’re not there yet. ... We’ll see what the Republicans have to offer.”
Senate Finance Committee Chairman Max Baucus (D-Mont.) said he was pleased to see that the bill mirrors much in the Senate version of reform. “It’s close. I mean, this is a democracy — you have 535 members of Congress, plus a president, and we hope to put these provisions together. I’m pleased,” Baucus said. “We will get health care reform passed this year.”
But for all the talk of the details in Obama’s bill, it’s politics, not policy, that has been the biggest sticking point for Democrats of late.
Since losing the Massachusetts Senate election, Democrats have struggled with finding a legislative path to move forward in the House and Senate.
In the Senate, they are moving toward using reconciliation, a parliamentary maneuver that allows legislation to be passed with a simple majority. But Democrats remain skittish about using that tool, as Republicans have cast it as a shortcut, even though they, too, have used it to pass legislation.
The White House went further Monday than it has before in signaling support for reconciliation. Pfeiffer said the president believes the bill should receive an up-or-down vote.
“This is designed to provide us maximum flexibility if the opposition decides to take the extraordinary step of filibustering health reform,” Pfeiffer said.
A senior Democratic Senate aide said any decision on how to proceed will wait until after the summit.
The White House plan adopts the broad framework of the House and Senate bills, which require individuals to purchase insurance, provide subsidies for lower-income Americans to buy coverage and prohibit insurers from refusing to cover people with pre-existing conditions.
The plan appears designed to allay liberals in the House while not going too far in a way that would alienate Senate moderates. For example, it delays an unpopular tax on “Cadillac” insurance plans until 2018 for all Americans, which will please liberal Democrats, but omits the public option, which aims to keep moderates on board.
Obama has long said he would sign a bill without a public option, and his own legislation confirms that.
“It would have been nice if it was in there, but I think there are practical reasons for that, and I hope we can continue to work our way through those,” said Whitehouse, who signed a letter last week urging Senate Majority Leader Harry Reid (D-Nev.) to include the public option in the bill.
Asked if he was disappointed the bill doesn’t include a public option, Sen. Bernie Sanders (I-Vt.) said, “We’re going to fight to put it in.”
At the same time, the president makes a run at Republicans by boosting measures to crack down on waste, fraud and abuse in Medicare — a fixture in GOP talking points.
The proposal eliminates some of the most maligned elements of the Senate bill and enhances popular provisions, such as fully closing the “doughnut hole” for Medicare prescription drug beneficiaries. Obama’s proposal also includes a legal requirement for all Americans to own insurance but lowers the penalty on individuals who don’t, to just $325 in the first year.
After months of losing the messaging war on health care, the White House put a new frame on the subsidies for lower-income Americans to purchase health insurance, describing them as the “largest middle-class tax cut for health care in history.” At the same time, the plan would raise the Medicare payroll tax on couples earning more than $250,000 a year.
The bill also gives the federal government sweeping new powers to curb exorbitant rate hikes by the nation’s health insurance companies.
“It is a very constructive step forward, and we are now prepared to see what the Republicans will bring to the table Thursday,” said Sen. Ben Cardin (D-Md.).
Chris Frates, John Bresnahan and Meredith Shiner contributed to this report.
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