Obama's proposal unveiled

[Startraveler]

The health care reform saga continues. Today the President unveiled the proposal he intends to take into Thursday's health care summit. Before we get to that, let's take a look back at what's happened so far. Feel free to skip past this if you're familiar with the story.

Recap

Two years ago, during an election cycle in which the issue of comprehensive health care reform took on a prominent role, relevant Congressional committees began laying the groundwork for a reform push the following year (for example, the Senate Finance Committee began holding health care hearings in May of 2008). Last July, a reform bill, H.R. 3200, was introduced in the House. It then simultaneously went to the three committees with jurisdiction over its contents for a markup, the process of debating and amending those contents (majority and minority members of each committee participated in the markups). Each committee voted out a version of H.R. 3200 that was a bit different from the original, since the original bill was amended by committee members. By the August recess, the House was sitting on three slightly different versions of the same bill.

Meanwhile, the Senate was attempting to simultaneously produce its own comprehensive reform bill. The two relevant Senate committees--the Finance committee and the HELP committee--each wrote their own bills. The HELP committee markup, like the markups in the House, had been completed by August. The process of drafting the Finance bill took considerably longer and the markup of that bill didn't begin until late September; it wasn't passed out of the committee until mid-October.

By that point, there were still three competing versions of H.R. 3200 in the House that needed to be merged and two health care bills in the Senate that needed to be merged. By late October, the Speaker had unveiled the merger of the three versions of H.R. 3200: a new bill, H.R. 3962. This bill was debated on the House floor and passed at the end of the first week of November. Meanwhile, the Majority Leader fused the two Senate bills into one final bill in November, with some tweaks made in December. That bill, H.R. 3590, was debated on the Senate floor and passed on Christmas eve.

Throughout this long process, we've been tracking it here:

What's IN this health care bill?, a look at the evolution of H.R. 3200

Better Know a Health Care Bill, a look at how H.R. 3962 differed from H.R. 3200

Better Know a Health Care Bill, Part II, a look at the final, merged Senate bill

Where things stand today

Both chambers of Congress have passed comprehensive health care reform bills, a historic feat by itself. But they have to pass identical bills, which is the step in the process we're at right now. The majority of the House liked the House bill, a majority of the Senate liked the Senate bill. Merging them into a final bill that a majority of both chambers likes is difficult but not impossible and that step was reportedly completed by negotiators at the end of January. However, Republicans have made it clear they'll use procedural means to block the necessary 2nd vote on a final bill.

And thus the President has called Thursday's health summit to regain momentum, fix some of the Senate's mistakes, and allow the Republicans to voice their objections. And perhaps to lay the groundwork for the alternative to forcing the Senate to try and once again pass a full bill.

To that end, the President today released his proposal, which mostly amounts to his version of a merger of the House and Senate bills.

The President's proposal rectifies some of the provisions of the Senate bill that have been heavily criticized: it removes the additional FMAP assistance for Nebraska and instead provides all states extra assistance in paying for the Medicaid expansions and it removes the advantage collectively bargained health plans had in delaying the excise tax on their plans (instead all plans will enjoy that delay and higher threshold). Or, as the summary puts it, his proposal changes the Senate bill by:

• Eliminating the Nebraska FMAP provision and providing significant additional Federal financing to all States for the expansion of Medicaid;
  
• Closing the Medicare prescription drug “donut hole” coverage gap;
  
• Strengthening the Senate bill’s provisions that make insurance affordable for individuals and families;
  
• Strengthening the provisions to fight fraud, waste, and abuse in Medicare and Medicaid;
  
• Increasing the threshold for the excise tax on the most expensive health plans from $23,000 for a family plan to $27,500 and starting it in 2018 for all plans;
  
• Improving insurance protections for consumers and creating a new Health Insurance Rate Authority to provide Federal assistance and oversight to States in conducting reviews of unreasonable rate increases and other unfair practices of insurance plans.

More than it, it increases the amount of assistance for which low-to-middle- income families are eligible, it tweaks the individual mandate, it invests in community health centers, and several other things you should just peruse.

What I found particularly interesting is that the White House site describing this proposal has a page with a partial list of Republican ideas that appear in the bills that have already passed and in the revisions Obama is proposing:

Review a few of the Republican initiatives included in legislation passed by Congress:

* Includes personal responsibility incentives: Allows health insurance premium to vary based on participation in proven employer wellness programs

o (Sources: H.R. 3468, “Promoting Health and Preventing Chronic Disease through Prevention and Wellness Programs for Employees, Communities, and Individuals Act” (Castle bill); H.R. 4038, “Common Sense Health Care Reform & Accountability Act” (Republican Substitute bill); H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill); H.R. 3970, “Medical Rights & Reform Act” (Kirk bill), "Coverage, Prevention and Reform Act")

* Advances medical liability reform through grants to States: Provides grants to States to jump-start and evaluate promising medical liability reform ideas to put patient safety first, prevent medical errors, and reduce liability premiums.

o (Sources: S. 1783, “Ten Steps to Transform Health Care in America Act” (Enzi bill); H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill); H.R. 4529, “Roadmap for America’s Future Act” (Ryan bill); S. 1099, “Patients’ Choice Act” (Burr-Coburn, Ryan-Nunes bill))

* Extends dependent coverage to age 26: Gives young adults new options.

o (Sources: H.R. 4038, “Common Sense Health Care Reform & Accountability Act” (Republican Substitute bill); H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))

* Allows automatic enrollment by employers in health insurance: Allows employee to opt-out.

o (Sources: House Republican Substitute; H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill); “Coverage, Prevention, and Reform Act” )

* Mechanisms to improve quality.

o (Sources: H.R. 4529, “Roadmap for America’s Future Act;” S. 1099, “Patients’ Choice Act;” H.R. 3400, Republican Study Group bill; S. 1783, “Ten Steps to Transform Health Care in America Act” (Enzi bill))

Review the new Republican initiatives included in the President’s Proposal:

* Comprehensive Sanctions Database. The President’s Proposal establishes a comprehensive Medicare and Medicaid sanctions database, overseen by the HHS Inspector General. This database will provide a central storage location, allowing for law enforcement access to information related to past sanctions on health care providers, suppliers and related entities.

o (Source: H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill))

* Registration and Background Checks of Billing Agencies and Individuals. In an effort to decrease dishonest billing practices in the Medicare program, the President’s Proposal will assist in reducing the number of individuals and agencies with a history of fraudulent activities participating in Federal health care programs. It ensures that entities that bill for Medicare on behalf of providers are in good standing. It also strengthens the Secretary’s ability to exclude from Medicare individuals who knowingly submit false or fraudulent claims.

o (Source: H.R. 3970, “Medical Rights & Reform Act”)

* Expanded Access to the Healthcare Integrity and Protection Data Bank. Increasing access to the health care integrity data bank will improve coordination and information sharing in anti-fraud efforts. The President’s Proposal broadens access to the data bank to quality control and peer review organizations and private plans that are involved in furnishing items or services reimbursed by Federal health care program. It includes criminal penalties for misuse.

o (Source: H.R. 3970, “Medical Rights & Reform Act”)

* Liability of Medicare Administrative Contractors for Claims Submitted by Excluded Providers. In attacking fraud, it is critical to ensure the contractors that are paying claims are doing their utmost to ensure excluded providers do not receive Medicare payments. Therefore, the President’s Proposal provision holds Medicare Administrative Contractors accountable for Federal payment for individuals or entities excluded from the Federal programs or items or services for which payment is denied.

o (Source: H.R. 3970, “Medical Rights & Reform Act”)

* Community Mental Health Centers. The President’s Proposal ensures that individuals have access to comprehensive mental health services in the community setting, but strengthens standards for facilities that seek reimbursement as community mental health centers by ensuring these facilities are not taking advantage of Medicare patients or the taxpayers.

o (Source: H.R. 3970, “Medical Rights & Reform Act”)

* Limiting Debt Discharge in Bankruptcies of Fraudulent Health Care Providers or Suppliers. The President’s Proposal will assist in recovering overpayments made to providers and suppliers and return such funds to the Medicare Trust Fund. It prevents fraudulent health care providers from discharging through bankruptcy amounts due to the Secretary from overpayments.

o (Source: H.R. 3970, “Medical Rights & Reform Act”)

* Use of Technology for Real-Time Data Review. The President’s Proposal speeds access to claims data to identify potentially fraudulent payments more quickly. It establishes a system for using technology to provide real-time data analysis of claim and payments under public programs to identify and stop waste, fraud and abuse.

o (Source: Roskam Amendment offered in House Ways & Means Committee markup)

* Illegal Distribution of a Medicare or Medicaid Beneficiary Identification or Billing Privileges. Fraudulent billing to Medicare and Medicaid programs costs taxpayers millions of dollars each year. Individuals looking to gain access to a beneficiary’s personal information approach Medicare and Medicaid beneficiaries with false incentives. Many beneficiaries unwittingly give over this personal information without ever receiving promised services. The President’s Proposal adds strong sanctions, including jail time, for individuals who purchase, sell or distribute Medicare beneficiary identification numbers or billing privileges under Medicare or Medicaid – if done knowingly, intentionally, and with intent to defraud.

o (Source: H.R. 3970, “Medical Rights & Reform Act”)

* Study of Universal Product Numbers Claims Forms for Selected Items and Services Under the Medicare Program. The President’s Proposal requires HHS to study and issue a report to Congress that examines the costs and benefits of assigning universal product numbers (UPNs) to selected items and services reimbursed under Medicare. The report must examine whether UPNs could help improve the efficient operation of Medicare and its ability to detect fraud and abuse.

o (Source: H.R. 3970, “Medical Rights & Reform Act”, Roskam Amendment offered in House Ways & Means Committee markup)

Anyway, it's worth looking through Obama's proposals. We'll see what the Republicans counter with and then what the final legislation looks like in future editions of BKaHCB.

[Pseudo Intellectual]

Too bad the CBO can't score it.

Although the proposal reflects many elements that were included in the health care bills passed by the House and the Senate last year, it modifies many of those elements and also includes new ones. Moreover, preparing a cost estimate requires very detailed specifications of numerous provisions, and the materials that were released this morning do not provide sufficient detail on all of the provisions. Therefore, CBO cannot provide a cost estimate for the proposal without additional detail, and, even if such detail were provided, analyzing the proposal would be a time-consuming process that could not be completed this week.

So I guess we'll just have to trust Barry and take his word for it.

[+DieChecker]

It is somewhere between the Senate and House bills, and I admire the ideas and work that went into the changes, but I think this will probably cost more then either of the two originals. Doesn't it basically promise a Cornhusker deal for everyone?

[Caesar]

OH no, Startraveler please stop with the messiahs HC plans... mercy, mercy, mercy!

[+DieChecker]

Sen. Orrin Hatch, R-Utah, sent Obama a letter today asking Obama to publicly renounce the reconciliation option.

"Using the budget reconciliation process, in the Senate for example, would limit debate to only 20 hours and restrict the ability of senators to amend a proposal that is intended to steer one-sixth of our economy in a new direction," Hatch wrote. "It would be a tremendous disservice to the American people and our nation."

http://content.usatoday.com/communities/theoval/post/2010/02/obama-health-care-plan-to-dominate-the-week/1

A piece in the NY Times. Several opinions and seemingly (To me) none of them in favor of Obama's plan.

http://roomfordebate.blogs.nytimes.com/2010/02/22/can-obama-bypass-republicans-on-health/

Edited February 23, 2010 by DieChecker

[ninjadude]

Star, isn't it unusual for a president to swoop in and try to do whatever it is he's trying to do, when the job is the Congress' to reconcile the bills into one? I'm unclear on what he hopes to accomplish with this. PR? The Congress needs to get off it's hind end and reconcile the two bills. Unless of course, they have thrown up their hands?

Regardless of opinions to the contrary about Health Care Reform, apparently some haven't gotten the memo. It PASSED in BOTH houses of CONGRESS.

Edited February 23, 2010 by ninjadude

[Startraveler]

It is somewhere between the Senate and House bills, and I admire the ideas and work that went into the changes, but I think this will probably cost more then either of the two originals. Doesn't it basically promise a Cornhusker deal for everyone?

No. Since there seems to be confusion at to what Nebraska was getting that other states weren't, let's walk through it. FMAP is the percentage of a state's Medicaid tab the federal government picks up (it varies between 50% for the wealthiest up to about 77% for the poorest). Since the reform bills expand Medicaid, they make poor people who couldn't get Medicaid before eligible for it. These newly eligible people get an FMAP different from the traditional Medicaid population--the federal government pays for a greater portion of their expenses to ease the burden on state governments. So here's what the Senate bill offered:

‘(y) Increased FMAP for Medical Assistance for Newly Eligible Mandatory Individuals-

‘(1) AMOUNT OF INCREASE-

‘(A) 100 PERCENT FMAP- During the period that begins on January 1, 2014, and ends on December 31, 2016, notwithstanding subsection (

, the Federal medical assistance percentage determined for a State that is one of the 50 States or the District of Columbia for each fiscal year occurring during that period with respect to amounts expended for medical assistance for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i) shall be equal to 100 percent.

‘(

2017 AND 2018-

‘(i) IN GENERAL- During the period that begins on January 1, 2017, and ends on December 31, 2018, notwithstanding subsection (

and subject to subparagraph (D), the Federal medical assistance percentage determined for a State that is one of the 50 States or the District of Columbia for each fiscal year occurring during that period with respect to amounts expended for medical assistance for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i), shall be increased by the applicable percentage point increase specified in clause (ii) for the quarter and the State. [..]

‘(C ) 2019 AND SUCCEEDING YEARS- Beginning January 1, 2019, notwithstanding subsection (

but subject to subparagraph (D), the Federal medical assistance percentage determined for a State that is one of the 50 States or the District of Columbia for each fiscal year quarter occurring during that period with respect to amounts expended for medical assistance for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i), shall be increased by 32.3 percentage points.

‘(D) LIMITATION- The Federal medical assistance percentage determined for a State under subparagraph (

or © shall in no case be more than 95 percent.

100% FMAP for the first 3 years (i.e. the federal government picking up the entire tab for the newly eligible population), eventually transitioning by 2019 to a state's standard FMAP + 32.3 percentage points, not to exceed a total FMAP of 95%. So California, a state with a high enough per capita GDP to get the lowest possible FMAP (50%) will be getting 50 + 32.3 = 82.3 FMAP for the newly eligible population from 2019 on. Other states will get even greater reimbursement, though it won't be more than 95% FMAP. So the vast majority of the costs of the newly eligible Medicaid population is going to be covered by the federal government indefinitely under the Senate bill.

The deal Nebraska got was:

‘(3) Notwithstanding subsection (

and paragraphs (1) and (2) of this subsection, the Federal medical assistance percentage otherwise determined under subsection (

with respect to all or any portion of a fiscal year that begins on or after January 1, 2017, for the State of Nebraska, with respect to amounts expended for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i), shall be determined as provided for under subsection (y)(1)(A) (notwithstanding the period provided for in such paragraph).

Subsection (y)(1)(A), as you can see above, is 100% FMAP. Thus Nebraska would have gotten 100% FMAP for their newly eligibles forever, instead of having to pay 7% of those costs, as they would have had to pay after 2019.

Obama's proposal is as follows:

Relative to the Senate bill, the President’s Proposal replaces the variable State support in the Senate bill with uniform 100% Federal support for all States for newly eligible individuals from 2014 through 2017, 95% support for 2018 and 2019, and 90% for 2020 and subsequent years. This approach resembles that in the House bill, which provided full support for all States for the first two years, and then 91% support thereafter. The President’s Proposal also recognizes the early investment that some States have made in helping the uninsured by expanding Medicaid to adults with income below 100% of poverty by increasing those States’ matching rate on certain health care services by 8 percentage points beginning in 2014. The President’s Proposal also provides additional assistance to the Territories, raising the Medicaid funding cap by 35% rather than the Senate bill’s 30%.

Instead of tagging the FMAP for newly eligibles to the state's overall FMAP, every state gets an identical FMAP. But that doesn't translate into 100% FMAP indefinitely, which is what Nebraska's deal was. Some states will get more money under Obama's proposal than they would have under the Senate bill, others will get less. So the cost impact points in two different directions--it's not a straight increase in the cost of the bill (though, to clarify, I imagine the net effect of this change is a cost increase).

OH no, Startraveler please stop with the messiahs HC plans... mercy, mercy, mercy!

You're free to read any of the numerous other threads in this forum that don't have any policy in them. No one's forcing you to read these.

A piece in the NY Times. Several opinions and seemingly (To me) none of them in favor of Obama's plan.

http://roomfordebate.blogs.nytimes.com/2010/02/22/can-obama-bypass-republicans-on-health/

Those are opinions on whether or not to simply use reconciliation to get a bill on his desk (i.e. they're about process, not policy). But the early word seems to be that reconciliation is going to be pursued.

Star, isn't it unusual for a president to swoop in and try to do whatever it is he's trying to do, when the job is the Congress' to reconcile the bills into one? I'm unclear on what he hopes to accomplish with this. PR? The Congress needs to get off it's hind end and reconcile the two bills. Unless of course, they have thrown up their hands?

Regardless of opinions to the contrary about Health Care Reform, apparently some haven't gotten the memo. It PASSED in BOTH houses of CONGRESS.

It is unusual. But we'll see what happens.

Edited February 23, 2010 by Startraveler

[Caesar]

You're free to read any of the numerous other threads in this forum that don't have any policy in them. No one's forcing you to read these.

Yup I think we agree on something

Those are opinions on whether or not to simply use reconciliation to get a bill on his desk (i.e. they're about process, not policy). But the early word seems to be that reconciliation is going to be pursued.

And you don't think this will really backfire on the Democrats, places like Massachusetts voted to stop this with Brown running on "I'll be the 41'st to stop it". and I don't think it will pass in 60 days there will be all kinds of things to go threw.

[ninjadude]

And you don't think this will really backfire on the Democrats, places like Massachusetts voted to stop this with Brown running on "I'll be the 41'st to stop it". and I don't think it will pass in 60 days there will be all kinds of things to go threw.

No. Brown won because of a Democratic party p***ing contest. This is well known in MA. After the primary, one Democratic party faction refused to support the others. You can spin it into health care reform all the Tea Partier network wants you to but it just isn't so. Reconciliation only requires 50 votes not 60.

[Startraveler]

And you don't think this will really backfire on the Democrats, places like Massachusetts voted to stop this with Brown running on "I'll be the 41'st to stop it". and I don't think it will pass in 60 days there will be all kinds of things to go threw.

How would it backfire? I think it's pretty clear that the unemployment rate in November is going to be the primary determinant in this year's elections. Anyone voting on the basis of the health care issue likely already knows how they're going to vote, particularly if they oppose these efforts; bills have already been passed by Congress and votes cast. You can't undo that to woo the opposition. And people who are going to vote based on health care and do want these bills passed won't be appeased unless they actually pass.

In the long run, process doesn't matter. Only policy matters, as people pay attention to outcomes. In five years (well, more like five months), most people won't remember or care if reconciliation was used to reconcile the House and Senate bills. They'll decide based on experience whether they like it, just as they've done in Massachusetts. Even a majority of Scott Brown's voters answered in the affirmative to this question:

As you may know, Massachusetts has a law that is aimed at assuring that virtually all Massachusetts residents have health insurance. Given what you know about it, in general, do you support or oppose the Massachusetts Universal Health Insurance Law?

Out of all voters who voted in that Senate election, the Massachusetts system was supported 68-27. They like it. Scott Brown even voted for it.

The reality is that these bills have already passed. That can't be undone and there's no political benefit in stopping on the final step and not sending the President a reconciled bill.

Edited February 23, 2010 by Startraveler

[Caesar]

How would it backfire? I think it's pretty clear that the unemployment rate in November is going to be the primary determinant in this year's elections. Anyone voting on the basis of the health care issue likely already knows how they're going to vote, particularly if they oppose these efforts; bills have already been passed by Congress and votes cast. You can't undo that to woo the opposition. And people who are going to vote based on health care and do want these bills passed won't be appeased unless they actually pass.

If the Democrats take the road of reconciliation on such a large bill it will backfire.

In the long run, process doesn't matter. Only policy matters, as people pay attention to outcomes. In five years (well, more like five months), most people won't remember or care if reconciliation was used to reconcile the House and Senate bills. They'll decide based on experience whether they like it, just as they've done in Massachusetts. Even a majority of Scott Brown's voters answered in the affirmative to this question:

If you have people paying more in taxes with the costs of HC and letting the Bush tax cuts expire they will remember, they won't see HC for years but pay for it right away.

As you may know, Massachusetts has a law that is aimed at assuring that virtually all Massachusetts residents have health insurance. Given what you know about it, in general, do you support or oppose the Massachusetts Universal Health Insurance Law?

Out of all voters who voted in that Senate election, the Massachusetts system was supported 68-27. They like it. Scott Brown even voted for it.

The reality is that these bills have already passed. That can't be undone and there's no political benefit in stopping on the final step and not sending the President a reconciled bill.

I support it if its done by the states but not by the Federal Government.

[Caesar]

No. Brown won because of a Democratic party p***ing contest. This is well known in MA. After the primary, one Democratic party faction refused to support the others. You can spin it into health care reform all the Tea Partier network wants you to but it just isn't so. Reconciliation only requires 50 votes not 60.

Its a very liberal state and he ran on crushing the bill, if this bill was so good how can a Republican win in MA? I would know because I lived in the Peoples Republic for 30 years and I'm 33 years old.

[J.B.]

I think Ninja means that the Democratic in-fighting split the vote enough for Brown to slip through and claim a victory that wasn't properly his. If this isn't what you mean, Ninja, I'm sure we'll listen to your explanation.

Edited February 23, 2010 by J.B.

[Tsukasa]

I think Ninja means that the Democratic in-fighting split the vote enough for Brown to slip through and claim a victory that wasn't properly his. If this isn't what you mean, Ninja, I'm sure we'll listen to your explanation.

Correct me if I am wrong, but from what I know only one democrat ran for the MA senate seat. So how do you split the democratic vote when only one democrat is running? Caesar may be able to shed some light on this since he has lived in MA.

[Caesar]

Correct me if I am wrong, but from what I know only one democrat ran for the MA senate seat. So how do you split the democratic vote when only one democrat is running? Caesar may be able to shed some light on this since he has lived in MA.

I think what happened was the left wasn't crazy about the liberal canidate or the direction Obama was taking this country so I think a large chunk of the base didn't go out and vote. while Brown took advantage of this with the indepence and the handfull of Republicans. I think this also happened in NJ and VA.

[WoIverine]

Sigh. To me, the healthcare issue is starting to feel like a dog chasing his tail for eternity. Are we getting anywhere yet?!

Edited February 23, 2010 by SpiderCyde

[Startraveler]

Sigh. To me, the healthcare issue is starting to feel like a dog chasing his tail for eternity. Are we getting anywhere yet?!

It looks like we are.

Now, some additional resources:

• Side-by-side comparison of the House proposal, the Senate proposal, and the Obama proposal
  
• Something similar but in chart form

[ninjadude]

If the Democrats take the road of reconciliation on such a large bill it will backfire.

we pass things by 51%. reconcilliation is completely valid.

If you have people paying more in taxes with the costs of HC and letting the Bush tax cuts expire they will remember, they won't see HC for years but pay for it right away.

You mean the uber rich. Because it's my understanding that most people will not pay higher taxes for healthcare.

I support it if its done by the states but not by the Federal Government.

that's how it works now. And it's completely broken. The laws in my state don't apply to my health insurance because my company uses insurance from another state. It's completely bogus.

[ninjadude]

Its a very liberal state and he ran on crushing the bill, if this bill was so good how can a Republican win in MA? I would know because I lived in the Peoples Republic for 30 years and I'm 33 years old.

Did you miss my post? If half the Democrats fail to support their candidate, a Repub can easily win. And did.

"Brown won because of a Democratic party p***ing contest. This is well known in MA. After the primary, one Democratic party faction refused to support the others."

[ninjadude]

I think Ninja means that the Democratic in-fighting split the vote enough for Brown to slip through and claim a victory that wasn't properly his. If this isn't what you mean, Ninja, I'm sure we'll listen to your explanation.

No no. He won fair and square. But you're right, the reason he won was D in-fighting. IF you don't vote, you don't get to complain.

[Caesar]

we pass things by 51%. reconcilliation is completely valid.

Reconcilliation is normaly used for small budget matters not big projects like this.

You mean the uber rich. Because it's my understanding that most people will not pay higher taxes for healthcare.

"Uber rich" I guess that means the middle class to most libearals, unless they work for unions.

that's how it works now. And it's completely broken. The laws in my state don't apply to my health insurance because my company uses insurance from another state. It's completely bogus.

No its not really like that.

[ninjadude]

Correct me if I am wrong, but from what I know only one democrat ran for the MA senate seat. So how do you split the democratic vote when only one democrat is running? Caesar may be able to shed some light on this since he has lived in MA.

Then there would be no need for a primary. of course there were other candidates in the primary.

A new Rasmussen Reports survey in the state shows Coakley with the support of 36% of likely primary voters, followed by Congressman Michael Capuano who earns 21%

a source from my favorite wacko pollster

[Caesar]

Did you miss my post? If half the Democrats fail to support their candidate, a Repub can easily win. And did.

"Brown won because of a Democratic party p***ing contest. This is well known in MA. After the primary, one Democratic party faction refused to support the others."

I think Obama scares even the people in MA.

[Caesar]

Then there would be no need for a primary. of course there were other candidates in the primary.

a source from my favorite wacko pollster

Of couse it was the primary

[ninjadude]

Sigh. To me, the healthcare issue is starting to feel like a dog chasing his tail for eternity. Are we getting anywhere yet?!

Schoolhouse rock. A bill is passed in the House. A bill is passed in the Senate. Both versions must be reconciled into a final bill and voted on. If passed, the pres signs. Pretty much how all bills are generated. A bill was passed in both houses. So we're at the reconcilation stage on health care reform.