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The Importance of Being Charles Grassley

The extension and expansion of the State Children’s Health Insurance Program SCHIP has now passed the full House and the Senate Finance Committee and is on its way to the full Senate. After minor differences between the House and Senate are reconciled it will become law.

However, the way it is being done does not give me a good feeling.

In the Senate Finance Committee the Democrats were only able to get the support of one Republican–Maine’s Olympia Snowe–on the way to a 12-7 approval. They did not have the support of the ranking Republican, Chuck Grassley of Iowa.

Senate Finance Democrats lost the support of the Republicans when they insisted on departing from last year’s bipartisan agreement to leave existing policy on covering the children of legal immigrants
as is. As it now stands, a legal immigrant agrees not to apply for Medicaid and SCHIP
benefits for the first five years they are in the country. Under the
new rules states would have the option of covering legal immigrants.
The new bill also left out provisions from the earlier bipartisan
comprise to limit benefits for higher income families.

<p>Without judging on the merits whether these two new provisions should have been in the bill, what the Democrats have done is moved away from earlier bipartisan agreements</span> and in doing so lost moderate Republicans like Grassley who showed good faith in reaching an earlier bipartisan compromise.</p>

<p>As I have repeatedly said on this blog, major health care reform is not possible unless it is bipartisan.</p>

<p>My simple definition of bipartisan reform is getting Chuck Grassley onside.</p>

<p>Ditching Grassley over SCHIP was a mistake and it does not bode well for bipartisan health care reform. This is the kind of dumb stuff the Clintons did in their failed 1993 unilateral health care reform effort.</p>

<p>To put it as simply as I can, no major reform of America’s health care system will pass without Chuck Grassley voting for it.</p>

Robert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog.

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8 replies »

  1. Brad,
    Good point. It is worse, and a lot of it is elite-driven; most public opinion has been pretty moderate and far more stable than rapidly polarizing elites. But will being nice to Republicans help remedy it? I would say no. Two reasons I am not convinced that Obama, or a design for a health care plan, can get us out of it:
    1. If we make the time series longer, this is reversion to a highly partisan country. The 1960s (approx.) were the high point of bipartisan comity in US history, and a lot of the reason was that the Democrats were split between the North and the South. Senior Southerners in Congress limited how far the Democrats could go left. Ideologically there were a good number of votes on which Republicans were between two wings of the Democrats (puts Rockefeller in perspective). Now that the South is essentially Republican, and the Democrats lead (House, Senate, pop vote) in the rest of the country, the regional and party differences reinforce each other- the rightward pull of the old South accelerates the Republican movement rather than counterbalancing leftish Democrats.
    2. The pattern since the 1980s in the public opinion shows in questions in which we ask voters to self-identify on a left-right scale and then ask them to place the parties. They have pretty consistently put the Democrats staying just left of the median voter- and the Republicans move farther right relative to the median voter in every survey. I think other evidence makes the same point- including the way independents, who normally split, broke for Obama and Democrats in 06 and 08. If this is the case, then bipartisanship only drags the Democrats to the right, something with no obvious benefit (the people who should reach out towards the center are the Republicans, if they want to hold any district not accessible by I-35 and I-40).
    So from a Democratic point of view, I would say that painting the Republicans into a corner and passing the legislation with only a little help would maximize the odds of both good legislation and Democrats reaping the rewards of their law. Bringing the Republicans in would probably just weaken or stop the legislation.
    From a Republican point of view, stopping serious health care access is crucial to preventing a realignment that will confine them to I-35 and the more stagnant bits of the South while refocusing donors in unpredictable ways.
    …hope this isn’t too much politics…
    Scott

  2. Scott
    I can think of a good reason for bipartisanship. Sharing blame or credit for success or failure is very important. The aftermath of anything done suboptimally now will linger and surely cause a repeat of history.
    Personally, I have had enough cyclical finger pointing, bickering, and venom. I would add that I am not being too idealistic. Those who study congress say that state of affairs for last 20 years IS really worse, and partisan divide is real. The last thing I want to see are power plays and “sticking it to the other side,” even if it means giving on a few things I am not happy about.
    Unilateral tactics should only be a pivot of last resort, and frankly, we are not there yet. My two cents.
    Brad

  3. “The belief amoung conservtives is a number of people who do not need assistance are taking advantage of minimial oversight to enroll kids in SCHIP instead of employer based plans and individual policies.”
    Seems easy enough, just ask parents for employer verification then work from there. We seem to do it for other programs – don’t we? I think the real belief amoung conservatives is this is the thin edge of the wedge to universal/single-pay – not a bad thing.

  4. The belief amoung conservtives is a number of people who do not need assistance are taking advantage of minimial oversight to enroll kids in SCHIP instead of employer based plans and individual policies.

  5. Your average kid is healthy and thus a good individual policy wouldn’t cost more then $100 per month. Enrolling kids who parents obviously have means to afford other coverage takes away from resources to cover those who do not.

  6. I like Grassley too, but why the worship of bipartisanship? There are only two structural reasons to seek a lot of Republican consensus: to get around/over a potential filibuster and to entrench the legislation so that a future change in government does not lead to its repeal. Both can be done without kowtowing to Republicans who are constructive only within narrow limits- the Senate had a filibuster when the Republicans ran it, too.
    As for immigrants, the focus groups are pretty clear. The people who invoke them are people who will never come around, and the rest of the population (incl. the overwhelming number of voters who need convincing). Grassley is a fairly sophisticated thinker but is not so far away from that. So while it is probably wise to think through some messaging in case the swing voters care more than we think, the idea that you can defeat opposition to health reform (especially from the contemporary Republican party) by giving them what they want on migration is a pipe dream.
    As for covering people who could potentially pay for health insurance, what is intrinsically wrong with that? The limited-resources argument is very poor. Our resources are limited in any one policy area because we limit them. We could go wild with SCHIP and it would still cost less than Medicare Part D, let alone the financial bailouts while having a much clearer positive effect on the economy.

  7. I haven’t had a chance to read the actual bill but I thought I heard it also watered down the verificaiton requirements. Depending on ideology it might not be an issue with some but a number of states are very lax in verifying income initially and even more so in following years. The belief amoung conservtives is a number of people who do not need assistance are taking advantage of minimial oversight to enroll kids in SCHIP instead of employer based plans and individual policies. Your average kid is healthy and thus a good individual policy wouldn’t cost more then $100 per month. Enrolling kids who parents obviously have means to afford other coverage takes away from resources to cover those who do not. If people are really concerned about covering kids you think they would want as much of the resources as possible going to those who really need it, I haven’t seen any inclination from Democrats like this at all. They seem to want to cover as many kids, legal or not, and even adults as possible with no regard for cost.

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