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Sleazy moves in health reform buy off senator

by Michael Gerson - Dec. 22, 2009 12:00 AM

Washington Post Writers Group

Sometimes there is a fine ethical line between legislative maneuvering and bribery. At other times, that line is crossed by a speeding, honking tractor-trailer, with outlines of shapely women on mud flaps bouncing as it rumbles past.

Such was the case in the final hours of Senate Majority Leader Harry Reid's successful attempt to get cloture on health-care reform. Sen. Ben Nelson of Nebraska, the last Democratic holdout, was offered and accepted a permanent exemption from his state's share of Medicaid expansion, amounting to $100 million over 10 years.

Afterward, Reid was unapologetic. "You'll find," he said, "a number of states that are treated differently than other states. That's what legislating is all about."

But legislating, presumably, is also about giving public reasons for the expenditure of public funds. Are Cornhuskers particularly sickly and fragile? Is there a malaria outbreak in Grand Island? Ebola detected in Lincoln?

Reid didn't even attempt to offer a reason why Medicaid in Nebraska should be treated differently from, say, Medicaid across the Missouri River in Iowa. The majority leader bought a vote with someone else's money. Does this conclusion sound harsh? Listen to Sen. Lindsey Graham of South Carolina, who accused the Senate leadership and the administration of "backroom deals that amount to bribes," and "seedy Chicago politics" that "personifies the worst of Washington."

This special deal for Nebraska raises an immediate question: Why doesn't every Democratic senator demand the same treatment for their state?

Eventually, they will. After the Nelson deal was announced, Sen. Tom Harkin of Iowa enthused, "When you look at it, I thought well, God, good, it is going to be the impetus for all the states to stay at 100 percent (coverage by the federal government). So he might have done all of us a favor." In a single concession, Reid undermined the theory of Medicaid - designed as a shared burden between states and the federal government - and added to future federal deficits.

Unless this little sweetener is stripped from the final bill by a House-Senate conference committee in January, leaving Nelson with a choice. He could enrage his party by blocking reform for the sake of $100 million - making the narrowness of his interests clear to everyone. Or he could give in - looking not only venal but foolish.

How did Nelson gain such leverage in the legislative process in the first place? Because many assumed that his objections to abortion coverage in the health bill were serious - not a cover, but a conviction.

Nelson, a rare pro-life Democrat, insisted in an interview he would not be a "cheap date." Republican leadership staffers in the Senate thought he might insist on language in the health-care bill preventing public funds from going to insurance plans that cover abortion on demand, as Democratic Rep. Bart Stupak had done in the House.

Instead, Nelson caved. The "compromise" he accepted allows states to prohibit the coverage of elective abortions in their own insurance exchanges. Which means that Nebraska taxpayers may not be forced to subsidize insurance plans that cover abortions in Nebraska. But they will certainly be required to subsidize such plans in California, New York and many other states.

In the end, Nelson not only surrendered his own beliefs, he betrayed the principle of the Hyde Amendment, which since 1976 has prevented the coverage of elective abortion in federally funded insurance. Nelson not only violated his own pro-life convictions, he may force millions of Americans to violate theirs as well.

I can respect those who are pro-life out of conviction, and those who are pro-choice out of conviction. It is more difficult to respect politicians willing to use their deepest beliefs - and the deepest beliefs of others - as bargaining chips.

In a single evening, Nelson managed to undermine the logic of Medicaid, abandon three decades of protections under the Hyde Amendment and increase the public stock of cynicism. For what? For the sake of legislation that greatly expands a health entitlement without reforming the health system; that siphons hundreds of billions of dollars out of Medicare, instead of using that money to reform Medicare itself; that imposes seven taxes on Americans making less than $250,000 a year, in direct violation of a presidential pledge; that employs Enron-style accounting methods to inflate future cost savings; that pretends to tame the insurance companies while making insurance companies the largest beneficiaries of reform.

And, yes, for $100 million. It is the cheap-date equivalent of Taco Bell.

The way government works is "I will vote for YOUR pork if you vote for MY pork". And that is how the health care bill is being passed. All of the Senators and Congressmen get a cut of the pork and the American public gets screwed and pays the bill!

"I don't know if there's a senator that doesn't have something in this bill that was important to them" Reid said

Source

Health care bill clears 2nd Senate hurdle Tues.

Posted 12/22/2009 9:09 AM ET

WASHINGTON (AP) — Two down and one to go. The health care bill has passed another 60-vote test in the Senate. Democrats remained united as they started voting at sunrise Tuesday, pushing toward their goal of passing President Barack Obama's health care overhaul by Christmas.

With not a vote to spare, the Senate voted 60-39 to shut off debate on Majority Leader Harry Reid's version of the bill. An earlier vote to approve a 400-page package of changes that sealed Democratic support for the health care bill also passed 60-39, though only a simple majority was required. No Republicans voted in favor.

With partisan feelings running high, Reid appealed to senators to forgo personal attacks. Democrats must pass another 60-vote test Wednesday before they vote on final passage, expected to come on Christmas Eve.

THIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP's earlier story is below.

WASHINGTON (AP) -- Exhausted but happy Democratic leaders began nudging their painstakingly crafted health care compromise a step closer to pre-Christmas passage with three votes that started as the sun rose Tuesday.

Only one requires the difficult tally of 60 senators, and the outcome of that vote -- to overcome GOP opposition to the sweeping legislation -- is preordained. Majority Leader Harry Reid, D-Nev., has herded 58 Democrats and two independents into line through a combination of wheedling, cajoling and dispensing special deals. The strategy has Republicans irate.

"That's not change you can believe in. That's sleazy," Sen. Lindsey Graham, R-S.C., told NBC's "Today" show Tuesday, just before the voting began.

Reid makes no apologies.

"I don't know if there's a senator that doesn't have something in this bill that was important to them, and if they don't have something in it important to them, then it doesn't speak well of them," Reid said Monday.

Graham cited the example of $100 million in the legislation to pay the full cost of a Medicaid expansion in Nebraska -- home to Democratic Sen. Ben Nelson, the crucial 60th vote for the bill. Another concession, sought by Sen. Bill Nelson, D-Fla., exempts roughly 800,000 seniors in Florida from potential benefit cuts by private Medicare Advantage plans.

The 10-year, nearly $1 trillion plan would extend coverage to some 30 million uninsured Americans, with a new requirement for almost everyone to purchase insurance. Subsidies would be provided to help lower-income people do so, and businesses would be encouraged to cover their employees through a combination of tax breaks and penalties.

Unpopular insurance company practices such as denying coverage to people with existing health conditions would be banned. Uninsured or self-employed Americans would have a new way to buy health insurance, via marketplaces called exchanges where private insurers would sell health plans required to meet certain minimum standards.

The legislation will make a "tremendous difference for families, for seniors, for businesses and for the country as a whole," Obama said Monday.

The American Medical Association announced its endorsement after Reid made some last-minute changes to please the doctors. A 5 percent tax on elective cosmetic surgery procedures was replaced with a 10 percent tax on indoor tanning services; a proposed fee on physicians to enroll in Medicare was dropped; and payment cuts to specialty and other physicians to pay for bonuses to primary care doctors in underserved areas were also eliminated, said the AMA's president-elect, Dr. Cecil B. Wilson.

"America has the best health care in the world -- if you can get it," Wilson said at a press conference with Reid and other leaders. "For far too many people access to care is out of reach because they lack insurance. This is not acceptable to physicians."

Democrats prevailed 60-40 over Republican opposition on the first test early Monday, voting to block a threatened GOP filibuster of a last-minute package of Democratic amendments. Tuesday morning a simple majority will be required to approve the amendments, and then 60 votes to move to consideration of Reid's bill.

A final 60-vote hurdle awaits Wednesday, and final passage of the legislation -- requiring a simple majority -- is set for late Thursday, Christmas Eve, if Republicans take all the available time. As of Monday they said they would.

"I am willing to stay here. The flight that I have is Christmas morning, and I don't plan on changing that reservation," Sen. Bob Corker, R-Tenn., told reporters after a meeting of GOP senators. "We potentially are getting ready to pass a bill that there's no question in my mind is going to lead to huge deficits down the road."

The Senate measure would still have to be harmonized with health care legislation passed by the House before a final bill could go to Obama.