Support for Health Care Reform Gains Support from Left and Middle

Health care reform is likely to pass the House of Representatives as early as this weekend or beginning of next week. The vote will be close. The methodology may open questions concerning legitimacy. But health care reform is likely to pass.

Consider: Liberals are falling into line. Some may have assumed this was a given, but some on the left oppose President Barack Obama’s health care reform package for failing to go far enough. They want their single payer system or their public option and don’t want to settle for anything less. Unless, it seems, anything less is nothing at all.

That, at least, is the explanation Representative Dennis Kucinich gave today when he switched his position and announced he’d vote “yes” on the President’s health care reform bill. As Sabrina Eaton of the Cleveland Plain Dealer writes about her home town Congressman, Representative Kucinich “acknowledged this morning that his choice now is to either vote ‘no’ on principle, and thereby possibly block the biggest (though imperfect) advance in health coverage in decades, or compromise for the good of the estimated 30 million more Americans who could gain insurance.”

More evidence: the opinion shows on MSNBC. Virtually all of the talking heads in their liberal line-up speak of the need for Democrats to pass the current version of health care reform even though it lacks their beloved government-run health plan. Even former Governor Howard Dean, speaking to a pro-health care reform march in Washington DC last week, was arguing for the legislation he often criticized , proclaiming, “We deserve a vote! Are you for the insurance companies or are you for the American people?”

The left, in short, has fallen into place. Liberals will not kill health care reform.

But liberals alone will not pass health care reform, either. That feat requires the support of moderate Democrats. And while centrists may not be rushing to support the current health care reform, at least a few are stepping forward. Representative James Oberstar was among the moderate Democrats who were following Representative Bart Stupak in opposing the Obama Administration’s health care reform bill over abortion language. This group of 12 (now, presumably fewer) Democrats, were holding out for the more restrictive abortion language in the House’s version of health care reform. Representative Oberstar today announced he would support the President’s health care reform bill saying “On balance, it does what we need to do,” according to the Minnesota Independent. Another pro-life Democrat, Representative Dale Kildee, a close ally and friend of Representative Stupak also announced his support of the Administration’s health care legislation today. According to the New York Times, Representative Kildee said “he was satisfied that the provisions in the health care bill passed by the Senate would prevent the use of federal money for insurance coverage of abortions.”

The U.S. Conference of Catholic Bishops and anti-abortion groups like the National Right to Life Committee have been the driving force behind the more restrictive abortion language included in the House bill.  As reported by McClatchy Newspapers, the Bishops believe the Senate abortion language would “open the door to federal financing” of the procedure. But today a group of 60 nuns, leaders of orders comprised of 59,000 Catholic nuns sent a letter to House members urging them to pass the Senate health care reform bill. According to the Associated Press. in their letter, the nuns claim that “despite false claims to the contrary, the Senate bill will not provide taxpayer funding for elective abortions.”

Whether the split between bishops and nuns will be enough turn all of Representative Stupak’s faction into supporters of health care reform is unlikely. But as Katie Connolly notes in her post on the Newsweek magazine, “Having high-profile support from a key Catholic group nudges fence-sitters in (the Stupak) group toward a yes vote. At the very least the (nuns) letter damages the validity of Stupak’s argument.

(What’s ironic about the fight over how health care reform addresses abortion is that, as a practical matter, both the House and Senate versions of health care reform are victories for anti-abortion advocates.)

Passage of health care reform is not a done deal. Momentum is not victory. Patrick O’connor of Politico.com provides an excellent summary of the challenge Speaker Nancy Pelosi faces in assembling 216 votes to in support of health care reform. And even if the bill passes in the House of Representatives, who really knows what will happen in the Senate? Given the twists and turns of our story so far, anything could happen.

But with liberals falling in line and moderates slowly coming to support President Obama’s health care reform package, passage is certainly more likely today than it was yesterday. For those who consider this the ruin of American ideals, the end of quality health care in this country and the demise of the health insurance industry, my advice is to take a deep breath.

There’s thousands of regulations yet to come. There’s plenty of opportunity for Congress to tweak the reforms for the better. And there’s always the adaptability of American business. Somehow these things have a way of working out. Careers continue. The country endures. Health care reform, 2010 style, is unlikely to be any different.

Pointed Questions for WellPoint

On February 24th WellPoint CEO Angela Brady will appear before the House Energy & Commerce Committee. She will attempt to explain why the company’s California operating unit, Anthem Blue Cross of California, recently sought to raise rates on some individual policy holders upward of 39 percent. While the effective date of the rate increase was postponed, the hearing is not. And that it is being held the day before President Barack Obama’s bi-partisan health care reform summit with Congressional leaders is no coincidence. The Administration and others have pointed to the rate increase as one of the reasons comprehensive health care reform – or at least health insurance reform – is needed.

In preparation for the hearing, House & Energy Committee Chair Henry Waxman and Subcommittee on Oversight and Investigations Chair Bart Stupak sent a letter to Ms. Braly asking for background information. The information ranges from the general (“reasons for the premium rate increase”) to the specific (for 2005-2008, “a table listing, as applicable, premium revenue, claims payments, sales expenses, other general or administrative expenses, and profits for all individual health insurance products”) to what some might call a fishing expedition “all internal communications, including e-mail, to or from senior corporate management relating to the company’s decision to increase premium rates in California in the individual health insurance market.”)

The hearing will be closely watched, not only by lawmakers but by WellPoint’s competitors. It could provide an interesting glimpse into the rate making process employed by health insurance carriers. The information will certainly be cited by advocates – and opponents – of requiring carriers to spend a certain percentage of the premiums they take in on medical claims as opposed to administrative expenses and profits.

Ms. Braly’s testimony will also likely highlight the different ways politicians and business people view the same data. What to a member of Congress may look like profiteering could look to an executive like a prudent hedge against unknown risk.

The Associated Press has taken a balanced approach to explaining the issues behind the Anthem Blue Cross of California rate increase. The analysis is worthwhile reading for anyone following this particular controversy. Among its conclusions: rising medical costs are the main driver of rate hikes, not profits; health insurance rate regulations vary considerably from state-to-state; non-profit health plans also have large rate increases; carriers can’t, and probably shouldn’t, subsidize rates for one business line in one state with profits earned by other lines of business, especially in other states; and that there’s a lot of elements taken into consideration by carriers when they set their rates. While there’s little specifics many insurance professionals don’t already know (other than the make-up of WellPoint’s profits), it’s a very useful summary and analysis of the issues.

The timing of Anthem Blue Cross of California’s rate increase is generally perceived as constituting political malpractice. But there may be a silver lining. Ms. Braly has an opportunity to educate lawmakers on how and why carriers charge the health insurance premiums they do. If members of the Energy & Commerce Committee are willing to look beyond the politics of the rate increase, they might gain a better understanding of how health insurance works in this country.