JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill. Today, a conversation about President Obama’s speech before Congress last night where he outlined his vision of health care reform. Joining me, as always, Mary Agnes Carey of Kaiser Health News and Eric Pianin, also of Kaiser Health News. Welcome to you both. General impressions, first, Eric?
ERIC PIANIN: Well, I thought that the President had a big challenge awaiting him when he reached The Hill last night, which was basically to call the Democratic troops to action and to in a sense reaffirm what the Democrats' goals and mission was in trying to recast health care reform this year.
Well, I thought that the President had a big challenge awaiting him when he reached The Hill last night, which was basically to call the Democratic troops to action and to in a sense reaffirm what the Democrats' goals and mission was in trying to recast health care reform this year.
I think that in a lot of ways he achieved both goals. I mean, I think he gave a very clear explanation of what he saw as the essence of health care reform but he also pushed back a little on his critics who had been beating up on him pretty well, very honest.
JACKIE JUDD: He said I am going to call you out.
ERIC PIANIN: He said he will call out his critics when they misrepresent what he’s suggesting and also he made it clear he really didn’t want to talk to people whose mission or calculation was to bring down the health care reform plan.
But he also showed a flexibility that I think was probably important in dealing with conservative Democrats and moderate Republicans in trying to fashion some kind of a compromise.
JACKIE JUDD: Mary Agnes?
MARY AGNES CAREY: I think he also spoke very powerfully to the voters. He talked about he wanted to reassure the people especially who have their health insurance; you will get more security and stability with his ideas. He talked a lot about his proposals for a plan, but I thought he was masterful in pointing out these examples of people who had their health care delayed and their health conditions worsened or may have even died because of a concern about health insurance, whether or not they were covered.
I think he really tried to put in the technical elements to appeal to Congress to say look, I want a bill that has an individual mandate, an employer mandate. He got that price tag out there of $900 billion. He tried to lay out the parameters to guide the members of Congress on what he expects to see in a bill, but I think he really tried to appeal to the American public.
JACKIE JUDD: Including older voters.
MARY AGNES CAREY: Exactly, he said to Medicare, you know, you are not going to be hurt.
JACKIE JUDD: Looked into the camera for a moment.
MARY AGNES CAREY: Exactly. He appealed to them. He talked about to people what are we in America? Is this the kind of country where people who if you don’t have health insurance shouldn’t get health care? I mean, I think that is what he was trying to say and he knows with the bad economy, a lot of people have lost their jobs. A lot of people have lost their health care. He said it could happen to anyone.
JACKIE JUDD: And I should mention, just this morning the census bureau came out with its uninsured figures. In 2007, it was 45.7 million Americans. Last year, it was 46.3 million Americans, a change of 600,000 and even that doesn’t reflect the depths of the recession.
MARY AGNES CAREY: Right. That is a 2008 number. It is a snapshot were you insured at some point during the year? I think proponents for reform will say this is a slight increase but it has only gotten worse with the recession. It’s only gotten worse through 2009 and that will put additional pressure on lawmakers to step up and drag aside what type of health care reform they want to pass this year, if in fact it happens.
JACKIE JUDD: And you mentioned, Eric, the point of flexibility. The President, in particular, showed flexibility when he was describing the possibility of a public option; walk us through that.
ERIC PIANIN: Well, I think he did. I think he sited several areas where he would show some flexibility or at least reflecting the concern of his critics. One would be on spending.
If the plan got out of control, the spending got out of control; he would consider going back and making additional spending cuts toward reform. This is an area the Republicans are very concerned about. They think a lot of money could be saved if you could limit the size of settlements against doctors but finally, probably the most important issue, which is whether or not to include a public insurance option in this bill, he made it clear.
First of all, he is in support of that, and that was an important message to get across to liberal democrats and he got some cheers for that. But he also pointed out that it was not the end all and be all of health care reform, and that it was an important vehicle but there were other options too that he was willing to look at.
So, he even sort of gave a nod to Olympia Snowe, the Republican Senator from Maine, who is talking about some kind of a trigger mechanism that would essentially hold the public option in abeyance, give the insurance industry several years to show that it intended to carry out all the reforms it has been talking about and make affordable insurance available to the millions of Americans who don’t have it now. And then if they don’t achieve those goals, then you step in with this public option.
JACKIE JUDD: I guess all lawmakers are not created equal, and there is a lot of reporting today including your own that part of the reason he phrased it this way was to attract Senator Olympia Snowe. Why has she become such an important vote in this?
MARY AGNES CAREY: Because there is great interest in getting Republican support. It doesn’t seem like it’s going to happen in the House. The hope is that it will happen in the Senate. But there may also be some difficulty in some more liberal Democrats who may be very upset if in fact the final bill does not have a public option, so he may need Republicans for that as well, but they really want to get bipartisan support.
They want to attract Republicans. If Olympia Snowe votes for this, that may mean some other Republicans come along which is a goal for Democrats definitely in the Senate, for President Obama to have Republican support.
Let’s remember if in fact health reform passes, it is going to be tough to get it passed, but then you have got to implement it. And the more bipartisan support you have, the better that is in the years ahead to confront issues, which will happen with implementation as they always do, especially for anything that would surround health care reform which would be, it’s a very sweeping issue, a very emotional issue.
And as they implement the Bill, you want to be able to say to a Republican, you supported it, help us with this issue, let’s examine a way to fix this, whatever, so I think that is another reason why they want Republicans on board.
ERIC PIANIN: It was interesting to watch the scene on the floor last night and like who was sitting next to whom and I noticed that Olympia Snowe and Orrin Hatch were seated next to each other. And, I think that is kind of significant. Orrin Hatch was one of those republicans that the Administration was sort of counting on to possibly work out some kind of a compromise.
JACKIE JUDD: And a close friend of Ted Kennedy.
ERIC PIANIN: And a very close friend of Ted Kennedy and he had worked with Kennedy on previous legislation in a bipartisan way. Orrin Hatch got frustrated or turned off by the whole process and basically pulled out of the negotiations. Olympia Snowe has stayed in, and she is sort of staying the course and she is probably the Administration’s best hope for getting some element of bipartisanship into legislation coming out of the Senate.
JACKIE JUDD: I want to stay on this idea of a potential trigger for one more moment. Both of you spoke with analysts outside of Capitol Hill about the upsides and the downsides of a trigger, what are they?
MARY AGNES CAREY: Well, no one is really a huge fan of it. I mean, if you are a fan of the public option, you want that option available right away to everyone to provide choice. If you are an opponent of it, you don’t want it to happen in any way, shape or form and there was one.
Some analyst expressed concern to me that let’s say for example that the trigger was activated and the public option was put into a market, how does that shape the market in the future? Could the government leave? Could they not leave? What does that mean? There may be some ramifications.
There is also a concern about this issue of affordability. There may be elements, there are proposals in both bills that in the mind of the insurance industry will increase the cost of insurance and so if insurance is more expensive the affordability threshold is higher to reach, therefore the public option could be triggered sooner rather than later.
So there are a lot of concerns about the implementation, of course the details on this can change. It is not really clear yet how it would go into the Bill, if it goes into the Bill, but there is definite concern about government involvement in providing health insurance.
ERIC PIANIN: Right. And proponents of the public option say that for it to be effective, it ought to be put into effect right away, you know, at the front-end, not at sort of the back-end of the process.
JACKIE JUDD: A final question for you both. Both of you have covered Capitol Hill for so many years now, do you view last night’s speech the morning after as a game changer?
MARY AGNES CAREY: I think it is in the sense of the passion the President brought to it. He has made it clear I want this done. This is the time to deliver. He repeated several lines along those lines that Congress, this is why you are here. This is what people expect from you.
But, a wonderful, powerful speech as good as it is doesn’t substitute for the hard work of counting those votes, knowing where the support is and where it isn’t. And I think that it has certainly given a lot of motivation to people to look at this again, to get this back on track after the August recess.
We have talked a lot about these Town Hall meetings and a lot of things where people felt Democrats and the President lost the momentum. I think he is back on top now with this but we will have to see how it plays out because it is going to be a pretty tough fall.
JACKIE JUDD: Final word?
ERIC PIANIN: I think there was a sense of things spinning out of control over the summer in that the Democratic approach lacked certain focus or coherence. There were too many things going on and too many different venues, too many different proposals.
JACKIE JUDD: And not enough direction from the White House?
ERIC PIANIN: Not enough direction from the White House and made it easy for critics to cherry pick issues that they wanted to go after and ignore others. I think what the President did last night was to step up to the plate, once again give a very coherent description and explanation of what it is he and the Democrats are attempting to achieve, and basically putting a lot of pressure on Democratic leaders now to get back to work, to get these Bills acted on this fall.
Vice President Biden was on television this morning saying he thinks that maybe by Thanksgiving there will be legislation. But anyway, it is sort of giving people a little kick in the pants and telling them to get going.
JACKIE JUDD: Okay. Thank you. Thank you both, Eric Pianin, Mary Agnes Carey. I’m Jackie Judd and thank you for joining us.