"Son of Chafee" Health Reform Bill May Be Most Likely Outcome

The choice of Paul Kirk (D) to temporarily fill the vacant Senate seat in Massachusetts was a first-rate move by Gov. Deval Patrick (D). Kirk has done a first-rate, bipartisan job with Frank Fahrenkopf on the Commission on Presidential Debates, and he did a terrific job with the Profile in Courage awards, especially the gutsy choice of Gerald Ford for his pardon of Richard Nixon. Kirk is smart, savvy, civil and seasoned, just what one would want for a temporary appointment.

Kirk arrives just in time for the pivotal stages of health reform. The Senate Finance Committee remains the central forum. For all the criticism Chairman Max Baucus (D-Mont.) has taken for his draft bill, it is the template for the likely reform plan, its structure all but endorsed by President Barack Obama in his speech to the joint session. The basic components--universal mandated coverage, subsidies for poorer Americans, health insurance exchanges to have competitive, regulated plans that offer minimum plans and others, a requirement that most employers subsidize coverage even if they don't offer insurance to their workers--are sound building blocks, within a reasonably fiscally disciplined frame.

That basic structure has a lot in common with the Massachusetts health plan--call it "nephew of Romneycare." The Baucus plan has even more in common with the alternative offered in 1994 by Republican Sen. John Chafee (R.I.)--call it "son of Chafee."

Take the Baucus template and make it better, in major part by adding nearly all of the amendments offered by Sen. Olympia Snowe (R-Maine).

So the fact that the basic template of reform could pass for a moderate Republican alternative, and has not a single Republican supporter, says all we need to know about the dysfunction in the political system, and especially in the minority party. Well, maybe not all we need to know. Take the juxtaposition of statements made over the past month by Sen. Chuck Grassley (R-Iowa), as pointed out by one of the sharpest analysts we have of the health care reform debate, Ezra Klein of the Washington Post:

"Quote one: As recently as a month ago, Chuck Grassley . . . announced that the way to get universal coverage is 'through an individual mandate.' He told Nightly Business report, 'That's individual responsibility, and even Republicans believe in individual responsibility.' Earlier this year, Grassley told Fox News that there wasn't 'anything wrong' with mandates, even if some may view them 'as an infringement upon individual freedom.'"

"Quote two: Iowa Sen. Charles Grassley, the Finance Committee's senior Republican, said the mandate is among the reasons that he couldn't support the bill despite months of negotiations with Mr. Baucus. 'Individuals should maintain their freedom to chose health-care coverage, or not,' he said."

Did Grassley have a sudden conversion on the subject? Of course not. Under severe pressure from his leaders, and facing the threat of a well-financed Club for Growth challenge from the right in a primary, Grassley is grasping for reasons to oppose a bill into which he had tremendous input and that, under "normal" circumstances, he would be supporting.

There are other reasons Grassley and other Finance Committee Republicans are leery of supporting the Baucus plan. They are worried, legitimately, about a "bait and switch," where a moderate bill passes the Senate, and then every reasonable provision they have added gets taken out in a conference committee, with the final take-it-or-leave-it conference report veering off into the unacceptable left.

The fear is legitimate because it is just what the Republicans did to the late Sen. Edward Kennedy (D-Mass.) and the Democrats with the Medicare prescription drug bill. A bipartisan effort in the Senate passed with 76 votes, but the conference process, with Baucus participating, excluded Finance Committee Democrats Tom Daschle (S.D.) and Jay Rockefeller (W.Va.) and stripped the Senate bill bare; the final package barely garnered a majority in the Senate.

But that is not the main impetus for GOP opposition. The desire to keep any bill from passing, to deny Obama a victory, remains the dominant motivation. It has been taken to an absurd level; GOP Chairman Michael Steele's "Medicare Bill of Rights" puts the Republican Party in support of every dollar spent on Medicare now and into the future. What a message for a party of fiscal discipline!

What to do? The path here seems clear. Take the Baucus template and make it better, in major part by adding nearly all of the amendments offered by Sen. Olympia Snowe (R-Maine). Klein has done an excellent job of analyzing Snowe's almost uniformly beneficial options. They expand the affordability of insurance on the exchanges for low-income workers; add significantly the number of small businesses given immediate access to the exchanges; put reasonable limits on employer-plan deductibles; effectively open the insurance exchanges to all employers from the get-go; and provide additional funding to the states to enroll people in Medicaid who are currently eligible but not enrolled.

All are very constructive. So is the Snowe concept of a trigger, to allow a public plan in geographical areas where there is no real insurance competition. So would be an amendment to toughen up the Fed-like board to keep health spending in line and set best medical practices.

Adding the Snowe amendments, then, is not just a pragmatic political ploy to get a Republican vote--it is a way to make a bill much better. If Snowe endorses it, there is a better than even chance that Sen. Susan Collins (R-Maine) will follow. (I would not want to explain to Mainers why I oppose a bill Snowe spent hundreds of hours working on, improving and supporting.) Then, Senate Democrats can either afford to lose two of their own or can try very hard to get united support to treat a cloture vote as a procedural vote, untied to a vote on passage of a bill.

Of course, if all of this works, there is still the hurdle of a conference, and the need by the White House and the Speaker to keep liberal House Democrats from revolting.

If I had my druthers, I would cut to the chase and go for the Healthy Americans Act, the comprehensive, cost-effective and sensible approach to health reform that was the brainchild of Sen. Ron Wyden (D-Ore.) and has substantial bipartisan support in both the House and Senate. Beyond its substantive strength, I would love to see it come up for a vote--and see if the Republicans who have co-sponsored or endorsed it would actually vote for it. But absent that, there is a path to significant reform, and not a bad one at that.

Norman J. Ornstein is a resident scholar at AEI.

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