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You are here: Home / Anderson On Health Insurance / The Senate, the 2020 Democratic Primary and health plans

The Senate, the 2020 Democratic Primary and health plans

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This is just a reminder.

Democratic candidates for President will be releasing quite a few health policy plans now and over the next several months. Those plans will be some variant of Medicare for All or pothole fillers for the ACA or somewhere in between. Some of them will be technically good in the sense that they have a clearly defined logic model that explains where we are, where they want to go and how to get there. They won’t invoke magic. Other plans are fantasies and feel good signifiers that would fall apart at the first touch of legislative text in a universe with seventy five willing Senators and 290 willing members in the House.

All of that is important. I like candidates who don’t invoke magic to explain how they intend to achieve their policy ends.

One of the critical things to remember though is that these plans don’t matter too much. The critical combination (as always) is 218-51-1-5 in 218 votes in the House (including the Speaker willing to schedule the vote), 51 in the Senate (including the Majority Leader willing to schedule the vote) a President to sign the law and 5 votes on the Supreme Court to interpret the law against highly probable challenges.

Under one branch of highly plausible scenarios, the winning coalition of 51 votes in the Senate will have Senator Manchin (D-WV) as a key member of the winning coalition on any health insurance reform bill. Under another branch of plausible scenarios, the marginal Senate vote is either Senator Collins (R-ME) or Senator Murkowski (R-AK).

Keep that in mind as you evaluate plans.

I think that the process of planning reveals quite a bit about candidates and their ability to be an executive even if there is a significant probability that anything that they propose won’t ever pass as initially proposed.

So remember the Senate as we listen to campaign promises.

Reader Interactions

17Comments

  2. 2.

    waratah

    What happens if we are able to have the majority house and senate next election.
    With a Democratic President.

  3. 3.

    wvng

    David, this point is critical: “Under one branch of highly plausible scenarios, the winning coalition of 51 votes in the Senate will have Senator Manchin (D-WV) as a key member of the winning coalition…” Democrats will always be constrained by the limits blue dogs place on policy, even when they have a substantial majority. And the only way Dems get that majority is by running conservative Democrats in red states and winning those seats. That has been the case since Johnson passed the Civil Rights Act and lost the South for, as it turns out, much more than a generation. Blue dogs constrained every piece of legislation Obama was able to pass while Dems held both houses, and they will continue to do so in the future because leadership has no leverage over them.

  4. 4.

    Another Scott

    “218-51-1-5”

    Yup.

    It’s great to want more liberal representatives, and we should do what we can so that they win, but in order to get things done one has to have the majority and the votes. It sucks sometimes, but that’s the way it is. As long as Manchin votes for a Democratic Majority Leader, and as long as the Senate is closely divided, he’s a plus in WV.

    Incremental progress is the way forward, even if we tear our hair out at how slow progress is…

    Cheers,
    Scott.

  5. 5.

    germy

    On Wednesday, Rep. Pramila Jayapal (D-Wash.) will introduce “The Medicare-For-All Act of 2019,” a comprehensive bill with over 100 cosponsors that is set to become the new Democratic House’s main pitch for how a single-payer health system might work.

    The bill draws inspiration from Sen. Bernie Sanders (I-Vt.) 2017 “Medicare For All” proposal and a House bill championed by former Rep. John Conyers (D-Mich.). But Jayapal’s plan goes much further than those past bills and includes a more robust set of benefit categories than traditional Medicare. Her bill adds vision, dental, mental health, and women’s reproductive benefits; coverage for long-term care, with a bias toward home-based care; and an elimination of all co-pays and deductibles. And this new form of Medicare would be available to everyone in the country within two years of the bill becoming law, doubling the transition speed of Sanders’ bill, which envisioned a four-year rollout. Staffers who worked on the bill say that they sped up the timeframe in order to hasten people away from private insurance companies that may decrease the level of service for customers when they know they’re about to head out of business.

    More than 100 Democrats have signed onto the bill—a third of whom are not members of the Congressional Progressive Caucus, the most liberal corner of the House that Jayapal co-chairs. And unlike past single-payer proposals, Jayapal managed to recruit a bevy of outside support from liberal organizations who hadn’t backed past Medicare for All bills to help boost the measure, ranging from labor unions like SEIU to Indivisible.

    https://www.motherjones.com/politics/2019/02/pramila-jayapal-medicare-for-all-health-care-congress-single-payer-progressive-caucus/

  6. 6.

    Major Major Major Major

    I think that the process of planning reveals quite a bit about candidates and their ability to be an executive even if there is a significant probability that anything that they propose won’t ever pass as initially proposed.

    This is mostly why I’m looking for proposals with at least a little more substance than unicorn farts. Not just for healthcare, but healthcare is a useful yardstick precisely because it’s so prone to unicorn-fartery. The same can be said for how the candidates assuage concerns about taxes and insurance plan disruptions.

  7. 7.

    Betty

    I was told on Twitter that I was wrong to describe Murkowski as a Republican. Can you explain her position? Thanks.

  8. 8.

    Shantanu Saha

    I like candidates who don’t invoke magic to explain how they intend to achieve their policy ends.

    So, not Wilmer, then.

  9. 9.

    Shantanu Saha

    @wvng: This is why pork was good, and why the loss of it was a net minus for our politics. Say what you want about Robert Byrd, but the enormous amount of pork that he brought home to West Virginia greased lots of liberal legislation.

  10. 10.

    Ryan

    “Under another branch of plausible scenarios, the marginal Senate vote is either Senator Collins (R-ME) or Senator Murkowski (R-AK).”

    Or, possibly, not Collins!

  11. 11.

    Uncle Ebeneezer

    Wait it sounds like you are suggesting that the actual make-up of Congress directly effects what can/can't be passed?? Unpossible!! The truth is whatever we get/don't get, we all know it will be because Neoliberal Demon-crats didn't. Even. Try.

  13. 13.

    wvng

    @Shantanu Saha: The end of earmarks was a terrible mistake. They had been made transparent, and that should have been plenty for anyone interested in good government. Legislators need to be able to bring stuff home.

  14. 14.

    Fair Economist

    @Betty: You are correct. Murkowski originally got to the Senate as a Republican. In 2010 Murkowski ran and won as an independent, but in 2016 she ran and won as a Republican again. Even when she was “independent” she caucused with the Republicans and very rarely broke with them.

    She is the most independent Republican (low bar though) but she is absolutely a Republican, both officially and practically.

  15. 15.

    daveNYC

    Are you saying that I should evaluate candidates’ health care plans on the basis of what will get Manchin’s vote? Because I don’t think anyone has proposed a plan that mandates charging $10,000 for an EpiPen.

    Evaluating candidate’s policies with a hypothetical Republican Senate is an even greater waste of time.

  17. 17.

    David Anderson

    @daveNYC: I am saying temper expectations and use the plan creation and dissemination process as a way to evaluate how a candidate/campaign makes decisions and choices. Anything that emerges from the Senate where Manchin is near the median vote will be significantly disappointing to the median Democratic primary voter. So use the process as information

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