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You are here: Home / Anderson On Health Insurance / Reconciliation sausage making is almost done

Reconciliation sausage making is almost done

by David Anderson|  August 5, 20228:00 am| 73 Comments

This post is in: Anderson On Health Insurance

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The fragments of Build Back Better are about to get a vote this weekend. It looks like the package has agreement from all 50 Democratic Senators at the moment now that the final component of the sausage making process had some things adds and some things removed.

NEW: DEMOCRATS REACH DEAL WITH SINEMA ON TAXES.

“We have agreed to remove the carried interest tax provision, protect advanced manufacturing, and boost our clean energy economy in the Senate’s budget reconciliation legislation.” She will move forward after parl review.

— Tony Romm (@TonyRomm) August 5, 2022

The big health policy things in here are:

  • Three year extension of ACA ARPA subsidies
  • Significant redesign of the Medicare Part D benefit to create an actual catastrophic out of pocket cap and insurance protection
  • Big drug pricing changes

There are a bunch of tax provisions that I have no ability to judge and a lot of environmental and climate provisions that the experts who follow these things are saying are necessary and useful.

 

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Reader Interactions

73Comments

  1. 1.

    MattF

    August 5, 2022 at 8:41 am

    I think both Manchin and Sinema have changed their minds about the mid-term electoral outlook. And, if you’ve changed your mind, and now  think Dem chances have improved, it makes perfect sense to do what you can to reinforce that improvement.

  2. 2.

    Geminid

    August 5, 2022 at 8:42 am

    I had thought that the Senate Parliamentarian had signed off on the bill, but Politico Playbook has a fairly long entry this morning about how Republican and Democratic staffers will be conferring with the parliamentarian today as to whether various provisions meet the standards of the Reconciliation rule. This might only regard new provisions added yesterday.

    The process is known as the “Byrd bath,” and is named after Senator Robert Byrd of West Virginia, who crafted the Reconciliation rule.

  3. 3.

    Ken

    August 5, 2022 at 8:42 am

    It’s so typical of the Democrats that they tackle climate change, drug pricing, the deficit, healthcare subsidies, and a dozen other things all at once. They need to take a lesson from the Republicans and learn how to focus. Just pick one important issue, like tax cuts, and do nothing else.

  4. 4.

    eclare

    August 5, 2022 at 8:44 am

    If this gets passed, which seems likely, it creates huge momentum going into midterms.

  5. 5.

    Ken

    August 5, 2022 at 8:45 am

    @MattF: I think both Manchin and Sinema have changed their minds about the mid-term electoral outlook.

    Thank you, Mr. Oz, Mr. Walker, Mr. Vance, and others, for your campaigning skills. And of course a big thank-you* to the stable genius who selected all these fine candidates.

    * Or some phrase matching “*k-you”.

  6. 6.

    David Anderson

    August 5, 2022 at 8:48 am

    @Ken: The challenge is that under current Senate rules where regular order is a 60 vote threshold, there is no more than 3 and usually 1 or 2  chances a year to get things passed with 51 votes so anything that can get 51 votes and meets reconciliation rules gets stuffed into one of those very limited vehicles.

  7. 7.

    OzarkHillbilly

    August 5, 2022 at 8:49 am

    @Ken: You left out Alito, Thomas, Gorsuch, Kavanaugh, and Barret.

  8. 8.

    Geminid

    August 5, 2022 at 8:50 am

    @Ken: With the existing rules in the Senate, measures that Democrats can’t pass otherwise have to be aggregated in a single Reconciliation package. Under the Reconciliation rule major legislation can pass with the 50 vote Democratic majority, plus the vote of Vice President Harris to break a tie. That is how the many disparate elements of the American Recovery Act were passed in the early weeks of this Congress.

  9. 9.

    Ken

    August 5, 2022 at 8:54 am

    @OzarkHillbilly: Please. They are members of the judicial branch, a wholly-impartial, “balls-and-strikes” branch of government whose actions cannot possibly have any impact on mere political matters.

  10. 10.

    prostratedragon

    August 5, 2022 at 8:57 am

    @Ken:  Wildcards are so powerful, aren’t they?

  11. 11.

    OzarkHillbilly

    August 5, 2022 at 9:02 am

    @Ken: DOH! You’re right of course. How silly of me to forget.

  12. 12.

    Xantar

    August 5, 2022 at 9:11 am

    @MattF: Manchin got a promise from Schumer to open up drilling and make some other regulatory changes to fossil fuels, so I think he genuinely wants this deal to happen now.

  13. 13.

    Ken

    August 5, 2022 at 9:13 am

    @OzarkHillbilly: It’s an easy mistake to make, and of course the occasional appearance at a political rally, Opus Dei rant about the Church Triumphant, or involvement of a lobbyist wife in seditious conspiracy could be misinterpreted. But the 62% 43% 29% 18% of the public that believe the court is impartial and apolitical surely can’t be mistaken.

  14. 14.

    bbleh

    August 5, 2022 at 9:13 am

    @MattF: @Ken:  I think maybe being on Team Obstruction also wasn’t turning out to be as popular as maybe those cute mavericky mavericks thought it might be.  But yeah, seeing the forecast switch back to D control of the Senate meant they’d have to deal with Schumer for 2 more years, and I’m sure that … focused their minds.

    I still won’t trust either one of them ’til the ink is dry.

  15. 15.

    geg6

    August 5, 2022 at 9:17 am

    @bbleh:

    Come sit by me.

  16. 16.

    Baud

    August 5, 2022 at 9:19 am

    I didn’t think Sinema would want to be the lone holdout.

  17. 17.

    Captain C

    August 5, 2022 at 9:19 am

    • @Ken: Six of them call balls and strikes with the accuracy and humility of Angel Hernandez.
  18. 18.

    Steeplejack

    August 5, 2022 at 9:21 am

    @David Anderson, @Geminid:

    Maybe give your snarkmeter a whack to make sure it’s working.

  19. 19.

    Patricia Kayden

    August 5, 2022 at 9:21 am

    I really hope Sinema loses when she runs again. She’s horrible.

  20. 20.

    Immanentize

    August 5, 2022 at 9:24 am

    @Ken: What did Orban say yesterday in his Nuremberg Dallas speech?

    “Christians cannot be racists.”

  21. 21.

    Suzanne

    August 5, 2022 at 9:24 am

    @bbleh: Agreed. They can both go back to their constituents and say that they used their leverage to forward their interests and isn’t that so great for them?

    Whatever. I still think Sinema is looking to cash out and take an easier/more fun/more lucrative job.

  22. 22.

    Baud

    August 5, 2022 at 9:24 am

    @Immanentize:

    Ergo, racists are not true Christians.

  23. 23.

    Soprano2

    August 5, 2022 at 9:24 am

    Someday we’re going to get rid of the carried interest loophole, but I guess this won’t be that day. Maybe next year if we get a couple more Democratic senators. The only people that thing is popular with is hedge fund managers.

  24. 24.

    Bruce K in ATH-GR

    August 5, 2022 at 9:25 am

    @Steeplejack: Political climate change, dude. Your typical snarkmeter works about as well in these political conditions as a drugstore flashlight does in a blizzard.

  25. 25.

    Gin & Tonic

    August 5, 2022 at 9:25 am

    I like the phrasing “Democrats make deal with Sinema” like she’s not a Democrat.

  26. 26.

    Baud

    August 5, 2022 at 9:26 am

    @Soprano2:

    And Sinema and the GOP caucus.

  27. 27.

    Immanentize

    August 5, 2022 at 9:26 am

    @Baud: That is a tautological error, don’t you see?

  28. 28.

    WereBear

    August 5, 2022 at 9:27 am

    I think releasing the Supreme Court decision before the midterms showed their contempt for women and will damage their prospects in the election. And was it deliberate?

    The ancient Greeks knew all about the downfall that comes with arrogance. But Republicans don’t value education, so I guess they don’t know that.

  29. 29.

    Suzanne

    August 5, 2022 at 9:27 am

    @Patricia Kayden:

    I really hope Sinema loses when she runs again. She’s horrible. 

    I guarantee that the Republican candidate will be a Trumpy shitshow, and Arizona is by no means a reliable blue state.

  30. 30.

    Immanentize

    August 5, 2022 at 9:28 am

    @Gin & Tonic: Bernie is kicking up dust. But he got onto the grift train after the last stop.

  31. 31.

    geg6

    August 5, 2022 at 9:28 am

    @Patricia Kayden:

    I’m with Josh here:

    https://talkingpointsmemo.com/edblog/kyrsten-sinema-still-completely-terrible

  32. 32.

    OzarkHillbilly

    August 5, 2022 at 9:29 am

    @Immanentize: Just ask any Klansman.

  33. 33.

    eclare

    August 5, 2022 at 9:30 am

    @Soprano2:   The estimate I saw for revenue raised by eliminating it was $15B.  I don’t remember if that was per year or over a longer time frame.  Yes, this loophole is horribly unjust and unfair, but in the context of the big bill, IMHO, not a hill to die on.

  34. 34.

    Immanentize

    August 5, 2022 at 9:31 am

    @WereBear: Also — “pride” is the first of the deadly sins and certainly is a kissing cousin of arrogance.

  35. 35.

    Frankensteinbeck

    August 5, 2022 at 9:32 am

    @Baud:

    Ergo, racists are not true Christians.

    No, no.  Ergo, the racists are right, and being persecuted by the real racists for telling the truth.  It’s the not-racists who are not true Christians.

    @Suzanne:

    I guarantee Sinema is going to be primaried out of a job.  The Democratic primary voters in Arizona who gave her the job are furious and feel her betrayed.  She’s as popular as diarrhea with them.  I’m sure Sinema knows it, which is why she’s gobbling down the corruption while she can.

  36. 36.

    sixthdoctor

    August 5, 2022 at 9:32 am

    Glad that Senator Warnock’s insulin cap bill is in there; that’ll give him a big feather in his cap to run in a race that shouldn’t EVEN BE CLOSE MY GOD AMERICA WHAT THE HELL REALLY?????

    The sad thing is I’d feel sorry for Walker if it weren’t clear he’s fine with being used like this.

  37. 37.

    Anyway

    August 5, 2022 at 9:34 am

    Why is Sinema hung up on the carried interest loophole? Not like she’s the senator from NY…

  38. 38.

    Immanentize

    August 5, 2022 at 9:35 am

    @OzarkHillbilly: I have — they agree with Orban.

  39. 39.

    Frankensteinbeck

    August 5, 2022 at 9:35 am

    @sixthdoctor:

    MY GOD AMERICA WHAT THE HELL REALLY?????

    The answer to that hasn’t changed.  Racism is a hell of a drug.

  40. 40.

    Immanentize

    August 5, 2022 at 9:37 am

    @Anyway: i think it was her summer internship at the fancy winery last summer. Hedge Fund Gods are her people!

  41. 41.

    WereBear

    August 5, 2022 at 9:38 am

    @Frankensteinbeck:  When I think of them as people who are both criminally minded and cowardly, a lot becomes clear about why they are so paranoid.

  42. 42.

    WaterGirl

    August 5, 2022 at 9:57 am

    @Ken: That’s not for real, right?  You are mocking the people who are suggesting such a thing?

  43. 43.

    Tony G

    August 5, 2022 at 10:02 am

    @Frankensteinbeck: I will bet a shiny nickel that, within a few years, Sinema will have a new job as a “personality” on Fox News.  She’ll be presented as a token “liberal” (yeah, she’s not, but what do Fox viewers know?).  She has the flamboyant looks for the job, she’ll make some significant money, and people will continue to talk about her.  She’ll be happy — at least as happy as a narcissist can be.

  44. 44.

    Ken

    August 5, 2022 at 10:03 am

    @WaterGirl: Yes, though maybe I was too subtle. Steeplejack got it, though. Maybe if I’d added one word:

    Just pick one important issue, like tax cuts, and do nothing else. Ever.

  45. 45.

    Frankensteinbeck

    August 5, 2022 at 10:04 am

    @Tony G:

    Logic checks out.

    EDIT – @Ken:

    I got it, but it did take me a minute.  You were very deadpan.

  46. 46.

    Hamlet of Melnibone

    August 5, 2022 at 10:07 am

    @Suzanne: I don’t think Sinema can win a general election again.  The Democrats of the state hate her, and we’ll need strong turnout to win in Arizona.  I’ve gone from wondering if primarying her is worth the risk to thinking that our only shot at keeping the seat is to primary her.

  47. 47.

    Geminid

    August 5, 2022 at 10:14 am

    @Hamlet of Melnibone: Representative Ruben Gallego seems ready to challenge Sinema. I think he would be strong candidate in a general election.

  48. 48.

    Suzanne

    August 5, 2022 at 10:22 am

    @Frankensteinbeck:

    I guarantee Sinema is going to be primaried out of a job.  The Democratic primary voters in Arizona who gave her the job are furious and feel her betrayed.  She’s as popular as diarrhea with them.  I’m sure Sinema knows it, which is why she’s gobbling down the corruption while she can. 

    No argument on that.

    But everyone needs to be aware that nominating Ruben Gallego (or someone else) for this job is a big gamble. The Arizona Dem bench is not deep. The state is not reliably blue. The party has really had a hard time with Senate races up until, well, Kyrsten Sinema and Mark Kelly.

  49. 49.

    Suzanne

    August 5, 2022 at 10:28 am

    @Geminid:

    Representative Ruben Gallego seems ready to challenge Sinema. I think he would be strong candidate in a general election. 

    I say this as someone who loves Ruben Gallego, but I’m not really sure what evidence exists for this. He represents a district that is one of Arizona’s two majority-minority districts (drawn under the VRA). It is very urban and has a large Mexican population. Gallego is awesome and maaaaaaaaaybe he has the special sauce (military background, good constituent services, etc.) to win, especially if other forces converge in his favor. But the evidence suggests that the (relatively few) Dems who win statewide there — Kelly, Napolitano, Sinema, Hoffman — are all very much in the more “moderate” vein.

  50. 50.

    Kristine

    August 5, 2022 at 10:40 am

    @Suzanne: So if we want to squelch Sinema’s leverage, we need to elect more D senators because we may be stuck with her or may lose the seat if she loses the primary. Well damn but that’s politics at this point, multiple layers/multiple fronts.

    Yes, stating the obvious but I’m still on my first cup of coffee and too many D’s still seem to harbor the notion that This One Weird Trick will make it all better and no.**

    **present company excepted

    Also, enjoying all the Dark Brandon memes over on the Twitter. He’s currently flashing lasers out of his eyes.

  51. 51.

    Geminid

    August 5, 2022 at 10:54 am

    @Suzanne: I wonder if Gallego is really too liberal for Arizona. He is a member of the Progressive Caucus, but I don’t think there is much separation in policy between Gallego and New Democratic Coalition member Greg Stanton, or Mark Kelly.

    The three qualties that I think would make Gallego a strong candidate are that he’s smart, he’s a Marine combat veteran, and he’s a Latino. The Latino Democratic vote in Arizona has become more of a force, but I think that group still lags in participation. Gallego is relatively young, and could be a good vote getter with this group as well as with Democrats and Independents.

  52. 52.

    Suzanne

    August 5, 2022 at 11:01 am

    @Kristine:

    So if we want to squelch Sinema’s leverage, we need to elect more D senators because we may be stuck with her or may lose the seat if she loses the primary. Well damn but that’s politics at this point, multiple layers/multiple fronts. 

    Exactly right.
    Everyone on the liberal/left who’s saying with great pleasure that we should “primary Sinema” (as if we have not) needs to accept that it is a big risk. No one should be confident (hopeful, yes, but not confident) that a Dem will win, and certainly not a more progressive candidate like Gallego.

    I started voting for Kyrsten Sinema in the early 2000s, back when she really was on the left. She did not win until she became the horror show that she is now. She has faced primary opponents, many of whom were progressive, and she has won easily. I beg commenters to remember that — for better and certainly for worse — she has figured out how to put together a winning coalition there when very few other Dems have done so. That winning coalition should indicate something to you.

    Putting together a winning coalition behind another candidate is certainly not impossible, but it is very much an uphill fight, and it will require resources and a shit-ton of luck.

  53. 53.

    kalakal

    August 5, 2022 at 11:04 am

    I’m rather enjoying this week. I’m allowing myself a bout of cautious optimism that the pendulum is swinging back to the Dems. The vote in Kansas, the polls generally and more specifically for the electoral races of the likes of Oz & Mastriano (sp), the latest jobs report, gas prices dropping ($2.99 in Oklahoma City) , the Repugnants losing it over CHIPS+, PACT and hopefully Build Back Better Lite are all good signs. I espescially like the passing of legislation because for months now Biden & the Dems have looked weak to Normies , unable to get anything done. All govts go through phases when they can’t seem to do anything right ( often due to circumstances beyond their control) as far as the punters see it, and more importantly are told it by the MSM, and it seems to me the Dems may have broken out of that phase at a very good time electorally.

  54. 54.

    Geminid

    August 5, 2022 at 11:08 am

    @Suzanne: Mark Kelly and Joe Biden have now also put together a winning coalition in Arizona. We’ll see how Mark Kelly and Katie Hobbs do this fall. Then I think we’ll know more about how singular Sinema’s success was in 2018.

  55. 55.

    Soprano2

    August 5, 2022 at 11:08 am

    @Suzanne: I think our biggest hope is that she loses the Democratic primary.

  56. 56.

    Miss Bianca

    August 5, 2022 at 11:16 am

    @Kristine: So, I finally looked up “Dark Brandon” in “Know Your Memes”, and I read about its evolution, and the chef’s kiss at the end is where they cite a MAGAt blubbering on Twitter, “Dark Brandon has been coopted by the libs it’s all over”. LMAO

  57. 57.

    Soprano2

    August 5, 2022 at 11:22 am

    @kalakal: This is true, for “normies” Congress and Biden have had a good week. Biden’s military killed a terrorist, and Congress passed the PACT Act (with the bonus that the own-goal the R’s did probably penetrated to the normies because it was so huge). Pelosi put a thumb in the eye of China – why does anyone think we should allow another country to dictate where our people go?

  58. 58.

    Geminid

    August 5, 2022 at 11:31 am

    @Miss Bianca: I like the Dark Brandon meme where Biden has a short, grizzled beard and an eyepatch.

  59. 59.

    Geminid

    August 5, 2022 at 11:35 am

    @Soprano2: The streak started last Thursday when Congress passed the CHIPS+ Act and then Schumer and Manchin announced they had agreed on a reconciliation package.  Then on Friday the House passed the Assault Weapons Ban.

  60. 60.

    Soprano2

    August 5, 2022 at 11:38 am

    @Geminid: I should have included the CHIPS act. I don’t include anything that was passed by one chamber but has zero chance of passing the other. “Normies” only know that there is no actual law, that Biden never signed it. They’re mostly aware of things Biden actually signs.

  61. 61.

    Geminid

    August 5, 2022 at 12:08 pm

    @Soprano2: “Normies” who keep up with news know that the assault weapons ban passed. It was a lead item  on the network radio news and I expect TV too (although it was the weekend).

    They may also have heard it is unlikely to pass the Senate but can draw the right conclusions from this. And where Democratic House candidates think it’s good politics they’ll be letting voters know about their vote for the ban. If they’re challenging a Republican in suburban districts they’ll be making a no vote a campaign issue. It may be a good one for Senate candidates too.

  62. 62.

    Geminid

    August 5, 2022 at 12:38 pm

    @Geminid: And the winning steak continues! The Friday employment report shows a gain of 520,000 jobs, significantly higher than forecast.

  63. 63.

    Kristine

    August 5, 2022 at 12:38 pm

    @Miss Bianca: I love Dark Brandon because it so runs counter to Biden’s kindly grandfather image.

  64. 64.

    Suzanne

    August 5, 2022 at 12:55 pm

    @Geminid: Mark Kelly is a goddamn astronaut, and the husband of a former politician who has a whole stack of ride-or-die supporters. And Biden barely squeaked it out there. Again, it will probably take a good candidate, a terrible opponent, and a bunch of luck.

  65. 65.

    Geminid

    August 5, 2022 at 1:34 pm

    @Suzanne: You’ll  know even more about the Arizona electorate after this November. But I think Ruben Gallego will challenge Sinema. Do you think Democrats will give her the votes to beat him?  If not, we’ll get to find out how strong a candiate he is.

  66. 66.

    Bill Arnold

    August 5, 2022 at 2:21 pm

    @Anyway:

    Why is Sinema hung up on the carried interest loophole? Not like she’s the senator from NY…

    Loose change from 15 billion per year will buy a Senator like her. I would frankly be surprised if she hasn’t somehow been bribed. No evidence, though.

  67. 67.

    J R in WV

    August 5, 2022 at 3:05 pm

    @Patricia Kayden:

    I really hope Sinema loses when she runs again. She’s horrible.

    Yes, she is…  I’m embarrassed to have to confess that we actually contributed to her Senate campaign, since she appeared to be a liberal Democratic candidate in AZ, a place we love to visit. Along with Capt Mark Kelly, etc. Not a lot, but more than nothing… oops!

  68. 68.

    Geminid

    August 5, 2022 at 3:26 pm

    @J R in WV: Sinema joined the Blue Dog Caucus when she entered Congress in 2013. But she was certainly more liberal than Martha McSally.

  69. 69.

    Suzanne

    August 5, 2022 at 3:29 pm

    @Geminid: Honestly, I think it will depend on if anyone else jumps into that race. The active Dems have “known” Sinema for a long time, and everyone seems to hate her…. but she has shown enough crossover appeal (to the Mormon mom set) that it is impossible to deny. I honestly think that a more milquetoast Dem like Greg Stanton has a better shot in a general than Gallego. (Which is not to say that I like him better.)

    The question isn’t, “now that everyone sees that Sinema sucks, we’ll primary her, and can we find someone to win that primary?”. The question is, “has she pissed us off SO FUCKING MUCH that we simply can’t bear her anymore and we’ll nominate someone else and if we lose the general, oh well?”.

  70. 70.

    Suzanne

    August 5, 2022 at 3:34 pm

    @J R in WV: Hell, I volunteered. Hours. HOURS OF MY LIFE for Kyrsten Sinema. I made phone calls and talked to people about her shitty ass.

    And I hate it, but I don’t regret it. There hadn’t been a Dem Senator there since Dennis DeConcini (ancient fucking history). She sucks, but she came through this week.

    Again, I just want y’all to realize that Arizona is not like other places. Before you get too excited about throwing her overboard, recognize that she might be the best you can get out of that shithole (other than, you know, a literal astronaut).

    The best way to deal with this is to elect more Dems in other places. I would feel a lot more inclined toward positivity if we weren’t literally talking about this seat as a tipping point.

  71. 71.

    Bill Arnold

    August 5, 2022 at 3:39 pm

    @Geminid:

    The Friday employment report shows a gain of 520,000 jobs, significantly higher than forecast.

    Bad News For The Real Economy!!! /s
    US government bonds and stocks drop after hot jobs report – Traders crank up expectations for Fed rate rises after data show big increase in hiring (2022/08/05)

    Meanwhile, the S&P 500 was down 0.4 per cent by the afternoon as traders worried about the prospect of further hawkish rate rises from the Fed. The tech-heavy Nasdaq Composite, the components of which are particularly sensitive to interest rates, was down 0.8 per cent. Both indices had recouped some losses from earlier in the day.
    “The narrative is going to be that it’s come in way too hot, the Fed is right, and the markets were wrong,” said Jim Paulsen, chief investment strategist of The Leuthold Group. “I think it’s a muted response . . . on the stock and bond market relative to the emotion generated by the headline numbers.”

    I admit to smiling on seeing the words “the markets were wrong”.

  72. 72.

    Geminid

    August 5, 2022 at 3:48 pm

    @Bill Arnold: The Fed screwed up when they did not raise rates last year, when inflation overshot their estimate for 2021. But when stocks drop on the expectation of interest rate hikes, not all of the drop is from the prospect of a recession. Some of it is because interest bearing assets become relatively more valuable than equities. At least, I think so.

  73. 73.

    Bill Arnold

    August 5, 2022 at 5:15 pm

    @Geminid:

    Some of it is because interest bearing assets become relatively more valuable than equities. At least, I think so.

    Yes, but we should take every opportunity we get to point out that the correlation between main street/jobs/employment numbers and the frothing of the equities markets is not a tight correlation.

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