Recent Articles The American Prospect - articles by author en The Art of the Possible <div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"> <p>In the first year of his presidency, Barack Obama had two ways to make significant progress toward the platform for which Americans voted. One avenue involved cross-partisan legislative negotiations; the other involved a pure exercise of the partisan power of a 60-40 Senate majority. By the anniversary of his inauguration, both avenues seemed blockaded: the first by near-total Republican intransigence, the second because that intransigence led to delay and ugly wheeling and dealing with marginal Democrats on health care, which in turn led to a Democratic defeat in a Massachusetts special election and pulled the Democratic majority below the magic number of 60. </p> <p>Fortunately there are other ways to govern, and many of the lasting achievements of presidents past have come not from the high-profile legislative battles like this winter's fight over health care but in quieter moves. From Ronald Reagan's firing of the air-traffic controllers in 1981 (the beginning of the end of organized labor) to Bill Clinton's protection of millions of acres of wilderness land in the Mountain West, executive orders and regulations have changed the direction of policy. Even a change of emphasis within an executive-branch agency, or the installation of midlevel staffers who believe in the mission of, say, the Occupational Safety and Health Administration, can have lasting consequences that affect the lives of millions. Finally, there are areas of policy where enough bipartisan support is already established that an initiative can bypass the usual congressional deadlock. </p> <p>Obama has already begun to exercise power through these alternative means, but in the second and perhaps later years of his administration, they are likely to be central to getting anything done. This might seem less exciting than sweeping reforms enacted with the help of both parties in Congress, but have no doubt -- big changes are possible without big showdowns.<i> </i></p> <p><i>-- The Editors</i> </p> <p><b></b></p> <h3>Nominations</h3> <p><br /> What: Make appointments during a congressional recess to send qualified nominees to their posts as soon as possible. </p> <p>How: Republican obstructionism, recalcitrant moderate Democrats, and White House foot-dragging have left scores of key leadership positions vacant. Despite having over 200 pending nominations at the beginning of the year, Obama refrained from making any recess appointments during the first year of his presidency. Bush, by comparison, had 70 pending nominees by the end of year one. But now it seems that Obama has finally warmed up to the idea. In February, shortly after Sen. Richard Shelby of Alabama placed a ham-fisted hold on 70 executive-branch nominees, Obama said for the first time that he would consider bypassing the politically deadlocked Senate. </p> <p>There are many noncontroversial, qualified nominees who have been held up by Republicans for purely tactical reasons. Even after he released his hold on most of Obama's appointees, Shelby continued to block three Department of Defense nominees to draw attention to parochial spending demands for his home state. Obama could clamp down on such maneuvering by putting these kinds of nominees through straightaway. He could also use recess appointments for candidates who have needlessly become political lightning rods. Erroll Southers, for example, withdrew his nomination for head of the Transportation Security Administration when Republicans hyperventilated that he would "unionize" the agency. Obama could consider renominating Southers and appoint him during a recess. Similarly, Dawn Johnsen's appointment to the Office of Legal Counsel has been delayed for more than a year because of conservatives' concerns about her pro-choice views. Obama could be much more assertive about defending qualified nominees whose views are well in line with the administration's overall ideology -- after all, he has many ways to put them through. </p> <p>Why: Far too many federal agencies have been languishing without leadership, and recess appointees can serve for up to two years. <i> -- Suzy Khimm <br /></i></p> <p><i><br /></i></p> <p><i></i> </p> <h3><b>Wall Street</b> </h3> <p><i>What:</i> Tighten the rules on banks -- -and see that regulatory agencies improve their enforcement of those rules -- so we don't have another major financial crisis. </p> <p><i>How:</i> Obama could start by holding people accountable. He could fire Comptroller of the Currency John Dugan and use a recess appointment to put a real reformer in his place. Dugan's history as an opponent of regulation was revealed during the crisis, and recently he has spoken out against reforms advocated by fellow regulators like Federal Deposit Insurance Corporation Chair Sheila Bair and Securities and Exchange Commission Chair Mary Schapiro. At the FDIC, Bair has put forward new rules that could link bank-executive compensation to risk and make packaging loans into securities safer and more transparent, while new SEC proposals would regulate so-called dark pools that operate as a shadow banking system. By endorsing these rules and getting rid of Dugan, Obama could encourage these regulatory agencies to keep doing their jobs. </p> <p>The president can also further increase funding to regulatory agencies under his purview -- the SEC and FDIC as well as the Financial Crimes Section at the FBI -- and task them with increasing their focus on the financial sector. These agencies are plagued by a shortage of talented personnel and resources, which seriously undercuts their ability to perform effectively. Putting real muscle behind their regulation efforts would make for better enforcement and send a deterrent message across Wall Street. </p> <p><i>Why:</i> Keeping the financial system from taking on too much unhealthy risk will protect the entire economy in the short term and lay the ground work for real financial-reform legislation in the long term. Plus, changing the bank's focus from quick-profit trades to loans will help economic recovery. <i> -- Tim Fernholz <br /></i></p> <p><i><br /></i></p> <p><i></i> </p> <h3><b>Environment</b> </h3> <p><i>What</i>: Strengthen industry reporting requirements to bolster regulation of toxic substances. </p> <p><i>How: </i>There are immediate steps that the Obama administration could take to reverse the federal government's decades-long inaction on regulating chemicals that are hazardous to the environment and public health. Of the 80,000 chemicals in the federal government's database, the Environmental Protection Agency only requires testing on about 200 substances and has regulated a grand total of five. Within its existing authority under the 1976 Toxic Substances Control Act (TSCA), the EPA could issue rules requiring that manufacturers provide all the information they have about certain high-volume industrial chemicals, as few companies have chosen to disclose such information under its current voluntary program. </p> <p>The EPA could also require new companies that start manufacturing select hazardous chemicals -- or use them in a new fashion -- to report these activities. Such requirements would enhance the EPA's ability to pinpoint the hazardous materials that need greater regulation, particularly if the agency allotted greater resources to its woefully incomplete toxic-chemical database. The EPA has already laid out action plans for regulating four hazardous chemicals at the end of 2009, but it needs the full support of the White House to expedite the process. Though public concern is growing -- witness the recent widespread panic about Bisphenol A -- comprehensive TSCA reform is likely to be a protracted legislative battle. In the meantime, the Obama administration could take the lead by demanding that industry manufacturers disclose what they know about the hazardous substances they use. </p> <p><i>Why:</i> Countless numbers of Americans are regularly exposed to toxic chemicals, whether because of environmental hazards or ordinary consumer products. Research suggests chemical exposure could be contributing to the rise of certain chronic diseases, elevating medical costs. As a result, broad coalitions of consumer and environmental advocates have formed to push for stronger regulation, and such efforts could have widespread popular appeal. <i> -- S.K.</i></p> <p><i><br /></i> </p> <p><b></b></p> <h3>Housing</h3> <p> </p> <p><i>What:</i> Ramp up efforts to deal with the predicted glut of foreclosures, which exacerbate economic hardship and drive home prices even lower. </p> <p><i>How: </i>The administration's current anti-foreclosure effort, Home Affordable Refinance Program, has failed to provide long-term solutions to troubled borrowers even as their numbers grow. The Treasury Department uses Troubled Asset Relief Program funds as an incentive for lenders to modify home loans so that borrowers can have more reasonable monthly payments, but slow--moving banks and worsening economic conditions have left millions without aid. Those who do receive help often find themselves with a loan that can't be sustained over the long term. Now, with more banks leaving TARP, the program could be adapted to provide more aggressive assistance to borrowers. </p> <p>The Obama team could change the program's focus to writing down the principal of a borrower's loan to better match its real, pre-bubble value, forcing banks to absorb a partial share of the loss on the loan. They could also put money behind programs that help homeowners who owe more than their house is worth walk away from their loan while receiving an incentive payment and access to rental housing to ease the transition. To encourage the banks' cooperation, the administration could endorse legislative proposals that would give homeowners a right to rent their home instead of being kicked out of it, and another that would allow bankruptcy judges to modify mortgages that have become unreasonable. </p> <p><i>Why:</i> If the administration successfully adapts its program, homeowners would have more security. Protecting borrowers from a sudden foreclosure will bring meaningful economic benefits from increased consumer spending and a stabilized housing market. And making the banks share homeowner sacrifice can't hurt the president's image. <i> -- T.F. <br /></i></p> <p><i><br /></i></p> <p><i></i> </p> <h3><b>Telecommunications</b> </h3> <p><i>What:</i> Expand high-speed Internet access to rural and underserved communities by incorporating broadband infrastructure into federal highway construction and public--housing projects. </p> <p><i>How:</i> The Obama administration has already committed to closing the digital divide by pledging $7.2 billion to high-speed Internet projects in its stimulus package. But officials have been inundated with over 2,000 applications for the funds since then, while large telecom companies have challenged many of the proposals as intruding upon their existing broadband plans. The bureaucratic bottleneck has meant that only a fraction of the funds have been distributed so far, and the government needs to figure out the best way to build upon its existing investments and cut down on the procedural hurdles. </p> <p>First the administration could commission a more comprehensive map of expected broadband-access gaps, which would include both underserved areas that have no access and communities where broadband is still prohibitively expensive. The government could then help fill those gaps by incorporating broadband conduits into the $4 billion investment in transportation infrastructure projects that Obama included in his 2011 budget. "We can leverage other federal investment that's happening anyway," says Michael Calabrese, director of the Wireless Future Program at the New America Foundation. As more than half the cost of installing broadband conduits entails ripping up roads and digging trenches, the broadband fiber could be added at a relatively minimal cost. The government could also require that public housing that is newly built or renovated include the capability for high-capacity broadband. These reforms would require congressional approval, but they could be bundled into infrastructure-building programs that already have broad-based support. </p> <p><i>Why:</i> Both underserved families and small businesses would stand to gain from this federal push: One recent Columbia University report estimates that as many as 10 million households will have inadequate broadband access in 2013 without additional outlays. And telecom companies would be able to pursue "last mile" projects to connect households to the Internet once the costly step of creating broadband conduits is completed. <i> -- S.K. <br /></i></p> <p><i><br /></i></p> <p><i></i> </p> <p><b></b></p> <h3>Immigration</h3> <p> </p> <p><i>What:</i> Overhaul the country's detention system for those held in immigration custody by supporting detention alternatives for low-risk immigrants and more robust, independent monitoring of the rights of detainees. </p> <p><i>How:</i> In August the Obama administration announced its plans to reform the country's immigrant-detention system, where individuals are held while the government decides whether to deport them. Currently, at a cost of nearly $2 billion, more than 400,000 people are being detained in a patchwork of county jails, federal centers, and privately run prisons. Recent high-profile exposés of violations within the detention system -- ranging from lack of medical care and legal counsel to forcible drugging and inhumane treatment of children -- have created new urgency for reform. As a result, the Department of Homeland Security has begun to revamp its regulatory standards for the facilities and reorganize its Immigration and Customs Enforcement Agency to create more centralized oversight. But part of the problem is that officials within ICE and its contracted detention facilities have also been complicit in perpetuating systemic abuses, and more independent regulation is necessary. </p> <p>The DHS could empower its Office of Civil Rights and Civil Liberties -- which operates outside of ICE -- to conduct periodic audits and investigations into suspect facilities. Doing so would increase accountability and strengthen enforcement. In addition, DHS could allocate funds to detention alternatives for non-criminals who pose little flight risk. Currently, asylum-seekers, human--trafficking and torture victims, children, and other vulnerable groups are regularly thrown into criminal detention facilities when electronic monitoring, parole, shelters, or other community-based facilities could be more appropriate options. Undocumented presence is a civil violation, not a criminal offense, and the Obama administration needs to find better ways to ensure its detention system conforms to the law. </p> <p><i>Why</i>: Such reforms would create more humane conditions for detainees. The changes would also encourage a more levelheaded approach to comprehensive immigration reform that considers the entire spectrum of immigrant groups in the U.S. <i> -- S.K. <br /></i></p> <p><i><br /></i></p> <p><i></i> </p> <h3><b>Gay Rights</b> </h3> <p><i>What: </i>Expand Title IX, a 1972 law that bans sex discrimination in federally funded education programs, to prohibit discrimination on the basis of sexual orientation. </p> <p><i>How: </i>Title IX protects students against sex stereotyping as well as harassment that creates a "sexually hostile environment," which are both provisions that could be interpreted to include anti-gay discrimination. In January, the Department of Justice took the bold step of intervening on behalf of an openly gay ninth-grader who was beaten up and bullied. In joining the lawsuit, the department argued that the law's sex-discrimination statute should also cover discrimination based on gender stereotypes, opening the pathway for a broader interpretation of Title IX. While this court case is pending, the Justice Department could pursue other Title IX anti-gay discrimination cases, as well as launch a public-advocacy and awareness campaign to encourage schools to protect students against sex stereotyping, according to Hayley Gorenberg, deputy legal director for Lambda Legal. Such concerted efforts would help ensure that this expanded interpretation of Title IX becomes enshrined both in law and in practice. </p> <p>A big push by the Obama administration on this issue would also add momentum to Rep. Jared Polis' Student Nondiscrimination Act, which would explicitly prohibit discrimination against LGBT students in federally funded education programs. The bill, introduced in the House in late January, has 65 co-sponsors, including one Republican. In the wake of the White House's turnaround on the policy of "don't ask, don't tell," Polis' bill now stands a better chance. </p> <p><i>Why:</i> In addition to protecting the civil rights of LGBT students, such victories would help bolster support for the administration among gay-rights activists and help energize a disenchanted liberal base. <i> -- S.K. <br /></i></p> <p><i><br /></i></p> <p><i></i> </p> <h3><b>Criminal Justice</b> </h3> <p><i>What:</i> Make a large-scale federal push for parole, probation, and sentencing reform that would revamp the country's needlessly draconian criminal-justice system and reduce the prison population. </p> <p><i>How</i>: The growing economic and social costs of mass incarceration have encouraged officials across the political spectrum to embrace pragmatic alternatives like Hawaii's Opportunity Probation with Enforcement. Citing the Hawaii program as a model, Democratic Rep. Adam Schiff of California and Republican Rep. Ted Poe of Texas jointly introduced a bill that would create federal grants for states to experiment with "graduated sanctions," which deliver quick, moderate punishment to those who violate the terms of their probation instead of automatically putting them back into jail. Obama could throw his support behind the bill. </p> <p>The Obama administration could also take executive action to address the crack/powder cocaine sentencing disparity. Since the passage of the 1986 Anti-Drug Abuse Act, a federal conviction for possessing 5 grams of crack results in a five-year prison sentence -- the same sentence for possessing 100 times that amount of cocaine. With the support of the White House, Sen. Dick Durbin has introduced the Fair Sentencing Act, but the bill has since stalled in committee. </p> <p>In the meantime, the attorney general could require crack cases that involve more than 5 grams -- but less than 500 grams, the five-year mandatory sentencing trigger for powder cocaine -- to receive clearance with the Justice Department before U.S. attorneys can proceed with indictments. "It's a way to make sure that low-level players are not doing five-year federal prison terms," says Mark A.R. Kleiman, a public-policy professor at the University of California, Los Angeles. </p> <p><i>Why</i>: These reforms could alleviate state budgets, reduce recidivism among offenders, and combat the negative social effects of over-incarceration on poor communities. Eliminating the crack/powder cocaine sentencing disparity would help close the racial gap that has put a disproportionate number of black Americans in jail. <i> -- S.K. </i></p> <p><i></i> </p> </div></div></div> Fri, 26 Feb 2010 23:53:01 +0000 148501 at Suzy Khimm It's Been Real. <div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"> <p>I've had a great time guest-blogging here at TAPPED, amid all the health-care and election madness last week. Many thanks again to the editors for bringing me on board -- and to the TAPPED readership for your attention. But our wonktastic journey doesn't have to end here. Visit me back at <em>The New Republic</em>, where I'll continue to be covering health care for <a href="">The Treatment</a> and politics for <a href="">The Plank</a>. And for those who tweet, you can always follow me <a href="">here</a>. Bye!</p> <p><em>--Suzy Khimm</em></p> </div></div></div> Mon, 09 Nov 2009 17:43:21 +0000 201068 at Suzy Khimm Why Cost Control for Medical Devices Is Likely To Fail. <div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"> <p>As <b>Ezra</b> <a href="">noted</a> earlier this week, much of the reason that American health care is so expensive is because we pay so much per-unit of care, whether it's a prescription or a CT scan. In order to insure health care remains affordable and that reform is sustainable in the long term, these costs <a href="">need</a> to be brought under control -- a point conservatives, to their credit, have repeatedly raised. Democrats have tried to address the issue by trying to extract savings and price-control measures from groups like the drug industry, given the federal government's buying power through entitlement programs like Medicare. But, as <em>The New York Times </em><a href="">points out</a> today, there's at least one area in which rapidly escalating costs will be far more difficult to constrain: the medical device industry. And it's not certain that the current health-care legislation will be able to make a big difference.</p> <p>At the heart of the problem is that device makers, unlike the drug industry or health providers, don't receive Medicare payments directly from the government. Instead, as the <em>Times </em>article <a href="">explains</a>, the government gives a flat fee to hospitals, who are left to negotiate individually with device makers and manufacturers. Hospitals, however, often have little data to be able to gauge the relative effectiveness of different devices. Moreover, they're often contractually prohibited from disclosing how much they end up paying. As a result, hospitals -- and public entitlement programs -- end up relying on devices whose cost can vastly outstrip their value. </p> <p>What's more, given the current fee-for-service model, hospitals themselves can also profit from inflated prices. In a separate <em>Times</em> story, <strong>David Leonhardt</strong> <a href=";em">reveals</a> how the Intermountain hospital chain managed to negotiate a significant price reduction for a certain medical device but still decided to charge patients -- and insurers like Medicare -- the old price:</p> <blockquote style="MARGIN-RIGHT: 0px" dir="ltr"><p>A few people in the meeting were clearly bothered by this. They asked the finance executive, participating by speakerphone, if anything could be done. One committee member argued that Intermountain (which is nonprofit) should not overcharge for a treatment, even if it helped the hospital cover its overall expenses. The finance executive replied, apologetically, that changing the reimbursement rate would cost Intermountain millions of dollars and that there did not seem to be any way to make up for the loss. </p> </blockquote> <p dir="ltr">Unfortunately, the current health-care legislation doesn't do anything to change this payment system, and legislators decided not to hit up hospitals themselves on the issue of medical-device payments. Unable to use Medicare price negotiations as a point of leverage, Congress ended up having to use a sledgehammer instead of a scalpel: they imposed a direct $40 million tax on the device industry itself. The device lobby lashed out and immediately rounded up a slew of Democratic legislators to protest the tax on the grounds that it would stifle innovation and job creation in their home states. And it seems like the device lobby has <a href="">won</a>: the House decided to halve the tax to $20 million, and the Senate is likely to follow suit. </p> <p dir="ltr">Given the fact that medical-device costs are rising even faster than drug costs, such a measure hardly seems like it will squeeze adequate savings from the industry. It is a small consolation, at least, that the bill's comparative-effectiveness research will enable hospitals to make better cost-value judgments. But, in the end, it doesn't seem like it will be enough to fix a faulty, bloated payment system.</p> <p dir="ltr"><em>--Suzy Khimm</em></p> <p dir="ltr"> </p> </div></div></div> Fri, 06 Nov 2009 23:50:51 +0000 201064 at Suzy Khimm The Flawed Logic of Banning Immigrants from the Insurance Exchange. <div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"> <p>Should illegal immigrants be able to purchase private health insurance within the newly created federal exchanges if they use their own money? That question, as I <a href=";year=2009&amp;base_name=the_immigration_dustup_ahead">noted</a> yesterday, is one of the biggest sticking points in the fight about immigration in the health-care bill. The Senate supports such a prohibition, while the House hasn't done so. Spooked early this fall on by accusations that the bill would cover illegal immigrants -- e.g. <b>Joe </b>“You Lie!” <b>Wilson</b> -- the White House has made it clear that it prefers the Senate's prohibition. Congressional Democrats wary of looking soft on illegal immigrants have echoed such concerns: Rep. <b>Gerald Connolly</b> <a href="">told</a> <em>The Washington Post</em> yesterday that he wants to make sure that those "who are here illegally cannot avail themselves of the infrastructure that we're creating."</p> <p>But what these wary Dems seem to be overlooking is just how extreme such a prohibition would be. Those who advocate for cracking down on illegal immigrants always insist that taxpayer money shouldn't be spent on supporting their welfare. But the federal government wouldn't be spending any more money if it allowed unauthorized immigrants to purchase private plans on the exchange, as they wouldn't be receiving any subsidies to do so. And, yes, while taxpayer dollars are subsidizing the infrastructure for the private insurance exchange, the same can be said for the nation's public transportation system, energy supplies, and agricultural output. Should unauthorized immigrants also be prohibited from riding buses, filling up a tank of gas, or buying groceries because these industries are supported by federal subsidies and infrastructure? That's essentially the logic that those who want to exclude illegal immigrants from the exchange are subscribing to.</p> <p><em>--Suzy Khimm</em></p> </div></div></div> Fri, 06 Nov 2009 19:18:13 +0000 201054 at Suzy Khimm Could Surgeons and Docs Turn Against the Bill? <div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"> <p>Today the AARP and American Cancer Society <a href="">endorsed</a> the House health-care bill, with the American Medical Association expressing its positive (if qualified support). But amid this big news, a strong message of dissent was sent to the Senate side of things -- and it didn't come from <strong>Bachmann</strong>'s tea-party spectacular on Capitol Hill. </p> <p>In a letter sent to Senate Majority Leader <strong>Harry Reid</strong> today, the American College of Surgeons and 19 other physician groups <a href="">stated</a> their strong opposition to the current Senate legislation as based on the provisions in the Finance Committee's bill, primarily due to fears that it will not fix the Medicare payment system to doctors and will find other ways to cut down provider fees. The group <a href="">wrote</a>: "If these concerns are not adequately addressed when a health care reform package is brought to the Senate floor, we will have no other choice but to oppose the bill." </p> <p>At heart, the AMA's qualified support of the House bill and the surgeons' problems with the Senate bill are rooted in the same key issue: fixing Medicare's flawed payment system for providers. As <strong>Jonathan Cohn</strong> <a href=",%20with%20the%20American%20Medical%20Association%20expressing%20its%20positive,%20if%20qualified%20support%20for%20the%20legislation,%20a%20strong%20message%20of%20dissent%20was%20sent%20to%20the%20Senate%20side%20of%20the%20debate--%20and%20it%20didn%27t%20come%20from%20Michele%20Bachmann%27s%20tea-party%20spectacular%20on%20Capitol%20Hill.%20In%20a%20letter%20sent%20to%20Senate%20Majority%20Harry%20Reid%20today,%20the%20American%20College%20of%20Surgeons%20and%2019%20other%20surgeon%20groups%20stated%20their%20strong%20opposition%20to%20the%20current%20Senate%20legislation%20as%20based%20on%20the%20provisions%20in%20the%20Finance%20Committee%27s%20bill,%20primarily%20due%20to%20fears%20that%20it%20will%20not%20fix%20the%20Medicare%20payment%20system%20to%20doctors%20and%20will%20find%20other%20ways%20to%20cut%20down%20provider%20fees.%20The%20group%20wrote:%20%22If%20these%20concerns%20are%20not%20adequately%20addressed%20when%20a%20health%20care%20reform%20package%20is%20brought%20to%20the%20Senate%20floor,%20we%20will%20have%20no%20other%20choice%20but%20to%20oppose%20the%20bill.%22">points out</a>, in the endorsing health reform, AMA underscored the fact they they were supporting not one but two bills: the primary bill <strong>Nancy Pelosi</strong> has put forward, and a separate $210 billion bill that would do away with planned reductions to Medicare physician payment to bring them in line with the Sustainable Growth Rate (SGR). On the Senate side, however, the attempt to pass a version of the latter -- the so-called doc fix -- failed when Senate Democrats joined Republicans to defeat a $245 billion, unfunded bill. And ACS's letter today intended to send the message to the Democrats that such a move was unacceptable. </p> <p>So, in different ways, both the AMA and ACS made it clear today that their support for the health-care legislation is significantly contingent upon Congress's ability to pass some form of "doc fix." Problem is, it's far from certain that this will happen within the time frame of health-care reform debate. As Cohn <a href=",%20with%20the%20American%20Medical%20Association%20expressing%20its%20positive,%20if%20qualified%20support%20for%20the%20legislation,%20a%20strong%20message%20of%20dissent%20was%20sent%20to%20the%20Senate%20side%20of%20the%20debate--%20and%20it%20didn%27t%20come%20from%20Michele%20Bachmann%27s%20tea-party%20spectacular%20on%20Capitol%20Hill.%20In%20a%20letter%20sent%20to%20Senate%20Majority%20Harry%20Reid%20today,%20the%20American%20College%20of%20Surgeons%20and%2019%20other%20surgeon%20groups%20stated%20their%20strong%20opposition%20to%20the%20current%20Senate%20legislation%20as%20based%20on%20the%20provisions%20in%20the%20Finance%20Committee%27s%20bill,%20primarily%20due%20to%20fears%20that%20it%20will%20not%20fix%20the%20Medicare%20payment%20system%20to%20doctors%20and%20will%20find%20other%20ways%20to%20cut%20down%20provider%20fees.%20The%20group%20wrote:%20%22If%20these%20concerns%20are%20not%20adequately%20addressed%20when%20a%20health%20care%20reform%20package%20is%20brought%20to%20the%20Senate%20floor,%20we%20will%20have%20no%20other%20choice%20but%20to%20oppose%20the%20bill.%22">notes</a>, "Congress seems disinclined to pass an SGR fix, even as a separate bill, without new revenue or savings to offset the cost" -- and finding extra money will be extraordinarily difficult. If that's the case and the doc fix doesn't get passed, will doctors and surgeons end up turning against health reform? Surgeons certainly issued a credible threat to the Senate today.</p> <p>--Suzy Khimm</p> </div></div></div> Thu, 05 Nov 2009 23:35:07 +0000 201048 at Suzy Khimm The Immigration Dustup Ahead. <div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"> <p>The House may be closer to <a href="">settling</a> the immigration issues in the health-care bill this week, but the issue is sure to rear its head again further down the road in the legislative process. In the manager’s amendment to the bill released Tuesday, Speaker <strong>Nancy Pelosi </strong>confirmed that the House would not adopt the stricter measures included in the Senate Finance Committee’s bill to bar illegal immigrants from purchasing insurance in the federal health exchanges. With Pelosi's amendment now included, both the House and Senate bills follow the Social Security Act’s verification process to allow only immigrants who can provide a valid name and Social Security number to receive government subsidies to buy insurance on the exchanges. However, the House bill does not prohibit illegal immigrants from using their own money to purchase private insurance in the exchanges or the public plan, while the Senate bans this practice. </p> <p>Groups <a href=";id=21767&amp;security=1601&amp;news_iv_ctrl=1012#1">advocating</a> for a crackdown on illegal immigrants had been lobbying hard for the stricter provisions to be adopted on the House side, but they were met with fierce opposition from members of the Congressional Hispanic Caucus (CHC), who threatened to hold up the bill if stricter prohibitions were adopted. Interestingly, though, few House Democrats entered the fight to exclude illegal immigrants from accessing health care -- on the Hill, the concerns about immigration were essentially <a href="">taken up</a> by proxy, via DCCC chair <strong>Chris Van Hollen</strong>, who wanted to protect vulnerable members from getting slammed on the issue. The conservative House members angriest about the immigration provisions are Republicans like <strong>Joe Wilson</strong> who were going to vote against the bill anyway, giving their side little leverage compared to powerful Hispanic Caucus members like <strong>Xavier Becerra</strong>. With few conservative Dems making threats, the House seems to have reached a resolution of the issue that the CHC can live with. </p> <p>But the immigration question is far from being resolved in the larger legislative debate. For one thing, the White House supports the Senate's prohibition on allowing illegal immigrants to purchase health insurance with their own money on the exchange and had a meeting scheduled with the CHC today to discuss the issue. While allowing such access wouldn't entail government handouts to illegal immigrants, Senate Democrats and administration officials remain wary of such accusations. And when the Senate bill comes to the floor, expect a slew of Republican amendments that could force Democrats to take politically difficult votes on the issue. </p> <p><em>--Suzy Khimm</em></p> </div></div></div> Thu, 05 Nov 2009 22:09:38 +0000 201046 at Suzy Khimm Why Dems Should Worry: Connecticut Edition. <div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"> <p>Over at <em>Newsweek</em>,<strong> Ben Adler </strong><a href="">describes</a> how the Republican upsets in New York City's suburbs are “an actual bad sign for the Democrats.” I’d actually look a bit farther east to include the results in Connecticut as another reason for concern. </p> <p>Republicans <a href="">ousted</a> Democrats in municipal elections throughout the state, picking up seats in Stratford, Trumbull, Monroe, Darien, Guilford and other towns throughout southwestern and central Connecticut. In Stamford -- the state’s financial hub -- <strong>Michael Pavia</strong> <a href="">trounced</a> his Democratic opponent to become the city’s first Republican mayor in 14 years. </p> <p>“With the economy so bad, people are looking for change,” <strong>Nancy DiNardo</strong>, the state’s Democratic Party chair, <a href="">told</a> the AP, linking the results to a broader, national repudiation of incumbents. Even so, the results don’t bode well for politically embattled Sen. <strong>Chris Dodd</strong>, who still <a href="">trails</a> leading Republican challenger <strong>Rob Simmons </strong>by over six points. </p> <p>Less than two weeks ago, <strong>Obama </strong>himself traveled up to Stamford to attend a fundraising dinner for Dodd, <a href=",0,7582736.story">praising</a> his efforts to push for robust financial regulatory reform. But -- as I explained in a TNR <a href="">piece</a> earlier this year -- Dodd faces an uphill battle to dissociate himself from the deep-pocketed financial interests that reside in his state and <span dir="ltr" id=":2sl">shower him with campaign contributions, given his chairmanship of the Senate Banking Committee</span>. And a few of yesterday’s local Connecticut races pointed to some of the political challenges that Dodd is already facing. </p> <p>In Stamford’s mayoral race, for example, Pavia <a href="">railed</a> against the Democratic incumbent for favoring the financial titans over the town’s small businesses, recalling the kind of criticisms that Simmons has levied against him over the AIG bonus scandal and federal bank bailouts. Simmons, for one, has already taken the opportunity to link 2009 with 2010, <a href="">blasting</a> Dodd for being his role in the “economic meltdown and its myriad of failed responses” in the same breath that he praised yesterday’s GOP victories in the state. </p> <p>To be sure, Dodd could still have an opportunity to come back if the health-care bill and robust financial regulatory reform pass successfully. And if his Banking chairmanship makes him an easy target during economic hard times, he could conversely reap political rewards if the economy recovers to the public’s satisfaction next year. Either way, though, it seems unwise to overlook yesterday’s Republican victories in Dodd’s home state as insignificant. In a state that was at ground zero of the financial crisis, with a federal lawmaker who’s tried to guide its economic recovery, local and national concerns can be one and the same. </p> <p><em>--Suzy Khimm</em></p> </div></div></div> Thu, 05 Nov 2009 16:01:09 +0000 201038 at Suzy Khimm Potential Abortion Compromise Gets Closer Look. <div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"> <p>House leadership is still struggling to find a compromise on abortion provisions that could threaten to derail the health-care bill, which they are trying to bring to a vote as early as this weekend. Yesterday, Indiana Rep. <b>Brad Ellsworth</b>, an anti-abortion Democrat, <span dir="ltr" id=":3ii">put out his own amendment to try to break the legislative deadlock</span>. While Ellsworth has many of the same concerns as <b>Bart Stupak</b>, the Michigan representative who has <a href=";year=2009&amp;base_name=is_stupak_really_willing_to_ma">threatened</a> to hold up the bill with at least 39 others for not going far enough to prohibit federal funding of abortions. So what is Ellsworth asking for? Here’s the gist of his <a href=";task=view&amp;id=544">proposal</a> (abridged for length): </p> <ul><li>Explicitly prevents all federal tax dollars from being used to provide abortions in the public option; </li> <li>Prohibits any funds from the U.S. Treasury from paying for abortion services in any of the plans purchased through the proposed Health Insurance Exchange; </li> <li>Establishes clear, strict rules for separating public funds from the premiums of private individuals; </li> <li>Guarantees every American participating in the Health Insurance Exchange will always have access to a pro-life insurance option; </li> <li>Expands conscience protections to prevent the government from discriminating against pro-life health insurance plans.</li> </ul><p>Now, what's the difference between the Stupak and Ellsworth proposals? </p> <p>The current version of the bill requires each state to have one insurer that provides abortion services and one that does not. As I explained earlier this week, Stupak's main problem is that the bill allows insurers who provided abortion services to participate in the exchange, which has participants supported by government subsidies. Stupak would thus categorically prohibit any insurers in the exchange from offering abortion coverage. Meanwhile, Ellsworth's proposal seems to require that the exchanges only have an anti-abortion insurance option, without necessarily guaranteeing an option that provides abortion services. </p> <p>The reality is that most insurance companies do <a href="">cover</a> abortion services, making it fairly likely that a pro-choice insurer would be included. But Ellworth's proposal suggests that might not be guaranteed, though outside observers say it won't be entirely clear until the amendment's legislative language is released. The other provisions of Ellsworth's amendment <a href="">suggest</a> that the public plan would either prohibit any abortion coverage or have the public plan use money from private insurers (i.e. not Treasury's) for such coverage. </p> <p>The Ellsworth proposal has already attracted criticism from <a href="">reproductive rights</a> and <a href="">anti-abortion</a> groups -- though anti-abortion advocates were far more vehement in their attack. While Planned Parenthood said they were "concerned" about the effect of the amendment on women's rights, the National Right to Life Committee called the move "a phony compromise" that is "only intended to wrap the pro-abortion provisions in additional layers of concealment," as <em>Politico </em><a href="">reported</a>. Ellsworth has <a href="">received</a> the green light from the House leadership to try to whip other pro-life Democrats to support his compromise. </p> <p>While Stupak is "reviewing" Ellsworth's alternative, he is "continuing to hold firm" in supporting his own proposal, Stupak spokesperson <b>Michelle Begnoche</b> said today. But though Stupak might still be willing to <a href=";year=2009&amp;base_name=is_stupak_really_willing_to_ma">compromise</a>, it's unclear whether the House leadership will have the time or patience to <a href="">keep</a> negotiating with him further. If the Ellsworth alternative manages to strip away enough of Stupak supporters, it could be enough to move the bill forward. </p> <p><em>--Suzy Khimm</em></p> </div></div></div> Wed, 04 Nov 2009 23:17:06 +0000 201036 at Suzy Khimm Could Ending CHIP Be Good for Health Reform? <div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"> <p>Medicare and Medicaid aren't the only public insurance programs that could undergo a major overhaul under the current health-care reform bill. Over at <em>The Washington Independent</em>, <b>Mike Lillis</b> <a href="">explains</a> how the House bill proposes to eliminate CHIP -- the state children's health-insurance program that has enjoyed broad-based support from Democrats -- and move the low-income children covered by the government program into the health-insurance exchanges by 2013. The goal in doing so, Lillis <a href="">says</a>, is "to get family members under the same plan, to centralize control of the state-run CHIP program, and to shift more folks into private coverage to win the support of both the insurance lobby and moderate Democrats." </p> <p>Opponents of the move point to independent findings that the cost of insurance for children covered by CHIP could rise if they entered the exchange and that they could lose many of the protections they currently have under the public program, which covers children from low-income families that are above the cutoff for Medicaid. Sen. <b>Jay Rockefeller</b> <a href="">invoked</a> many of these arguments during the Finance Committee's markup of the bill, maintaining that young children shouldn't be subject to the whims of the private market, and successfully prevented the program from being eliminated in the Senate bill. </p> <p>I agree that it's important to pass additional protective measures to ensure that the benefits for these children remain comprehensive and affordable. Certainly, it would be a political disaster if Democratic reform disadvantaged low-income kids. That being said, if CHIP's dismantling ended up moving more folks into the health-insurance exchange, it wouldn't simply be a boon for "the insurance lobby and moderate Democrats." It could <a href="">strengthen</a> one of the most fundamental parts of the Democratic reform package -- a robust insurance exchange with a pool of participants that's large enough to drive down costs precisely <em>because </em>insurance companies have an incentive to jump in and compete for customers. Moreover, folding CHIP into the exchange would add a younger, healthier pool of participants to the exchange, offsetting its potential of becoming a dumping ground for the sick and elderly. Finally, CHIP has always suffered from under enrollment -- about 6 million children aren't insured in the program who should be -- and by bringing whole families in under the same plan, more children will be covered. </p> <p>Given CHIP's popularity among Democrats and the success it's enjoyed, the proposal to eliminate the program could still be a legislative sticking point when it comes to putting the House and Senate bills together. But it's also important to remember that the program was created in the wake of Clintoncare's failure in 1994 -- a stop-gap measure, let's say, to insure that some of the country's most vulnerable citizens were covered. This time, Democrats have the chance to pass a truly comprehensive reform package and to implement changes that could help a much broader swath of the population -- kids included.</p> <p>--<em>Suzy Khimm</em></p> </div></div></div> Tue, 03 Nov 2009 23:50:22 +0000 201023 at Suzy Khimm The Lobbying Underground. <div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"> <p>Are lobbyists really fleeing <b>Obama</b>’s Washington? Yesterday, the Center for Responsive Politics and OMB Watch jointly <a href="">released</a> a study revealing that some 1,400 lobbyists de-registered between April and June this year -- about 8 percent of the total number of registered lobbyists. Normally, only a few hundred lobbyists leave every quarter, but the exodus happened soon after Obama issued an executive order that imposed new rules on lobbying, restricting lobbyists' ability to serve in the administration and to have direct access to officials handling TARP and the stimulus package. The departures of registered lobbyists now outpace the number of new registrations each year, and the trend is only accelerating.</p> <p>Some have interpreted the news as a sign that the Obama administration has effectively fulfilled its pledge to crack down on lobbying. “It’s been a rough few years for lobbyists,” <b>Brody Mullins</b> <a href="">proclaimed</a> in <i>The Wall Street Journal</i>, adding that K Street has also borne the brunt of the recession."They have been attacked by President Barack Obama ... and they have been hurt by the economy. And many have decided they’re not going to take it anymore.” And some liberal outlets immediately cheered the news: As <i>Mother Jones</i> <a href="">tweeted</a>, “Good riddance, lobbyists.”</p> <p>But have all these lobbyists really fled the profession -- or have some returned under different guises? As OMB Watch and CRP <a href="">note</a>, many lobbyists who appear to have left have come back as unregistered lobbyists with executive titles like “senior adviser” or “consultant” to avoid having to comply with federal lobbying restrictions. One lobbyist I contacted confirmed this trend in an e-mail today:</p> <blockquote><p>For people wanting to reenter government, or who interact with "covered officials" not having to register as a lobbyist makes a job more attractive. At our firm we have brought attorneys who are not registered and used them to meet with officials who refuse to see lobbyists… I don't think many people have left the profession, in fact I'd bet the business of influencing government has actually grown over<br />the last year – registrations not withstanding.</p></blockquote> <p>If the Obama administration really wanted to crack down on the influence of lobbying, it could force anyone who met with officials “covered” under the current lobbying restrictions to register -- and cut down on the legislative earmarks that still abound. Moreover, OMB Watch’s<b> Lee Mason </b>told me, the White House (as well as Congress) could decide to disclose the meetings and communications it has with all the lobbyists and advocates it courts.</p> <p>Without taking these kind of measures, the system “basically disadvantages the people who play by the rules while creating a whole new underground influence game that flouts a law that can't be enforced,” the lobbyist source concluded. As it currently stands -- and as the debates over <a href="">health care</a> and <a href="">financial regulation</a> have made abundantly clear -- Obama’s anti-lobbying efforts haven’t certainly diminished the clout of K Street.</p> <p>--<i>Suzy Khimm</i></p> </div></div></div> Tue, 03 Nov 2009 20:20:53 +0000 201018 at Suzy Khimm Is There a Local-National Enthusiasm Gap in NY-23? <div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"> <p>The race in New York’s 23rd Congressional District has turned into nothing less than a passion play for many of the election’s liberal observers: Moderate Republican gets <a href="">martyred</a> by an insurgent grass-roots base purging members who don’t meet the conservative purity test. When the news broke about Republican <b>Dede Scozzafava</b>’s withdrawal from the race,’s <b>Erick Erickson</b> <a href="">exulted</a>: “I said this was our hill to die on, but to paraphrase Patton, we won my [sic] making the other guys die on our Hill!” </p> <p>There’s no doubt that candidate <b>Doug Hoffman</b> fits the mold of a tea party-friendly conservative, railing against tax increases, the stimulus, abortion, health-care reform, and gay marriage. But while the race has served as the perfect stage for high-voltage conservative leaders (with matching campaign funds) to swoop in, there’s also an underlying disjuncture between the national movement and the local electorate -- one that may point to some of the potential limits of the tea-party revolution. </p> <p>Over at FiveThirtyEight, <b>Nate Silver </b><a href="">points out</a> that despite the love that Hoffman has received from the right, there’s a distinct enthusiasm gap between the national and local grass-roots -- at least in terms of how much money they’re willing to put on the table. While Hoffman <a href="">enjoyed</a> a last-minute fundraising surge from national conservative PACs, raising over $200,000 in one week last month, the amount of local contributions has been puny. According to Silver’s rough calculations, Hoffman’s itemized contributions from within the district totaled only $12,610 through Oct. 15. Meanwhile, Democrat<b> Bill Owens</b> raised some $151,520 -- over 10 times as much. The huge gap suggest that the ideological makeup of the district doesn’t match the national enthusiasm for the race. After all, even New York’s own conservative party hasn’t always conformed to Glenn Beck’s ideological proclivities, having backed <b>George Pataki</b>’s gubernatorial candidacy in 1998 and 2002, despite the moderate Republican’s pro-choice <a href="">views</a>. </p> <p>Of course, the unusual circumstances, endorsements, and national money could end up putting Hoffman <a href="">over the top</a> tomorrow, potentially growing the coffers of similar candidates within the next year. But it’s also quite possible that that the local-national disjuncture could catch up to the Republicans if they decide to take NY-23 as a sign that they should push hard to recruit and fund more conservative, tea-party-friendly candidates across the board, without connecting to the local electorate. Without reconciling the national grass-roots fervor with the voters on the ground, the GOP could conceivably overestimate how red some swing-districts are really leaning and how far it can stretch campaign dollars to fill in the enthusiasm gap. </p> <p>--<i>Suzy Khimm</i></p> <div><i>Update</i>: <span class="Apple-style-span" style="color: rgb(0, 0, 0); font-family: arial,sans-serif;"><i>The Washington Independent </i><a href="">crunched</a> the numbers and found that only $12,360 of the $265,341 of Hoffman's campaign funds came from within his district. That's 95 percent out-of-district contributions. (h/t Andrew Sullivan) <p></p></span></div> </div></div></div> Mon, 02 Nov 2009 22:53:36 +0000 201009 at Suzy Khimm Is Stupak Really Willing to Make an Abortion Compromise? <div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"> <p>Would Democrat <b>Bart Stupak</b> really vote against the health-care bill if it contains the existing language on abortion? The Michigan representative has raised alarm bells among liberals for threatening to derail the House bill if certain abortion-related provisions aren't taken out. The Democratic leadership claims that the bill contains multiple restrictions to prevent the federal funding of abortions and restrict access -- <a href="">measures</a> that have actually raised the hackles of leading pro-choice organizations. But Stupak claims the bill doesn’t go far enough, as it still gives subsidies to individuals who could have access to insurance plans that cover abortions -- even the Capps amendment sets up a firewall to prevent subsidy money from going to abortions. Stupak's now trying to prohibit any coverage of abortions within the exchanges. Last week, he claimed that 39 other House Democrats supported his effort to strip out the provisions. And on Friday, <a href="">Democrats for Life of America</a> (DFLA) added a few to the tally, claiming that it had gotten commitments from 43 House Democrats who <a href="">said</a> they'd oppose the bill if Stupak "is not allowed to offer his amendment or his language is not included," according to the right-leaning <em>CNS News</em>.</p> <p>But DFLA's straw poll brings a notable distinction to light -- the difference between opposing the bill if the amendment's not brought to the floor, and opposing the bill if the abortion language is in there at all, no matter what votes are taken. And Stupak has put himself firmly in the first camp, as he <a href="">explained</a> at an Oct. 24 town hall:</p> <blockquote><p>If everything I want [is] in the final bill, I like everything in the bill except you have public funding for abortion, and we had a chance to run our amendment and we lost. OK, I voted my conscience, stayed true to my principles, stayed true to the beliefs of this district, could I vote for healthcare? Yes I still could. </p></blockquote> <p>Stupak's response drew jeers from the crowd, and conservative media outlets immediately assailed him for not taking a harder line. <em>Fox News</em> <a href=",2933,570430,00.html">accused</a> him of "trying to have it both ways," and <em>Life Site News </em>quoted a source <a href="">calling</a> the comments a "game-changer" and a "disaster." </p> <p>At the least, Stupak's remarks underscore the fact that he isn't dead-set upon opposing the bill -- and that a compromise is within reasonable striking distance. As<em> RH Reality Check</em> <a href="">points out</a>, Stupak conferred with <b>Henry Waxman</b> about abortion issues in the bill back in July. The details of a current compromise have yet to surface. But if it's true that Stupak's effort is gaining steam, <b>Nancy Pelosi</b> will surely try to hurry the deal-making along.</p> <p>--<em>Suzy Khimm</em></p> </div></div></div> Mon, 02 Nov 2009 19:01:37 +0000 201006 at Suzy Khimm Pleased to Make Your Acquaintance. <div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"> <p>I'm Suzy Khimm, and I'm delighted to be guest-blogging here this week. Before I dive into the wonderful world of wonkery, a bit more about me: I currently <a href="">work</a> at <em>The New Republic</em>, where I spend much of my time reporting on Congress, particularly the ins and outs of health-care reform. You'll find a lot of my recent writing on <a href="">The Treatmen</a>t, <em>TNR</em>'s health-care blog, where I'm lucky enough to work with <em>TAP</em> alum <b>Jonathan Cohn</b>. I've also written profiles of some of the key players behind the scenes and on the campaign trail, explaining the <a href="">reasoning</a> behind <b>Ben Nelson</b>'s political heresies, the <a href="">origin</a> of <b>Chris Dodd</b>'s woeful re-election prospects, and the <a href="">downfall</a> of the last New England Republican in the House. </p> <p>Before coming to D.C., I was <a href="">working</a> in Cambodia as a freelance writer and editor at the English-language <em>Cambodia Daily</em>. Before that, I was based in Brazil, <a href="">writing</a> about human-rights issues and <a href="">teaching</a> in a women's prison. At heart, I'm interested in how the personalities and power struggles up above shape the social policies that affect the rest of us. What does that mean in Washington this week? I look forward to finding out. And for those of you itching for real-time updates, one more plug: You can follow me on <a href="">Twitter</a>, too. </p> <p>--<i>Suzy Khimm</i></p> </div></div></div> Mon, 02 Nov 2009 17:27:22 +0000 201004 at Suzy Khimm