What’s Wrong With the Finance Bill? An Interview With Sen. Jay Rockefeller

Ezra Klein, Wash Post, Sept 22 2009

Sen. Jay Rockefeller (D-W.Va.) chairs the Finance Committee’s Health Care Subcommittee. His support will be crucial — maybe even decisive – in getting health-care reform out of the Finance Committee. And he’s been very public about his unhappiness with the bill. I spoke with the senator about his concerns this morning. An edited transcript follows.

Can you support the Finance Committee bill in its current form?

No.

Why?

There are a number of big things. The Children’s Health Insurance Program is put into the exchange. That’s like putting it into a farmer’s market. It loses its defined benefits. And children need defined benefits.

Obviously the public option. I feel very strongly about that as a discipline on the private health insurance market. The public health insurance option doesn’t have to make a dime. It doesn’t have to make Wall Street happy or shareholders happy. It just has to sell a product at cost. That will put pressure on private insurance companies to bring down their premiums. What’s the alternative? My staff has done extensive research on co-ops and everyone says they can’t do health insurance. The best health care co-op exists in the state of Washington, and both of Washington’s senators are adamantly for a public option. That ought to tell you something.

Another issue is that 46 percent of the American people have health insurance from fairly large companies that self-insure. And they’re not included in the regulations. They have to have protection from preexisting conditions and lifetime caps and rescissions too. People hear that the regulations in the bill don’t apply to these companies and they think it’s not possible. But it’s true. And it’s almost half of the insurance market!

Another piece is the MedPAC proposal. if you really want to be honest about it, eight to 10 percent of the members of Congress understand health care. At maximum. I chaired the intelligence committee, and health care makes it look like riding on a tricycle it’s so complicated. So what you have is lobbyists picking on congressmen who don’t know health-care reform, and they say, you know what, you could get a lot more jobs in your state if you only put more money into oxygen or a certain medical device. If you’re going to do Medicare right, understanding that the trust fund is going to go downhill in 2016, you can’t have Congress making these decisions. You need professionals.

That’s why I have well over 25 amendments ready for Tuesday.

Is this bill affordable?

Of course it isn’t. That’s where you get into the area of premiums and subsidies. We’ve got a big Senate Democratic caucus on this and we meet a lot. Everybody is really upset about affordability. it’s so easy to say you’ve done something, but it’s not yet enough for them to afford health insurance.

On the MedPAC issue, I’m always a bit appalled that you’re at the forefront of this. Shouldn’t Sen. Jay Rockefeller be pushing affordability, while Sen. Judd Gregg, or Chuck Grassley, pushes for entitlement reform? How did this too get left to the Democrats?

To be fair, it’s not all cost control. To give you an example, everyone is afraid of discussing end-of-life because they think you’ll kill granny. It’s nonsense. We train geriatrics in our medical schools. After a few years of practicing geriatrics, however, they go into other specialties that make more money. You could raise how you reimburse geriatricians so they stay in geriatrics. And since end-of-life care is so expensive, it would be good to have more doctors working on that. It’s not all about cutting. Some of it will be about increasing.

What’s the mood in the Democratic Caucus like right now?

There’s very hot discussion. At the second-to-last meeting with Baucus, Democrats really let loose at Baucus. When you’re getting close to the time you need to vote, public policy takes on a new type of intensity. Baucus, to his credit, had another meeting last night, and it was the best meeting we’ve ever had with the chairman. He told me they’d make sure CHIP is preserved. He knows he needs our votes. That’s why I said I wouldn’t vote for the bill. Democrats need leverage.

What about Olympia Snowe?

I think the world of Olympia Snowe. She’s got incredible courage, and the Republican leadership is brutal in the way they apply pressure. Much more so than the Democrats.

How so?

For example, when Clinton was elected president, and George Mitchell was majority leader, [Clinton] came to our Democratic Caucus, because he thought it would be nice to break bread with us. Mitchell told him he had to leave. They were part of different branches of government. And so Clinton and his Secret Service had to turn around and walk out. It was a historic moment. On the other side, there were very few caucuses that Dick Cheney didn’t attend himself. That’s why whether it’s intelligence or environment or elsewhere, they bring the hammer down in a way Democrats aren’t good at, which I’m sort of glad about.

How do they do this to Snowe?

They bring the hammer down on her, and I’m not going to say how. She’s very strong, and she represents a very rural state that has gone blue. So I don’t know what she’s going to do, and I’ll respect her whatever she does. But we need her vote, as Republicans filibuster every single amendment or item we bring out. We don’t have 60 members right now. This is where Olympia becomes very important.

What about reconciliation?

Reconciliation is always there. The public mentions it both publicly and privately. So does Max Baucus. But it’s filled with hazards. The Byrd rule. You can’t do anything that isn’t fully paid for. Points of order can be brought against anything.

You met with the president this week. How did that go?

I can’t talk about that.

Well, what did you tell him?

I gave him eight or nine or 10 things I thought were wrong in the bill. I feel very strongly about them and I said them very strongly and it was a terrific meeting. The 35 percent excise tax has a devastating effect on coal miners because they have good benefits. Suddenly coal miners, who need good health care because you can get black lung and the work is risky, are getting taxed. And I don’t want them getting taxed.

Are you optimistic about getting a bill?

Very. The meeting we had last night helps me say that. Max Baucus does need our votes to get the through the Senate Committee. And there was a coalescence of Democrats that hadn’t been pre-plotted. Some of these members had been quiet, and suddenly they were speaking, and loudly, about what was wrong. And if those things weren’t fixed, they implied they wouldn’t vote for it.

How will you pay for all this?

We’re not sure exactly. We spent the first hour talking only about affordability. But we had to talk about some other things, too. How we’re going to pay for this, I can’t yet answer you. That’s the amendment process. That’s the next few weeks.