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Sunday, July 25, 2010

Herseth Sandlin Wanted Tougher Health Insurance Reform?

Is Congresswoman Stephanie Herseth Sandlin a bigger liberal on health care than I thought? Here's a puzzler I've been trying to sort out for over a week.

A while back I fired off some grouchy missive to the Congresswoman's office about her position on health insurance reform. On the 16th, I received a reply from the Congresswoman's office. SHS says she digs the following big points of the reform passed in March:
  1. ending rescission and pre-existing condition exclusions
  2. extending kids' coverage on mom and dad's policy until age 26
  3. creating health insurance exchanges (more transparency and competition)
  4. reauthorizing of the Indian Health Care Improvement Act.
Yeah yeah, whatever, I thought, bracing myself for the familiar Blue Dog triangulation. She harped first on cost (as if any of us thought we could achieve reform without spending money). But then I started to hit lines that sounded more like they came from my man Dennis Kucinich.

SHS criticizes the watering-down of the excise tax on high-cost insurance plans. The Senate excluded more plans and delayed implementation of the tax until 2018. SHS appears to say she wanted a stiffer tax sooner to reduce overutilization and help pay for the reforms. In other words (pay attention, Kristi), SHS wanted more taxes on rich people with Cadillac insurance plans.

SHS says she wanted a tougher Independent Medicare Advisory Board. Some observers say this board as enacted still has some teeth. SHS, however, indicates she wanted more and again cites a delay in implementation (this time until 2015). Again, SHS wanted more government clout in health care sooner.

SHS includes some niggly-porky bits in her rationalization for opposing the bill: absence of inflation indexing from the Medicare Hospital Insurance Tax, increasing Medicaid costs for South Dakota, the medical device tax that South Dakota employer 3M doesn't like, and the inclusion of student loan reform in the reconciliation bill (SHS still prefers the Rube Goldberg system of federal subsidy for private profiteers).

But on two big points, SHS comes out sounding like she wanted a tougher health insurance reform bill, with stronger government action, the kind of liberal position that I think health care needs. That's certainly not the narrative I was hearing last year or even in SHS's most recent ad. Was I just not paying attention? Could the SHS narrative on health care be more complex than I in my Kucinichian froth recognized? Or might SHS be getting ready to wage the fight I want her to fight?

Related: President Obama sends a surprise video to Netroots Nation and tells liberal bloggers to "keep making your voices heard; to keep holding me accountable; to keep up the fight." Yes sir, Mr. President! Now about passing single-payer and repealing the Patriot Act....


  1. As you might surmise, for the sake of continuing marital bliss, I must be very delicate in the way I comment on SHS. But as I indicated in a recent post, hers and the Blue Dog's position on the health care bill appeared to be as obstructionist as the Republican's. It seemed to be "our way or no way at all." I certainly never heard their alternatives presented in the way you summarize. It is almost as if the rationales came after the fact. There are still too many people excluded who should not be, but maybe the focus will be on improvements as HCR is implemented.

  2. I appreciate your careful words, David. Dennis Kucinich certainly proposed a number of clear alternatives, but in the end, he was able to see the bill as a step toward the much more radical alternatives he wanted and vote for it. SHS's stated objections seem much less radical than Kucinich's, and much less difficult to build onto the current law with future legislation... yet she still said no to building the foundation. I'm still trying to sort the position out. Anyone else?

  3. SHS wanted more taxes on rich people with Cadillac insurance plans.

    Easy there. As a Federal employee, I have access to so-called "Cadillac health insurance" -- it's actually a bit more like a dependable Yugo, and it goes up 10-15% a year for us too.

    To me the thing limiting meaningful reform is not cost, but the refusal of the health care biz and the wealthy to share those costs equitably.


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