With the public option dead, progressives are looking for something else to get out of negotiations and moving up the list is the possibility of speeding up implementation.
When the two chambers meet in conference, House leaders will have a prioritized package of goodies in mind, and they’ll be pushing hard for them. On the list will likely be familiar issues like financing–should wealthy Americans pay for reform, or should a tax on high-end health insurance policies cover the cost, or should it be a mix of the two?
But a separate issue is beginning to come into focus.
“I think one other one, is starting date,” Sen. Tom Harkin (D-IA) told reporters today.The Senate bill is set to implement most of its largest reforms (the mandates, subsidies, and exchanges) in 2014. The House bill kicks into high gear a year earlier, in 2013.
“[Q]uite frankly it ought to even be sooner than that,” Harkin said.
That meshes with the focus of Democratic aides in both the House and Senate–and with one of the House’s leading progressives.
Earlier today, Rep. Raul Grijalva (D-AZ)–co-chair of the Congressional Progressive Caucus–told Greg Sargent that the idea of moving the implementation date forward is of interest to him and other Democrats.
“It would sweeten it somewhat,” Grijalva said, “if they speed up the coverage mechanism.”
Obviously, for political reasons, all Democrats would like to speed up the implementation of this reform package. It’s hard to run for office on the platform of having passed an unpopular bill that hasn’t really done anything yet. But moving day-one forward a year isn’t free. Crucially, it would require the government to cover an extra year’s worth of premium subsidies in the CBO’s 10 year budget window. And that would cause the price tag of the bill to jump noticeably.
Conservative Democrats have blanched at the idea of voting for a bill with a significantly higher pricetag than the bills that are on the table right now, so it would be a complicated trade-off. And there are other outstanding issues as well, including whether to organize insurance exchanges at the state or national level. But implementation is worth keeping an eye on.