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Mr. Wyden's moment

Posted by John McDonough  January 6, 2014 09:23 PM

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One transition almost certainly ahead in 2014 is the chairmanship of the U.S. Senate Finance Committee (SFC). I know -- inside baseball. But this will matters for many key issues, not the least of which is national health policy. And the likely new chairman has a compelling and unorthodox profile on health reform, and some trophies on the wall for his efforts.

The current chair, Sen. Max Baucus of Montana, is President Obama's choice to be the next US baucus wyden.jpegAmbassador to China. His certain SFC successor will be Sen. Ron Wyden of Oregon. To say that Baucus and Wyden did not see eye-to-eye is putting it mildly. (Picture on right shows Wyden on left and Baucus in center; Hatch and Grassley to Baucus' right.) In spite of a shared tendency to cross party lines and find alignment with Republicans on controversial issues (Baucus supported the '01-03 Bush tax cuts and '03 Medicare drug benefit; Wyden co-wrote a radical Medicare reform plan in 2011 with Rep. Paul Ryan), neither has joined the other's fan club.

It was in 2007 when Wyden really stood out by introducing a comprehensive national health reform plan known as the "Healthy Americans Act (HAA)." It was noteworthy substantively and politically. Substantively, it was far bolder than the Affordable Care Act (ACA), proposing the near elimination of the federal tax subsidies for employer sponsored health insurance, and requiring that nearly everybody (except Medicare enrollees) buy their coverage through a form of health exchanges, with income-based subsidies for the neediest. No more Medicaid or CHIP. It was universal coverage with everyone treated the same based on income. The Congressional Budget Office scored is as deficit neutral in year one and going forward. Though Wyden made adjustments along the way to smooth the politics, he held to the basic formula.

On the politics, Wyden really surprised. Right out of the box, he recruited a surprising Republican lead co-sponsor, conservative Utah Senator Robert Bennett (hence the shorthand title: Wyden-Bennett). He only allowed additional members to sign on as co-sponsors in bipartisan pairs, two by two, the Noah's Ark of health reform, and the highpoint reached a total of 16 sponsors, including Republicans such as Judd Gregg of New Hampshire and Lamar Alexander of Tennessee. For a while, DC talking heads were gaga about Wyden's plan because it was bipartisan, and included both individual and employer mandates to boot. Later, just about all Wyden's Republican co-sponsors made it clear that they would not vote for the HAA as written, and signed on only to signal their interest in bipartisanship. Bennett lost his Senate seat in 2010 to a Tea Party conservative, significantly because of his partnership with Wyden on the HAA.

There was more irony. Max Baucus and Ron Wyden were perhaps the only two Democrats in Washington who wanted to finance health reform by eliminating or sharply reducing the federal tax deduction for employer sponsored health insurance. But their shared passion did not bring them together. Baucus was decidedly not a fan of Wyden's plan, substantively or politically. On substance, Baucus bought the logic that the 1994 Clinton plan tanked because it promised to change health insurance for everyone, a promise that Clinton's opposition rode to victory. Big business and labor adamantly opposed tanking the insurance tax deduction and bad-mouthed Wyden's plan all over town. Beyond that, Baucus felt there was room for only one health reform hero from his Committee, and it was not going to be Wyden. It would be tough enough to compete with Ted Kennedy, and he didn't need a competitor on his own Committee.

In 2008, Wyden began losing support among his 16 as the spotlight turned to Baucus and Kennedy, with Wyden able to find no path forward. Instead, he supported Baucus' efforts while looking for ways to insert his pet ideas into the Baucus plan. One pet was called "free choice vouchers" to allow individual workers, whose employer coverage was too expensive, to grab the employer premium contribution and use it to buy individual coverage on the Exchange. With strong opposition from business and labor, Baucus blocked its path in the SFC in their markup sessions in September/October 2009; in December 2009, though, Wyden played hardball with Majority Leader Harry Reid and got the waiver provision inserted into the final Senate health reform legislation and thus into the ACA that Barack Obama signed on March 23 2010.

His victory didn't last.

In the April 2011 deal on raising the federal debt ceiling limit, the dealmakers, including Baucus, repealed the Wyden free choice provision, even though it had zero debt or budget implications. Wyden felt betrayed and was furious.

Now it will soon be Senate Finance Committee Chairman Ron Wyden.

Wyden got another piece into the ACA that will survive. Section 1332 is titled "State Innovation Waivers" and allows any state, beginning in 2017, to obtain a federal waiver to set up their own plan to replace the key sections of the ACA in whole or in part as long as the replacement covers at least the same number as would be covered in the ACA, includes at least the same benefits and cost sharing protections, and doesn't increase the federal deficit. Vermont sees 1332 as an essential part of their strategy to create a state-based single payer system beginning in -- 2017. Now, if anyone tries to mess with 1332, they will have to get past Ron Wyden (unless, of course, the Rs win back the Senate in November 2014, a real possibility).

Wyden thought he was building a new bipartisan bridge to the future in 2011 when he co-wrote a Medicare reform plan with House Budget Chair Paul Ryan (R-WI). The bridge became a plank that no Democrat would walk as Republicans gave Wyden their 2011 BFF award.  Finally Wyden had to separate himself publicly from the plan he had helped to author.

Thinking big means taking risks and being willing to end up on the wrong side. I admire Wyden as an individual who things big, takes risks, cares about ideas, and brings passion to his work. He will probably do things I will strongly dislike, and some things I will appreciate. He's going to be an interesting, dynamic chairman and I look forward to his tenure.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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