WASHINGTON – It was a bold response to skyrocketing health insurance premiums. President Barack Obama would give federal authorities the power to block unreasonable rate hikes.
Yet when Democrats unveiled the final, incarnation of their health care bill this week, the proposal was nowhere to be found.
Ditto with several Republican ideas that Obama had said he wanted to include after a televised bipartisan summit last month, including a plan by Sen. Tom Coburn of Oklahoma to send investigators disguised as patients to hospitals in search of waste, fraud and abuse.
And those "special deals" that Obama railed against and said he wanted to eliminate? With the exception of two of the most notorious — extra Medicaid money for Nebraska and a carve-out for Florida seniors faced with losing certain extra Medicare benefits — they are all still there.
For the White House, these were the latest unfulfilled commitments related to Obama's health care proposal, starting with his campaign promise to let C-SPAN cameras film negotiations over the bill. Obama also backed down with little apparent regret on his support for a new government-run insurance plan as part of the legislation, a liberal priority.
But was it all the president's doing?
In the cases of the insurance rate authority, the Republican ideas and the special deals, it came down to Obama making promises that Congress didn't keep. He can propose whatever he wants, but it's up to Congress to enshrine it into law.
Arguably, the president could have foreseen that outcome, and was making a low-risk p.r. move by floating proposals — dismissed by critics as insubstantial anyway — whose demise he couldn't be blamed for.
While the White House worked hard to trumpet Obama's plans for the rate authority, his embrace of bipartisanship and his opposition to special deals, the administration hardly advertised the lack of follow-through. Understandable, certainly, but perhaps not the new way of doing business that Obama promised to bring to Washington.
Removing the special deals ran into opposition from powerful lawmakers including Sens. Chris Dodd, D-Conn., and Max Baucus, D-Mont. The rate-limiting authority and the Republican ideas were left out of the legislation because the bill is going to be considered under special filibuster-proof Senate rules that prohibit provisions that don't have a budgetary impact, and those ideas don't fit in.
"There are a number of proposals that the president wanted to incorporate into the legislation including additional Republican proposals, but the parliamentarian ruled against allowing those proposals to be included," said White House spokesman Reid Cherlin. "We would like to enact those proposals in separate legislation in the coming months. In the meantime, some important Republican measures remain."
Of the four main Republican ideas Obama endorsed, only one made it into the final bill — a proposal embraced by Sen. Charles Grassley of Iowa to bump up payments to primary care physicians under Medicaid. A proposal to expand the use of health savings accounts was rejected out of hand by congressional Democrats, while a plan to increase funding for medical malpractice reform projects was also determined to be undoable under fast-track Senate rules.
Coburn's spokesman, John Hart, complained that Democrats "found time to buy votes with earmarks but couldn't include bipartisan ideas endorsed by President Obama." House Minority Leader John Boehner, R-Ohio, had dismissed the GOP ideas Obama endorsed as "bread crumbs" sprinkled atop the health bill — and now even most of those bread crumbs are blown away.
At the same time, Baucus got to keep a provision to give Medicare benefits to asbestos-sickened residents of Libby, Mont., and Dodd still has one that could result in a new hospital being built at the University of Connecticut. Both senators argue their special deals aren't really special deals, because the Medicare provision could apply to other places where public health emergencies are declared, and other sites outside of Connecticut could be eligible for the hospital.
Most of the provisions of the health care bill don't kick in until 2014, so Obama still has time to make good on everything he promised — or try to get Congress to do so.
"To hold the president accountable for every single provision he advocates for is simply unreasonable," said Alec Vachon, a health policy consultant and former Republican Capitol Hill aide. "Some things aren't in there because the members of Congress who have the votes don't want it. Some things aren't in there because congressional rules which Republicans will be enforcing won't allow it. But Democrats will have three years to tinker with health reform before universal coverage goes live."