Louisiana Has Shaped Healthcare Debate

Congress, or congressional Democrats, move closer to passing major healthcare legislation that would extend insurance coverage to nearly all Americans, whether they want it or not. Major provisions, from the public option to employer mandates and taxes, are still to be decided. But barring some intra-party blow-up, and a Republican goal-line stand notwithstanding, the president most likely will get a bill that will largely reshape the healthcare system.

As a recent public opinion poll indicates, voters in few states are more opposed than in Louisiana to what President Obama and Democratic leaders propose. The Southern Media survey showed 58 percent of respondents oppose "the Obama administration healthcare reform position" to 36 percent who favor it. That should be no surprise to anyone who attended any of the town hall meetings on the subject held in Louisiana in August and September.

Yet, despite that strong local opposition to the Democrats' plan, few states' voters have done more to move it forward than in Louisiana. They re-elected Mary Landrieu.

Because of last year's election, which was closer than polls and pundits predicted, John Kennedy is not the junior senator from Louisiana, Republicans do not have 41 votes to maintain a filibuster, and Democrats have just wide enough a window to push through most of what they want in a bill. The handful of Minnesota voters who provided the thin margin of victory for liberal Democrat Al Franken are just as responsible. Yet, with the possible exception of Sen. Blanche Lincoln of Arkansas, who is up for re-election next year, no Democratic senator is swimming against a stronger tide of public opinion than is Landrieu by even considering voting for the bill under discussion.

But for the choice made by Louisiana voters last year, the president and liberal Democrats would not have as strong a hand in fashioning maximum change.

Landrieu has not committed to support whatever bill emerges. But she, who wants to find a way to expand coverage to 650,000 uninsured Louisianians, is in a key position to negotiate major aspects of a final bill and, as these things go, to get something in return for the state for her vote. As for accountability, she must face the voters again in 2014. For the next five years, however, she will work within a possible Democratic majority either as a player or a marginalized maverick, largely depending on this vote.

She has maintained her opposition to the controversial public option provision, which appeared to be killed a few weeks ago, but, appropriate to the season, has returned from the dead. Many voters oppose the government getting into the health insurance business on conservative philosophical grounds, even though senior citizens can't imagine life without Medicare and the middle-aged can't wait to get on it. Another major concern is that many workers would be forced into the public system because their employers will dump private healthcare plans for it. There is strong disagreement that would be the case, just as it is irrelevant to growing numbers of the self-employed and those whose employers don't offer health insurance.

The resurgent public option would be a major problem for Landrieu but for the best idea to come out of the whole healthcare debate, an opt-out provision for the states. This would allow Landrieu to vote for a bill that contains a public option, knowing full well that state legislators will be falling over themselves to vote to keep the government-run plan out of Louisiana.
More than just a political solution, the opt-out idea would set up a national experiment that would compare states with public options to those without. Over the not-so-long-term, the fears of government-run insurance plans will be confirmed or dispelled state by state, instead of by Congress betting one way or the other.

There are other hard points for Landrieu to settle on, such as employer or individual coverage mandates, funding restrictions on abortions, how much it will cost and who will pay. But by her statements, it's clear the senator is looking for more reasons to vote with the president and her party than against. That would not be her choice to make had voters chosen differently last fall.