Recently the Senate passed Sen. Barbara Mikulski's Women's Health Amendment, which requires health insurance companies to provide free mammograms and other preventive health services for women. Sounds good, doesn't it? Women's health needs have traditionally been underserved by the insurance system. But, ironically, the Senate's excise tax will force many women to pay indirectly for these "free" services.

Here's how: For one thing, the cost of the services mandated in the Mikulski Amendment will cause even more health plans to exceed the cost cap for the excise tax. And it's expected that 20% of plans will already be over the limit when the tax takes effect. In practical terms, any added costs for new services provided by these plans (like those mammograms) will be taxable. So, in one very real sense, the Senate plans to tax some of this preventive care for women - at a staggering 40% of cost.

The Mikulski Amendment looks like a step forward, but many women will pay for these services indirectly - in the form of higher premiums or increased out-of-pocket costs. One hand giveth and the other taketh away. And speaking of irony ...

Guess who voted for the Mikulski amendment? Some Senators who haven't even committed themselves to voting for the final bill, including Lieberman, Landrieu, and Snowe (who even cosponsored the amendment. Here's an idea: They can make sure these women's services really remain "free" by supporting the Sanders-Franken-Brown Amendment, which would replace the excise tax with a tax on the extremely wealthy (the way the house does it.)

That would remove the irony in the Senate's actions and replace it with fairness.

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Andrea Mitchell asked a Villager health-care panel on her show today to discuss how Harry Reid can get to 60 votes with the public option since the "Gang of Four" refuses to budge and threatens to kill health-care reform entirely.

Mitchell: And Ruth Marcus, what do they do, how do they water down the public option to make it acceptable to some of the moderates but placate some of the more liberals?

Marcus: Well, it's the "and still placate some of the more liberals" is the hardest part. You're dealing with a very complex Rubik's cube really at this point because every time you change something to please someone, you're annoying someone else and potentially losing his or her vote.

But the public option, I think, could be scaled back. There is already something that Sen. Carper from Delaware is working on in terms of allowing it to take effect perhaps more quickly in states or immediately in states which have very high costs and other states could opt in. There is Sen. Snowe's old trigger option that one could still pull the trigger on, so there are ways of doing it.

I think that in the end it is possible to mollify enough of the centrist Democrats, perhaps even a Republican -- now that seems awfully remote. The president, I think, is going to have to tell the left wing of his party and the balking liberal Senators that it is crazy to pull down the entirety of health care over this one issue which the president has already said is not the be all end all of health reform.

It's always the liberals who need to compromise their positions to the conventional wisdom of the Villagers. The Gang of Four are all righteous and virtuous while liberals are out-of-control hippies who act like barking dogs. How dare they want to produce a real reform measure that could eventually provide true competition for the health care industry and that will help lower overall health care costs? Outrageous!

Remember, Marcus was being a concern troll the day after America elected Obama to the presidency with a mandate to overhaul health care and wrote a column telling him to not to govern from the left.

Yet the experience of President Bill Clinton's rocky early months -- remember gays in the military? the BTU tax? -- suggests the steep political price of governing in a way that is, or seems, skewed to the left. This risk is particularly acute for Obama, whose opponents have painted him as a leftist extremist. The good news is that his advisers seem exquisitely aware of this trap and determined not to fall into it.

As David Sirota wrote:

The standard lie about Clinton's failures aside (it was NAFTA, stupid), the last sentence is particularly odd. Obama's "opponents have painted him as a leftist extremist." Yet, that supposed "leftist extremist" won the largest presidential mandate in the last generation.

And somehow, having done that, we are supposed to believe that means he should tack to the right.

Say what?

Email Marcus and ask her why the Gang of Four aren't the real problem, since 56 other Senators are fine with the public option: marcusr@washpost.com

This is just plain crazy. Why should one woman in the opposing party have so much power over our futures, just because Obama has a "bipartisan" fetish? This is about offering a protective cover to Blue Dogs; I get that. But man, it's galling that everything gets pulled down to the lowest common denominator by one woman who's been enjoying taxpayer-funded healthcare coverage for a very long time:

WASHINGTON — As the White House and Congressional leaders turned in earnest on Wednesday to working out big differences in the five health care bills, perhaps no issue loomed as a greater obstacle than whether to establish a government-run competitor to the insurance industry.

One day after the Senate Finance Committee approved a measure without a “public option,” the question on Capitol Hill was how President Obama could reconcile the deep divisions within his party on the issue. All eyes were on Senator Olympia J. Snowe, the Maine Republican whose call for a “trigger” that would establish a government plan as a fallback is one of the leading compromise ideas.

No "deep divisions" out here with the overwhelming majority of Democrats, or anyone else for that matter. It's only the Democratic Blue Dogs who have such "dainty" concerns. Oddly enough, the more those members got in contributions from the death-for-profit healthcare industry, the stronger those "concerns" are! Hmm.

Two senior administration officials, speaking on condition of anonymity, said the White House looked favorably on the Snowe plan. But liberal Democrats were maneuvering against it Wednesday, arguing that Ms. Snowe, the lone Republican to vote in favor of the Finance Committee’s bill, was gaining undue influence over the talks.

“It’s one vote, she won’t make the commitment on the final product, and she says she’s got to have the trigger,” said Representative Raúl M. Grijalva, Democrat of Arizona, who is leading an effort in the House to round up votes for a government plan akin to Medicare. “I think the administration has put her in the driver’s seat; it’s very disconcerting.”

Of the many difficult decisions remaining — including how to pay for an overhaul and how many people will be left uninsured — few carry as much political weight for the president as the public option. The plan, which would be for people who do not get health care through their employers, has become a proxy for a larger debate over where Mr. Obama is taking the country.

“What’s going on here is not simply health care and the public option,” said Kenneth M. Duberstein, a chief of staff in the Reagan White House. “In light of the auto bailout, the bank bailout, the stimulus package, the public option fight is a surrogate for how much government is too much.”

I wish all those Members who have such concerns would turn back the government-funded healthcare largesse they enjoy and turn instead to the free market. Perhaps I wouldn't despise them quite so much.

With Democrats split, an array of compromises are being floated — including the nonprofit cooperatives in the Finance Committee bill and the latest idea to capture some Democrats’ fancy, leaving the public option to the states. But economists say few would fulfill Mr. Obama’s stated goal of injecting “choice and competition” into the marketplace.

Mr. Obama’s health care adviser, Nancy-Ann DeParle, said she was convinced that Democrats could “find convergence.” She and several other officials, including Rahm Emanuel, the chief of staff, and Peter R. Orszag, the budget director, met Wednesday with Senator Harry Reid of Nevada, the Democratic leader, to discuss merging the Senate’s bills.

Aides say Mr. Obama has reviewed the alternatives to the public option but has not settled on which, if any, he prefers. And some Democrats say a backlash against insurers is creating renewed interest in a public plan. But in private conversations with Ms. Snowe, Mr. Obama has brought up her idea for a trigger that would create a government-run plan in states where at least 5 percent of residents lacked access to affordable care. One senior White House official called the idea “very reasonable.”

Must. Go. Hit. Head. On. Wall. Now.

Queen Olympia has decided that the very thing that would make insurance exchanges work is the thing that has to go. And you know when the queen speaks, the Senate listens! (Do you ever get the impression that the Queen is actually wearing no clothes?)

Olympia Snowe looks set to reprise her role in hobbling the stimulus bill in exchange for providing the key pivotal vote for it by killing John Kerry’s amendment, “Empowering State Exchanges to be Prudent Purchasers.” Jon Cohn explains:

In the bills that passed three House committees and the Senate Health, Education, Labor, and Pensions (HELP) Committee, the exchange would be a “prudent purchaser.” In other words, it would have a staff that bargained with insurers to bring down premiums — and that made sure all plans lived up to strict guidelines for coverage and customer service. In effect, any insurer that wants to offer coverage through the exchanges has to get the equivalent of a “Good Housekeeping Seal of Approval” from the administrators. This is precisely how it works in Massachusetts.

By contrast, the Senate Finance bill envisions much weaker exchanges. Instead of choosing which plans to make available, the exchange administrators would, by law, have to accept any plan that meets a relatively minimal set of standards.

There are several problems with this. One is that it’s going to be a mess for consumers. Another is that it threatens to turn the exchanges into playgrounds of implicit risk-shifting efforts wherein companies try to design policies specifically around dissuading high-need people from signing up. Thus ever-more burden is going to be placed on the untested risk-adjustment machinery that’s supposed to even this all out. Ezra Klein observes that Jon Kingsdale is basically the only person in America’s who’s run anything like the exchanges envisioned in all the different bills—he does the job in Massachusetts—and he views the prudent purchaser rule as absolutely essential. Against that Snowe is pitting, I guess, her intuition that this is too much government involvement.

TNR's Jonathan Cohn lays out his argument here:

The bills moving through Congress all set up exchanges modeled more or less on what Massachusetts has done. But there are a few critical differences. Among the most important is a difference in how the exchanges would select which plans to offer people.

In the bills that passed three House committees and the Senate Health, Education, Labor, and Pensions (HELP) Committee, the exchange would be a "prudent purchaser." In other words, it would have a staff that bargained with insurers to bring down premiums--and that made sure all plans lived up to strict guidelines for coverage and customer service. In effect, any insurer that wants to offer coverage through the exchanges has to get the equivalent of a "Good Housekeeping Seal of Approval" from the administrators. This is precisely how it works in Massachusetts.

By contrast, the Senate Finance bill envisions much weaker exchanges. Instead of choosing which plans to make available, the exchange administrators would, by law, have to accept any plan that meets a relatively minimal set of standards.

Jon Kingsdale, who runs the Massachusetts exchange, calls that a recipe for "policy disaster," as consumers faced a dizzying array of more expensive, less regulated choices. "It would be like telling your grocery store they have to offer every single kind of bread baked by every single bakery. ... The exchanges would be nothing more than an automated Yellow Pages."

Kingsdale is among several Massachusetts-based policy experts who have been ringing the alarm bells about this flaw in the Finance bill. And it's no coincidence that it's a Massachusetts senator, Kerry, who now proposed to fix it by giving the exchanges the same powers envisioned in the House and HELP bills.

But when Kerry introduced his plan last week, he couldn't get the votes to pass it. The reason, several sources on Capitol Hill say, was opposition from Olympia Snowe, the Maine Republican who also sits on Senate Finance. Snowe seems to be concerned that a more aggressive exchange would amount to more government--which, in fact, it would be. But, as Massachusetts has shown, sometimes more government is exactly what health care needs.

Chances are reasonably good that Kerry's vision of reform will prevail, if not during the Senate floor debate then afterwards, when a conference committee merges whatever passes from the two congressional chambers. But it's not a sure thing, which is why this seemingly narrow question deserves a lot more attention.

Exchange design doesn't get the attention of controversies like the public option, abortion, or supposed death panels. In the long run, though, it could be far more decisive in whether reform works.

(h/t Blue Gal.)

President Obama, I do hope you stop wooing this "reasonable" woman, one whose intellectual capabilities are far exceeded by her political grasp. (She's proposed some breathtakingly bad ideas, like this one.)

Sen. Olympia J. Snowe, R-Maine, praised President Obama's speech to Congress on health care, but said Thursday that his refusal to drop the "public option" insurance proposal will delay action on health care reform.

Snowe said in a prepared statement that the proposal to offer a government alternative to private insurance is "divisive" and is "unnecessarily delaying our ability to reach common ground."

Olympia? If you know how to read polls, you'd know the only place the public option is divisive is in the corporate political class. We The People like it just fine.

Obama spoke before Congress on Wednesday night and maintained his support for the public option, but said he is willing to listen to a reasonable alternative that provides affordable coverage to Americans without insurance.

Snowe, who opposes the public option, has been working with five fellow members of the Senate Finance Committee to draft a health care reform bill. As a moderate Republican, Snowe is considered a pivotal figure in the debate and a potentially decisive vote.

Snowe said Obama indicated that he's willing to work with Republicans to move the reform measure forward. But Snowe said many Americans are afraid that the public option represents a government takeover of health care.

She has proposed a "safety net" that would provide health insurance if private insurers failed to offer affordable coverage after reforms took effect.

See, now, I'm confused. I thought the public option was the safety net? What would this net be, Your Majesty?

Oh noes! If you can't hold on to your basic, "queer"-hatin', low-information, unlicensed plumber not really named Joe that you hold up for WAAAAYYYY past his fifteen minutes as the epitome of the Republican Party, who can you hold on to?

Samuel Wurzelbacher, better known as Joe the Plumber, tells TIME he's so outraged by GOP overspending, he's quitting the party — and he's the bull's-eye of its target audience. But he also said he wouldn't support any cuts in defense, Social Security, Medicare or Medicaid — which, along with debt payments, would put more than two-thirds of the budget off limits. It's no coincidence that many Republicans who voted against the stimulus have claimed credit for stimulus projects in their district — or that Louisiana Governor Bobby Jindal stopped ridiculing volcano-monitoring programs after a volcano erupted in Alaska. "We can't be the antigovernment party," Snowe says. "That's not what people want."

All this while the Republicans back-pedal off their "listening tour" to find out how real Republicans want their party to move towards because they can't bear the thought of upsetting Rush Limbaugh. Tellingly, the enabling and complicit Time Magazine completely buries the lede deep within the article--fourteen paragraphs down--that the man who owes his entire fame to the Republican Party is now taking his ball and going home.

Our Kansas Roots effort last week was a real success. We managed to get lots of letters about the illegal NSA wiretaps published in local Kansas papers where the Chairman of the Senate Initelligence Committee Pat Roberts no doubt felt their heat, and now we're asking everyone to do the same thing for Chuck Hagel in Nebraska and Olympia Snowe in Maine who are also on the committee.

FDL has a post about today's action.

Glenn Greenwald has a talking points refresher.

Information on calling Snowe's office is here.

Information on calling Hagel's office is here. Information on writing to Maine newspapers is here. Information on writing to Nebraska newspapers is here.

The Senate Intelligence Committee will be taking a vote on March 7 to decide whether they will investigate the illegal NSA wiretaps or not. Everyone who is concerned about this matter should take some action today in order to have an impact this very important upcoming vote.

Well Operation Yellow Elephant is producing results way past our expectaions. Steve Gilliard has more. AmericaBlog found that Grover Norquist attacked three GOP Senators over at the College Chickenhawks conference: Speaking to the same group a few hours later, party strategist Grover Norquist lambasted three Republicans who broke party ranks over the issue of judicial filibusters. He referred to them as "the two girls from Maine and the nut-job from Arizona" - Sens. Susan Collins, Olympia Snowe and John McCain.

Way to go Grover, he must have read our Special Ops manual.

I have some more Special Ops planned after my encounter with the YRNC that helped to kick off the whole project. DU Top Ten Conservative Idiots of the Week was kind enough to list the project at #9. Check it out for a highlight. I've almost got a radio talk show host commited to go down to Las Vegas and set up shop for the July 6-10 convention. Stay tuned...

via The Carpet Bagger:

...So, who’s on Roll Call’s list on undecideds? Sens. Susan Collins (Maine), Chuck Hagel (Neb.), Dick Lugar (Ind.), Lisa Murkowski (Alaska), Olympia Snowe (Maine), Arlen Specter (Pa.), and John Warner (Va.). Which ever side gets four of these seven will prevail.

Collins and Snowe have hinted at opposition and Dems on the Hill generally count them as “no” votes when doing nuclear head counts. Likewise, Lugar and Murkowski are believed to be leaning in the other direction. Warner and Specter have publicly criticized the nuclear option, but remain noncommittal, while Hagel is a complete mystery.

Stay tuned.