In what is likely to be one of the last acts of health care reform kabuki theater, the role of the football will be played by President Obama’s proposed National Insurance Rate Authority. As always, the role of the Lucy shall be played by the Senate.

The role of the football has previously been played by direct Medicare drug price negotiation, the public option, Medicare buy-in, 90% minimum medical loss ratio, and a national exchange. Not surprisingly, the Huffington Post is reporting that the Rate Authority will likely be dropped because it can’t survive the Byrd rule in a reconciliation bill.

Like previous provisions that have played the role of the football, the National Insurance Rate Authority was a smart-sounding, progressive idea put forward to make people feel more kindly toward the health care bill, only to see it pulled away at the last minute.

What makes this final act with the Rate Authority so disgusting is the incredibly pure cynicism all around. Within minutes of seeing that Obama proposed it be part of the reconciliation bill, I questioned its ability to survive the Byrd rule. It simply did not seem likely, based on my knowledge of reconciliation.

If I could clearly see that it would likely not survive the Byrd rule, so should have Obama’s team, the Democratic leadership in Congress, and all the big, pro-reform groups that tried to use its inclusion as justification for supporting the bill. In fact, Democrats should have (and probably did) ask the Senate parliamentarian about it before saying they would put it in the reconciliation package.

Instead, they put the provision in the package to get people excited, knowing full well it would be removed weeks later. They then waited until literally the 11th hour to crush people’s hopes by pulling the football away one more time.

To add insult to injury, they could actually still pass the Rating Authority using reconciliation. There is no reason, according to a reading of the Senate rules, that it must be removed because the Senate parliamentarian does not think it directly affects the budget enough. If Democrats really wanted the new agency, they could get it by having Joe Biden use his own judgment on the Byrd rule instead of following the parliamentarian’s non-binding suggestion.

For this latest, incredibly cynical move, I feel a lot of people are owed an apology by a large part of the Democratic/liberal/progressive establishment. Of course, if they are actually handing out apologies for broken promises and back stabs, this latest act would be at the bottom of a very long list. It is amazing how every provision suggested that might have reined in the health insurance industry always got removed, time and time again.