Congressional Leaders Begin Reconciling Healthcare Bills

When members of the U.S. House of Representatives return to Washington this week, they will fully immerse themselves in the daunting task of reconciling the House and Senate healthcare reform bills into a final piece of legislation that President Barack Obama can sign into law before his first State of the Union address. Or so they hope.

Anticipating the inevitable intraparty disputes, Democratic leaders and committee chairs such as Ways and Means Chairman Charles Rangel (D-New York) spent part of last week strategizing behind closed doors. They also held a telephone caucus meeting with approximately 175 members to begin addressing their concern that the Senate version will prevail.

They have reason to worry. Obama appears to be leaning more toward some key provisions in the Senate bill that House lawmakers oppose. But perhaps more important, given the almost Herculean effort required to muster the 60 votes necessary to pass a Senate bill, Democrats can’t afford to upset the fragile coalition that delivered them. The political reality is that it’s much harder to get to 60 than 218, the number of votes required to pass a bill in the House.

As a result, there won’t be a formal conference and lawmakers will negotiate the final deal privately, which some critics have decried as an assault on democracy.

“Harry Reid has a different set of rules and a much harder job than Speaker Nancy Pelosi does,” said Majority Whip James Clyburn (D-South Carolina) before Reid’s negative comments about Obama came to light.

The most controversial, and possibly irreconcilable, difference is a public option, the prospect of which is looking, well, more optional. Sens.  Mary Landrieu (D-Louisiana), Joesph Lieberman (I-Connecticut), Blanche Lincoln (D-Arkansas), and Ben Nelson (D-Nebraska) have pledged to vote against any bill that includes it. House Democratic leaders also seem to be backing away from it.

“What’s in a name?” Clyburn asks.

The goals of a public option, he says, are to make healthcare affordable and accessible and to make insurance companies accountable, which the House bill achieves in the form of a hybrid.

“I’ve never been hung up on or an advocate of a public

option and have said from day one that we ought to be looking at a hybrid that can do that for us,” he said. “We’ll be looking at what the Senate’s done, look at what we did, and see whether or not we can get those things melded. Are we going to have a ‘robust public option’? I don’t think so. I think we are going to have a plan that will achieve those three As.”

Progressives may still try to press their case, although they, too, seem to realize it’s likely a lost cause.

“My guess is that there isn’t going to be a public option,” said Dean Baker, co-director of the Center for Economic and Policy Research, at a forum hosted by the Congressional Progressive Caucus last week. But in return for giving it up, progressives should get something significant in exchange. Baker believes that one option would be a federal, rather than state-administered, exchange, where consumers could shop for private insurance, because of regulatory gaps that would allow some states to create weak marketplaces.

“There’s greater hope for higher standards in a federal exchange,” said Baker.

Another key difference is an excise tax on Cadillac, or high-cost, healthcare plans, that the Senate has proposed to help pay for the bill. The lower chamber’s measure calls instead for a surtax on high-income earners.

“The majority of the House takes the position that to tax healthcare benefits is tantamount to raising taxes on people who make less than $250,000 per year and we don’t want to do that,” said Clyburn.

Labor unions bitterly oppose taxing Cadillac plans, but Baker, who prefers the millionaire’s tax, said it wouldn’t be a disaster because it would not affect low-income earners.

But Senate Democrats are feeling just as adamant about not raising income taxes, says Cato Institute senior fellow Michael Tanner. For some, particularly those from red states, such a move could hurt them politically. Then there are others, said Tanner, who’d rather reserve the option to increase taxes to help pay for entitlements or to lower the budget deficit.

And then there is the abortion issue. House Democrats

were able to pass their bill only after agreeing to support a measure sponsored by Michigan Rep. Bart Stupak, which would restrict abortions that could be offered through a public option and private insurance plans that receive government subsidies.

“It’s the toughest of all because it’s a moral issue, which makes it much harder to compromise,” said Tanner.
Clyburn disagrees and expressed confidence that the Senate bill’s language on abortion will satisfy who voted for the Stupak amendment.

Getting a bill to Obama is the one thing most people can agree on and Baker says even that will be just the beginning.

“This is a two-part agenda. One was to cover the people who aren’t covered; this goes far, though not as far as we want. The second goal is to fix the health care system,” Baker explains. “We’ve done very little on that so the question is how do we set the stage to be in a better position to confront it in the future because we know we have to; there is no choice.”