Four Key Health Reform Questions

Time for a gut check. Can skittish Democrats still find a way to rally around reform?

By Carrie Budoff Brown and Patrick O'Connor
|  Sunday, Jan 24, 2010  |  Updated 11:00 PM CDT
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Four Key Health Reform Questions

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House Speaker Pelosi and Senate Majority Leader Sen. Harry Reid are trying to salvage health care reform.

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President Barack Obama’s push for sweeping health care reform hangs in the balance when Congress returns this week, after being thrown into doubt by Republican Scott Brown’s special election win in Massachusetts.

House and Senate leaders spent the weekend mulling over their decidedly narrow options to get reform back on track, as Obama’s advisers took to the airwaves Sunday, vowing to push ahead — but offering few specifics on what they realistically think they can achieve.

So before Democrats can resuscitate their yearlong push for near-universal health coverage, it’s time for a gut check. Can skittish Democrats still find a way to rally around reform, despite the drubbing in Massachusetts? Is Obama still willing to push, or does he need to show his main focus is jobs and the economy?

And are Democrats really ready to play hardball, knowing the best shot at reform is jamming it through on a party-line vote in the Senate — using a parliamentary maneuver that the GOP says is no different than the partisan deal making that voters have rejected?

Here are the questions that will determine whether health reform rises or falls:

If you don’t have 60, how about 51?

Obama himself said Friday he thinks one problem with reform is that voters view it as a “monstrosity,” cobbled together by special interests through special deals. But the Democrats’ best hope of passage lies in another parliamentary trick that would allow a one-party vote to carry the day on reform.

The maneuver, known as reconciliation, allows Democrats to break a Republican filibuster and approve the legislation with 51 votes in the Senate. Although a Republican-controlled Congress used reconciliation to pass former President George W. Bush’s signature tax cuts, Democrats have been hesitant to pull the trigger.

And Republicans are saying, in effect, make my day.

“If they try to jam health care through on partisan lines, I think November 2010 will be a very good month for us,” Sen. John Cornyn (R-Texas), chairman of the National Republican Senatorial Committee, said on “Fox News Sunday.”

Sources say Senate Majority Leader Harry Reid (D-Nev.) and House Speaker Nancy Pelosi (D-Calif.) are trying to craft a “cleanup” bill that satisfies House liberals by fixing parts of the Senate bill they don’t like. But their challenge is to avoid making it look like a messy stew of legislative deal making — which won’t be easy to do because one of the main things the bill is likely to fix is the so-called Cadillac tax, which would exempt union members through 2017.

Try selling that to a public already upset about Sen. Ben Nelson’s so-called Cornhusker Kickback, which exempts his state from reform-related Medicaid increases forever. (The cleanup bill might eliminate the Nebraska provision, too, sources say, but the PR damage has already been done.)

In terms of pure mathematics, it seems that Reid could muster the 51 votes out of the 59-member Democratic Caucus. But there’s a political equation as well. Even some Democrats are urging him to go slow, including centrists like Sen. Evan Bayh (D-Ind.). 

Possible fixes, sources say, include the deal with labor unions to ease the tax on high-end insurance plans, additional Medicare cuts and a move to help cover the gap in seniors’ prescription-drug coverage.

How close will the House come to the Senate?

Pelosi doesn’t have votes to pass the Senate health care bill exactly as it was approved last year. But the good news for Democrats is that she might be able to muster the 218 votes she needs to pass something a lot like it.

Negotiators were on the brink of a deal when Democrats lost the Massachusetts Senate race last week.

“We have to find out what is most important to our members — getting a bill or getting the bill,” a House leadership aide said. “They will probably prefer the Senate bill with fixes than nothing.”

But, at this point, not even Pelosi knows for certain what her members will accept.

Can you actually do a scaled-down bill, given how interconnected the legislation is?

The president and others have floated the idea of rewriting a bill that focuses solely on insurance-market reforms.

Politically, liberal groups quickly assailed the suggestion that Democrats might abandon sweeping reform, saying the states have learned that piecemeal fixes don’t solve the problem.

But the idea appeals to lawmakers. Emerging from one such meeting the speaker held last week with second-term House Democrats, Minnesota Rep. Tim Walz said, “The consensus was, ‘Why don’t we do the things that were universally popular?’”

How many “yeses” have turned to “nos”?

The House passed its bill with 220 “yes” votes. But Republican Louisiana Rep. Anh “Joseph” Cao” has vowed to oppose the final package, and Florida Democrat Robert Wexler’s midterm resignation leaves Pelosi at 218 — the minimum threshold for passage.

Pelosi’s caucus was all over the place last week, with some Democrats pushing for a scaled-back bill, others calling for multiple, more incremental bills and a growing rank of silent detractors hoping the White House would abandon the effort entirely.

The good news: As of Sunday afternoon, none of these now-wavering Democrats had made an official statement promising to vote against retooled legislation.

First-year Virginia Rep. Gerry Connolly said, “I think doing nothing is not an option. that would be a huge mistake.”

How hard will Obama push?

In the wake of Massachusetts, most congressional Democrats agree that this week’s State of the Union address is setting up as another make-or-break moment in the president’s push for near-universal health coverage.

The president told ABC News that lawmakers should retrench by rallying around some of the most popular reforms, but the White House added to the confusion by trying to walk back those remarks.

Congressional Democrats expect Obama to focus on jobs on Wednesday night, but they also want to see him reiterate the reasons for tackling health care. Most agree that failure to give Democrats a jolt could kill any prospects for a sweeping bill.

“He needs to talk about health care. He can’t be afraid to punch back,” said New York Rep. Eliot Engel. “He needs to be forceful. He needs to show strength.”

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