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Health Care Reform Still a Delicate Dance

Although Senators remain optimistic that they can meet an ambitious June deadline for drafting bipartisan health care legislation, major philosophical differences could easily derail the process and send both sides back to their political corners.

Democratic and Republican Senators have been working for months to bridge the partisan divide on health care reform. And while Democratic satisfaction in the process is not a surprise given the party’s majority status, Republicans also have been pleased with Senators’ progress.

But with the pace and tenor of the negotiations set to heat up this week as Congress returns from its spring recess, the limits of bipartisanship on the issue could be severely tested. Looming over any final agreement on health care reform are how much it will cost, who is going to pay for it, and the level of government involvement. Complicating matters further is a threat that Democrats will use a budget procedure called reconciliation to jam through a bill without any GOP votes.

Sen. Orrin Hatch (R-Utah), a key player on health care reform given his close relationship with Health, Education, Labor and Pensions Chairman Edward Kennedy (D-Mass.) and his seats on the HELP and Finance panels, said in a statement that Republicans are committed to working with Democrats to improve health care access and quality. But Hatch’s outstretched hand also came with a warning.

“I, along with my Republican colleagues, stand ready to work across the aisle on this important issue,— Hatch said. “I call on those Democrats who have not already openly rejected partisan budgetary tactics, to stand up and make their voices heard against reconciliation, so we can move forward in an inclusive way to bring about comprehensive health care reform.—

Democrats, for their part, aren’t shutting the door on using reconciliation to try to get sweeping health care reform done this year. If included in the final budget resolution, reconciliation instructions would allow the Senate to advance health care legislation with a simple majority vote of 51 Senators.

Kennedy spokesman Anthony Coley said his boss was retaining the right to use the procedure.

“Our first preference is to continue to work with our Republican colleagues on this effort, and if bipartisan talks don’t produce desired results, then reconciliation would be an important measure to have,— Coley said.

The Senate’s budget resolution passed without reconciliation for health care, but the House-Senate conference report is expected to include it.

Senate Majority Leader Harry Reid (D-Nev.) has said that he wants a health care bill to hit the floor before Congress adjourns for the August recess. Jim Manley, Reid’s spokesman, confirmed Friday that his boss hasn’t changed those plans. In the House, Democratic leaders have similarly slated the August recess as a deadline for passing their version of a health care overhaul bill.

In the Senate, the process for getting from here to there involves both the HELP and Finance committees marking up separate bills that would later be merged into one. Kennedy and Finance Chairman Max Baucus (D-Mont.) are working closely together to ensure that their two bills don’t end up so far apart that reconciling them is impossible.

Both Senate committees are set to hold hearings and working-group meetings between now and the Memorial Day recess to debate many of the most contentious issues.

Tuesday is the first big day, with Sen. Jeff Bingaman (D-N.M.) leading a HELP working group on expanding coverage and the Finance Committee hosting a working group on overhauling the health care delivery system. A Democratic Senate aide familiar with the process described the next six to eight weeks as crucial.

“As this work period closes, we’ll have a very good picture of what this bill is going to look like and where this bill stands,— this aide said. “And we’ll be moving very quickly on this bill after the Memorial Day recess.—

Yet as Democrats and Republicans move beyond discussing broad goals for reform to determining how best to achieve that reform, the long-standing partisan and philosophical differences are expected to magnify.

Republicans in particular are wary of how President Barack Obama and Congressional Democrats plan to pay for health care reform — and more specifically how much an overhaul would add to the deficit and national debt. Additionally, Republicans are worried about the speed at which the bill is being drafted and the fact that reconciliation remains on the table.

A senior Democratic Senate aide confirmed that these issues will probably remain the largest obstacles to achieving consensus, noting that agreeing on how to pay for the overhaul is “the most challenging.— The business community, which unlike 16 years ago has generally been on board with advancing a health care reform bill, might also recoil, as corporate America may be asked to foot part of the bill.

“We were in the honeymoon phase. I think the honeymoon is over,— said one Republican Senate aide familiar with the health care process. “I think the road will only get harder.—

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