With the finish line tantalizingly in view, House Democrats aim to sprint through final deal-making on their sweeping health care overhaul in the hopes of approving the package at the end of the week.
But getting there will require leaders to hurdle hang-ups over abortion and immigration language, moderates’ gripes on the overall cost of the bill, liberal demands for symbolic votes on their preferred provisions and an unknown array of parochial concerns.
Leaders are trying to streamline debate on the measure by wrapping up legislative tweaks into a single manager’s amendment, which they could roll out as early as Tuesday. Since they have pledged to post that measure online 72 hours before a vote, that would set up a floor vote on the entire package as early as Friday.
“Unless there are glaring problems, I would expect the opportunity for amendments will be very limited, if at all,— Education and Labor Chairman George Miller (D-Calif.) told reporters during a conference call last week.
Floor strategy and timing remain fluid, however, as Democratic leaders work at the margins to gather majority support. Top aides suggested leaders will allow additional amendments if doing so is necessary to muster 218 votes.
On the schedule, Democrats plan to stay through Saturday if they need to, and they will return next Monday and Tuesday for a final vote if they can’t wrap up the horse-trading earlier.
The demands from Rep. Raúl Grijalva (D-Ariz.), co-chairman of the Congressional Progressive Caucus, and other liberals for votes on proposals like a single-payer system and a more robust plan such as one tied to Medicare rates also are being discouraged.
“I think it harms the cause to bring an amendment to the floor when you don’t have the votes,— a Democratic leadership aide said. “You don’t want anyone to know how far gone your cause is.—
Democratic leaders also plan to arm Members with a binder full of fact sheets on the bills’ benefits for women, seniors, young people, small businesses, rural communities and minorities. And in case lawmakers aren’t familiar enough on the measure’s details after more than 80 hours of caucus meetings on it, they are kicking off the week with a marathon Members-only session Monday night to review the bill section by section.
Looming largest among the unresolved issues are the twin social debates over abortion and immigration. Leaders are stepping gingerly through the disputes, since both threaten to cause significant blocs of Democrats to bolt. Top aides reported no breakthroughs on either issue at press time, and leaders were expected to continue working on them throughout the weekend.
The abortion dispute centers on whether new national insurance plans will cover abortions. Energy and Commerce Chairman Henry Waxman (D-Calif.) said the House bill already prohibits the use of taxpayer funding for abortions and requires insurance companies to keep federal subsidies separate from funding for abortions.
That’s similar to how Medicaid is run: Federal funds cannot be used to pay for an abortion, but states are free to use their own funds to pay for such a procedure.
But opponents argue that because federal subsidies would help pay for plans that include abortion coverage, that does not go far enough. They want a more explicit ban on abortion coverage on any plan paid for in part by a federal subsidy.
[IMGCAP(1)]They also want to prohibit the public insurance option from including abortion in any plan because that would lead to checks going directly from the federal Treasury to abortion clinics.
Waxman said opponents’ proposals are simply “not acceptable.— He noted that the federal government already gives tax breaks for all health insurance provided by employers, including abortion coverage.
Waxman and Rep. Lois Capps (D-Calif.), who authored the compromise language in the House bill that keeps in place a ban on use of federal dollars but requires abortions to be covered by at least some of the insurance plans in the exchange, said they are open to changing the language to make abortion foes more comfortable but do not want to change the substance of the bill.
Efforts are being made to craft compromise language that would be included in the manager’s amendment and stave off a request from Rep. Bart Stupak (Mich.) and dozens of other anti-abortion-rights Democrats for a floor vote on a much more restrictive amendment. Stupak has warned that he will likely mount an effort to bring down the rule on the bill if he isn’t satisfied.
On the immigration front, leaders are struggling with whether to match a hard-line Senate approach that would ban undocumented immigrants from using their own money to purchase insurance through on a new health care exchange. The Senate version has the backing of the White House and politically vulnerable House Democrats. Rep. Chris Van Hollen (Md.), charged with looking out for endangered Democrats as Assistant to the Speaker and Democratic Congressional Campaign Committee chairman, is trying to add the tougher language to the manager’s amendment. But the change is opposed by other top Democrats — and the Congressional Hispanic Caucus. A key question for Democratic leaders is whether most moderates insisting on the change plan to vote against the bill anyway or whether they can assuage the CHC with the promise that an immigration reform bill next year will render the debate moot.
Meanwhile, fiscally conservative Blue Dog Democrats are continuing to grumble about the long-term costs of the bill. They have sent a letter to the Congressional Budget Office asking whether the measure reduces health care costs over time and what additional items could be added to trim costs.
But the Blue Dogs have not been advocating as a group for any particular cost-saving measures — and it’s starting to get pretty late in the game to do so. Leadership also believes enough Blue Dogs will be swayed by the CBO’s determination that the bill slices the overall deficit by $100 billion in the first decade and continues cutting the deficit in the second decade, as well as by the inclusion of negotiated rates for the new public insurance option instead of the more liberal Medicare-based plan. But the CBO’s response will likely determine whether the moderates decide to mount a major challenge to the bill or stand down.