Health Debate Flatlines

Democrats Seek to Revive Effort

Posted January 22, 2010 at 6:11pm

Democratic leaders in Congress insist they will pass a health care reform bill. They just have no idea how or when they will do it.

“It’s unclear at this point,— Senate Democratic Policy Committee Chairman Byron Dorgan (N.D.) said Friday. “There’s an assessment going on of what is possible and the assessment is not complete, and it’s not quite clear what is possible at this point in terms of the road forward.—

After last week’s disastrous defeat in Massachusetts shattered their 60-vote Senate supermajority, Democrats floundered and appeared trapped between two political realities. If they don’t pass a reform bill, they will have failed a key test of their ability to govern and face a dispirited base and potentially catastrophic losses in November. But Members also fear that moving too quickly or aggressively will turn off independents and likewise lead to an electoral drubbing.

After seeing the seat of the revered late Sen. Edward Kennedy (D-Mass.) snatched away by Republican upstart Scott Brown on Tuesday, Senate Democratic leaders tried to strike a balance between giving the rank and file time to digest the Massachusetts special election results while not waiting so long as to make it impossible to salvage their health care efforts.

“A lot of people made clear that in light of the election results on Tuesday, they didn’t want to rush into anything,— one Senate Democratic leadership aide said. “We’re going to continue to discuss the next steps and strategy with the House and the White House.—

Senate Majority Whip Dick Durbin (D-Ill.) indicated Friday that leaders were prepared to hunker down this week to come up with a possible solution.

“The political trauma of Tuesday is still fresh. We’re trying to think through what the next steps are,— Durbin said. “By next week, I think we can come up with a preferred path.—

But Senators and aides indicated that the onus is on President Barack Obama to referee any negotiations between the House and Senate.

“Clearly he’s got to be a part of it, and obviously, as only a president can do, he has the ability to bring us all together,— said Sen. Chris Dodd (D-Conn.), a key health care negotiator. “That’s what presidents do.—

“The only way we’re going to get this done quickly is with the continued active support and involvement of the president,— the Senate Democratic leadership aide said. “Whatever needs to be done, it needs to be done quickly.—

Obama appeared to stumble in the first part of the week by sending conflicting messages about what he wanted to do on health care, but by Friday, Obama stumped in Ohio for both health care reform and economic recovery.

“I’m not going to walk away just because it’s hard,— Obama said. “We are going to keep on working to get this done — with Democrats, I hope with Republicans — anybody who’s willing to step up. Because I’m not going to watch more people get crushed by costs or denied care they need by insurance company bureaucrats.—

But without clear guidance from the White House, various House Democrats have been floating lots of trial balloons for saving at least a portion of their health care package.

They have various incarnations, but they involve two basic routes: Either Democrats would effectively start over with a new, scaled-down bill or bills focused not on universal coverage but on incremental insurance reforms in hopes of getting Republican support, or they would pursue a budget reconciliation bill that would pass significant pieces of the health care reform bill with a simple majority vote in the Senate.

The reconciliation path could also be used to effectively amend the Senate’s health care bill and perhaps make it palatable to a majority in the House. That is the direction most Senators would like to take.

Either path would take at least a month or two, and possibly much longer, at a time when every Democrat realizes the need to pivot to the economy and jobs.

After declaring last week that the House did not have the votes to simply pass the Senate bill, Speaker Nancy Pelosi (D-Calif.) talked to Obama and Senate Majority Leader Harry Reid (D-Nev.) in separate conversations to try to come up with a path forward, and staff planned to meet throughout the weekend. But using reconciliation in some way seemed increasingly likely as House Democratic aides sent around memos noting just how frequently Republicans used the procedure when they were in charge.

But Senate Budget Chairman Kent Conrad (D-N.D.) said Friday that leaders had not approached him to game out options for reconciliation.

Instead, Senate leaders said they were pivoting to a job creation measure and made plans Friday to unveil a bill to their caucus this week or next.

“I don’t know when we’re going to do health care,— Senate Finance Chairman Max Baucus (D-Mont.) said upon exiting a leadership meeting on the jobs bill Friday. “I think health care is extremely important, and we will find a way to do health care. We’ll also be getting a jobs package. We can walk and chew gum at the same time, and we’re going to do that.—

Meanwhile, rank-and-file House Members are pushing the idea of passing several scaled-back measures that would fall well short of universal coverage but would still include the most popular pieces of the overhaul.

Rep. Bill Pascrell (D-N.J.) has outlined to Republican and Democratic Members a series of bills that would include a patients bill of rights that would prevent insurance companies from rejecting customers based on pre-existing conditions, remove antitrust protections for insurers, close the “doughnut hole— in the Medicare prescription drug benefit and provide tax credits for buying insurance.

Such bills would lack any mandates on employers to provide insurance or individuals to buy it, but the bills would also have a much smaller price tag, which Pascrell put at about $300 billion over a decade.

Dodd pooh-poohed the notion of starting over or moving health care piecemeal.

“Every time you do one of those pieces, there’s no guarantee the other pieces will be done,— Dodd said. “For instance, if you do market reforms but you don’t deal with mandatory [insurance coverage], then it causes the insurance companies to spike those premiums.—

But House Democrats were not in the mood to listen to their Senate counterparts last week, because the Massachusetts election seemed to galvanize their anger at the Senate for taking too long to pass a bill and catering too much to the interests of health insurers, drug companies and other special interests.

House Democrats abhorred the special deals for Nebraska, Florida, Louisiana and other states in the Senate, and most oppose the “Cadillac— tax on high-cost health insurance plans that is a cornerstone of the Senate bill. Several House Democrats insisted those provisions be nixed entirely from the Senate bill before they would consider voting for it.

Pascrell was one of several House Democrats who declared the excise tax “dead— after the Massachusetts vote.

Rep. Raúl Grijalva (D-Ariz.), co-chairman of the Congressional Progressive Caucus, called the Senate bill “irredeemable— and suggested starting over with a new budget reconciliation bill including many aspects of health care reform that are budget-related and a separate bill or bills that would include insurance reforms that enjoy bipartisan support.

Grijalva ripped the Senate bill and the idea of fixing it later, calling that bill “a recipe for disaster.—

The Senate Democratic leadership aide said Senate leaders are fully aware of the predicament even if they don’t yet have a way out.

“There are a number of options out there, none of which are particularly appealing,— the aide said. “All of them are problematic.—