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Rx for Reform Needed

President Barack Obama’s State of the Union Address on Wednesday may give him his last, best chance to reboot his health care agenda in the minds of the public and regain momentum shattered by the loss of the Senate Democrats’ 60-seat supermajority.

House and Senate Democratic leaders have been talking behind the scenes about possible ways to revive their legislation but still don’t have a plan a week after Republican Scott Brown rocked their world by winning the Massachusetts Senate special election, aides said.

“Discussions are ongoing and options are being examined on the best way to ensure health care is available and affordable for all Americans and that insurance companies are held accountable, but no final decisions have been made,— said Nadeam Elshami, spokesman for Speaker Nancy Pelosi (D-Calif.).

Obama’s speech isn’t expected to resolve every detail, but it could serve as an opportunity to smooth over the intraparty warring that has taken place since the Massachusetts election and make more clear whether he will still push hard for a comprehensive health care bill or dramatically scale back his ambitions, aides said.

Senators and the White House still seem to be clinging to hopes that the House will at some point agree to pass the $871 billion Senate health care bill quickly, despite Pelosi’s contention last week that she doesn’t have the votes to do so. The challenges for the Senate bill are enormous; there is widespread disgust in the House for the special deals cut for Nebraska and other states, unions and rank-and-file Members oppose the excise tax it contains on high-cost “Cadillac— health plans, and a band of abortion-rights opponents led by Rep. Bart Stupak (D-Mich.) vow to oppose it. Indeed, the House’s opposition to the Cadillac tax seems to have solidified since last Tuesday’s vote in Massachusetts, potentially making moot a compromise deal that unions had cut with the White House shortly before Brown’s victory.

Pelosi and Senate Majority Leader Harry Reid (D-Nev.) have been exploring the use of a reconciliation bill to amend the Senate bill, requiring just 51 votes in the Senate. But that requires precious additional time and likely could not be used to resolve the abortion issue.

One senior Senate Democratic aide said the Senate is basically waiting for the House to realize that passing that chamber’s bill is only way to ensure that sweeping insurance reforms become law. The aide added that Senate Democratic leaders are prepared to promise passage of a package of fixes to appease House concerns, most likely through reconciliation, but that it would be unlikely to happen until after the House took action on the Senate bill.

But House liberals have vowed that they will not vote for the Senate bill without changes in hand, and some have even floated the idea of adding back in a public insurance option via reconciliation to help fire up the dispirited Democratic base and to save tens of billions for taxpayers.

“If you want to win back the voters, give them the one thing they clearly understand is a win for them over the insurance companies: the option to choose a public plan,— said Darcy Burner, executive director of the American Progressive Policy Foundation, which is affiliated with the Congressional Progressive Caucus, in a HuffingtonPost blog entry Monday. “Want to give the Democratic base some change they can believe in? Then give them the public option they’ve been clamoring for.—

Rep. Debbie Wasserman Schultz (D-Fla.), meanwhile, signaled a more incremental approach was likely in an MSNBC interview Monday. “We need to roll up our sleeves and sit down with a basic scaled-down version of health care reform that is going to broaden access to more Americans, provide security and stability to those Americans that have insurance, and bring costs down,— she said. “We can absolutely accomplish all of those things, we are just going to have to do it in a little more incremental way.—

Under another scenario pitched by some liberals, two new bills could be created from scratch — a new reconciliation bill with all of the budget-related health items included, and a new regulatory bill that would have to be negotiated with at least one Senate Republican.

But Senate Democrats are extremely reluctant to push multiple new health care bills, which could delay final action for months.

“We need to produce a health reform bill,— said a House Democratic leadership aide. “There are different ways to go about it.—

The aide said that the House could even try multiple approaches, bringing a series of smaller, easier-to-explain bills to the House floor quickly to put pressure on Republicans.

“If they decide to get on board the populist portions of this bill, then we’ve got law,— the aide said. “If they don’t, then you have a message opportunity. Democrats are on their side.—

Rep. Bill Pascrell (D-N.J.) has also been pushing the idea of passing a scaled-down health care bill that could garner Republican votes, warning that both the House and Senate measures are dead.

Meanwhile, Democratic leaders from both chambers will have a face-to-face meeting this afternoon, and a way forward on health care is sure to come up.

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