What Hurdles Remain for Health Care Reform?

(March 17) -- The massive overhaul of the health insurance industry could ultimately provide coverage for as many as 30 million uninsured Americans at a 10-year price tag of just under $1 trillion. But a range of complaints from rank-and-file Democrats, from how the package is paid for to the treatment of illegal immigrants to restrictions on abortion financing, have endangered the bill's prospects for passage. Nobody -- not the Democrats, not the Republicans and not the White House -- knows how it will end for President Barack Obama's top domestic priority once the votes are finally counted.

The climactic week began Monday with a meeting of the House Budget Committee, the panel that is required to review any bill coming through the House under the reconciliation process -- a path that will require 51 votes, rather than 60, to pass the Senate.

The House Budget Committee posted its bill online Sunday night, which is a previous version of the health care reform package, and began debating changes to it at 3 p.m. Monday. Any change under reconciliation must reduce the deficit over five years and remain deficit-neutral after that.

After the Budget Committee approved the use of reconciliation late Monday night, the bill went to the House Rules Committee, the hugely influential panel that decides how long the bill will be debated on the House floor and which amendments will get a vote by the full chamber.

A firestorm erupted Tuesday when House Speaker Nancy Pelosi raised the possibility the committee could use a process called "deem and pass" to declare the Senate's version of the health bill approved by the House, without having the House vote on it at all.

The Rules Committee is expected to meet Friday, when members will decide whether the House will vote on the Senate bill, when the final vote will take place, and what the substance of the package of "fixes" to the Senate bill will look like.

One addition we know is coming will be a giant overhaul of the student loan industry, which was tacked onto the health bill Monday night.

Other expected changes include:

• Eliminating the "Cornhusker kickback" that would have paid for Nebraska's Medicaid expansion.
• A much more generous deal for all states to cover their expenses.
• More money for subsidies to help people pay for health insurance premiums.
• A major scaling back of the excise tax approved by the Senate, which will be delayed until 2018 and will have a higher price threshold for plans that would trigger the 40 percent tax.

House Speaker Nancy Pelosi has said she wants a House final vote on health care by March 20 or 21, after which the bill will head to the Senate, likely sometime next week.

Once on the Senate floor, the bill can be debated for just 20 hours, and Republicans can offer as many amendments as they want, which is an are a of unknown peril for Democrats, who will have to vote on whatever the GOP proposes. At the end of that unwieldy process, Democrats will need just 50 of their 59 senators for vote for the bill, with any tie to be broken by the president of the Senate, Vice President Joe Biden.

Since the Senate is scheduled to recess for Easter on March 26, look for a major push by the Democrats to wrap up action before heading back to their states and districts. The only thing worse for Democrats than last year's tea party protests in August would be a repeat performance in April.

In the end, Americans will either see an overhauled landscape of the health insurance industry as we know it, including a requirement that every citizen purchase insurance for themselves, or they'll see the status quo for health care continue, along with a stinging defeat for Obama's top domestic issue at the only time his party is likely to hold massive majorities in the House and Senate.