Health care reform update: The politicking has only just begun

By Money Matters Editors

Health care reform update: Assuming a health care reform bill makes it out of the Senate Finance Committee - and one will - two, major hurdles remain: the Senate and the likely conference committee reconciling differences with the House’s health care reform legislation. Neither of these hurdles will be easy to mount.

Senate Majority Leader Harry Reid, D-Nevada, has the difficult task of trying to maintain liberal Democratic Senators’ support for the bill without angering Moderate Democrats. It’s critical that Reid retain at least 60 votes for the bill – in any combination – because a Republican-dominated coalition is set to filibuster any bill that falls below 60 votes, the level needed to invoke cloture and end a filibuster. In the United States, due to the filibuster’s unlimited debate provision, having a simple majority doe not mean you can govern: ‘in the Senate, it takes 60 to govern,’ as they say on Capitol Hill.

(Decades ago, a filibuster was rare. Today, in Washington’s highly partisan environment featuring two polarized parties, the filibuster is used routinely. The great former Senate Majority Leader, and President Lyndon B. Johnson is turning over in his grave!)

Is Sen. Reid ready?

What’s Sen. Reid likely to defend? The bill that makes it to the Senate is likely to have large, sliding-scale federal subsidies to help poor and working classes families pay for monthly health care premiums, along with a federal mandate requiring every American to purchase health insurance.

The bill will also likely require businesses to offer health care insurance to all employees, although there may be an exemption for small businesses. Those businesses required to purchase health insurance that don’t do so would have to pay into a fund for the same.

Further, in addition to Medicare changes aimed at lowering costs, the bill probably will contain an expansion of Medicaid, as part of a plan to provide insurance to the poor, and also contain health insurance exchanges aimed at increasing competition in markets across the United States. Total cost of the Senate bill? Probably $900 billion, with a net-zero increase in the U.S. budget deficit.

Meanwhile, probably on a party line vote (or close to it), the House will likely pass a health care reform bill with a public option; the Senate bill undoubtedly will not contain one. And that’s when the real fun begins: the conference committee to reconcile bill differences.

In the conference committee, up to a dozen members from each chamber, mostly Democrats, as they are the majority party, negotiate and resolve bill differences. And the emphasis is on negotiate, but really it is politicking and logrolling: more bills have been substantively changed in conference committee than one can imagine. Merit is usually the first casualty. Further, lawmakers frequently ‘trade’ votes - or logroll - to get preferred items retained in the bill. ‘Christmas tree’ items appear – usually from a powerful Senator or House member: these are items that have nothing to do with bill, but are included so as to keep a key Senate or Representative ‘on board’ i.e. supporting the bill.

As the above suggests, while the health care reform debate may seem long and, to some, interminable, the real debate on policy – the one driven by power-based coalitions and horse-trading in the conference committee – has only just begun.