No matter what President Obama says in his speech Wednesday about the way forward for health care reform, Democrats know that the only path ahead of them will be technically complicated and politically close to impossible.
The reality came into stark relief Tuesday at the Capitol, as Democratic leaders gamed out how to pass health care reform through reconciliation, a budget-related process that requires just 51 votes, rather than 60, to pass the Senate. It also requires the House to become deeply involved in the convoluted legislative process so that the two chambers can agree in advance on the eventual outcome, a prospect made more difficult by the Senate's repeated failures last year to pass controversial bills that House Speaker Nancy Pelosi and her caucus approved.
Senate Majority Leader Steny Hoyer explained two possible routes to getting reconciliation done, the last option left to Democrats after GOP Sen. Scott Brown's victory in Massachusetts ended Senate Democrats' filibuster-proof majority and in light of united Republican opposition to the health care bills.
Under the first scenario, Hoyer said, the House of Representatives will have to pass the entire Senate bill, complete with controversial abortion language, an excise tax, the infamous "Cornhusker kickback," and immigration language that many House Democrats oppose. Once the president signs that bill sign into law, Democrats will immediately go back and pass a new bill. It would amend budget-related portions of the Senate-passed version to reflect changes that House members will have negotiated in exchange for their support.
Hoyer admitted that passing the Senate bill through the House will be difficult. "Our caucus wants some assurance that those items that they have problems with are in fact modified before they vote for the Senate bill," he said. "I don't know that it's impossible, but it's difficult."
Under a second option, President Obama could avoid signing the Senate bill into law, but, Hoyer said, "that one is more complicated."
Sen. Kent Conrad (D-N.D.) laid out the challenges facing the Democrats on the Senate side as he discussed the complex process in the Capitol Tuesday afternoon. Conrad will take the lead for the Democrats on the reconciliation process as chairman of the Senate Budget Committee.
First, he said, any package approved for reconciliation must be directly related to the budget process, not merely incidental to it. It must reduce the deficit over five years and be revenue neutral every year thereafter. Then, the Congressional Budget Office must evaluate the spending effects of each item so that the Senate parliamentarian can decide what parts of the bill meet the test for reconciliation.
"You've got to have what the costs are and what the revenues are," Conrad said. "You can't easily answer these questions."
Conrad emphasized that several policy issues buried deep within the health care bill -- including the questions of whether whether illegal immigrants can access health insurance through new exchanges and whether abortion services may be covered -- cannot be changed in the budget process. House members have asked for a second bill to fix anything that's not allowed under reconciliation, but Senate leaders have dismissed that out of hand.
Finally, Conrad said, Republicans will be able to slow the process to a crawl by offering an unlimited number of amendments to be voted on by the full Senate, unless the Senate parliamentarian declares Republicans "dilatory."
Republicans hammered both the health care bill and the reconciliation process Tuesday as an end game around the rules of the Senate. Sen. Judd Gregg (R-N.H.) called the health care bill "an atrocity" and said it is "a giant asteroid headed at the Earth."
From his experience as the past chair of the Budget Committee, however, he had more substantive warnings for the Democrats.
"It's going to be a very difficult exercise, I suspect," he said. "And I think that House members who are relying on reconciliation to correct concerns they have with the Senate bill should think twice."
But Hoyer said the House Democrats want to work with the Senate Democrats to pass health care reform and that they trust Senate Majority Leader Harry Reid and the Senate Democrats to live up to promises they make the House.
"We'll trust," he said, "but verify."