Beginning of the End for Health Care Reform Starts Today
Patricia Murphy
Capitol Hill Bureau Chief
Posted:
03/15/10
After more than a year of negotiating, meeting, voting, pushing, prodding, rushing, delaying, and You Lie-ing, the end is finally near for the health care reform debate in Congress.
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. Incredibly, nobody -- not the Democrats, not the Republicans and not the White House -- knows how it will end for President Obama's top domestic priority once the votes are finally counted.
The climactic week begins today 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 Budget Committee posted its bill online last night, which is a previous version of the health reform package, and will start debating changes to it today at 3 p.m. Any change under reconciliation must reduce the deficit over five years and remain deficit-neutral after that.
After a vote by the Budget Committee, probably late Monday night, the measure goes 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.
By the end of that hearing, likely on Wednesday, we'll know exactly what the final health care reform bill will look like, how different it will be from the language that passed the Senate on Christmas Eve, and when the House will vote on the Senate bill (a necessity under the process being used) and the package of "fixes" that have been negotiated by House Democrats to win the requisite number of votes.
One addition we know is coming will be a giant overhaul of the student loan industry, which will be tacked onto the health bill. Other 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; and 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 said Friday she wants to have a House vote on the underlying Senate bill by this Friday or Saturday and a vote on the package of fixes moments later. But on "Meet the Press" Sunday, her top vote-counter, Rep. Jim Clyburn (D-S.C.), said the Democrats do not yet have commitments for the 216 votes they need. Factions of Democrats who voted for the bill last year continue to waver over the abortion and immigration provisions that the Senate bill will mandate.
If Pelosi and Clyburn do get the votes to pass the Senate bill, it will go to President Obama for his signature while the Senate begins the process of passing the House changes under reconciliation rules, 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, a huge area 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.
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 President Obama's top domestic issue at the only time his party is likely to hold massive majorities in the House and Senate.
Either way, the beginning of the end starts today.
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. Incredibly, nobody -- not the Democrats, not the Republicans and not the White House -- knows how it will end for President Obama's top domestic priority once the votes are finally counted.
The climactic week begins today 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 Budget Committee posted its bill online last night, which is a previous version of the health reform package, and will start debating changes to it today at 3 p.m. Any change under reconciliation must reduce the deficit over five years and remain deficit-neutral after that.
After a vote by the Budget Committee, probably late Monday night, the measure goes 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.
By the end of that hearing, likely on Wednesday, we'll know exactly what the final health care reform bill will look like, how different it will be from the language that passed the Senate on Christmas Eve, and when the House will vote on the Senate bill (a necessity under the process being used) and the package of "fixes" that have been negotiated by House Democrats to win the requisite number of votes.
One addition we know is coming will be a giant overhaul of the student loan industry, which will be tacked onto the health bill. Other 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; and 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 said Friday she wants to have a House vote on the underlying Senate bill by this Friday or Saturday and a vote on the package of fixes moments later. But on "Meet the Press" Sunday, her top vote-counter, Rep. Jim Clyburn (D-S.C.), said the Democrats do not yet have commitments for the 216 votes they need. Factions of Democrats who voted for the bill last year continue to waver over the abortion and immigration provisions that the Senate bill will mandate.
If Pelosi and Clyburn do get the votes to pass the Senate bill, it will go to President Obama for his signature while the Senate begins the process of passing the House changes under reconciliation rules, 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, a huge area 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.
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 President Obama's top domestic issue at the only time his party is likely to hold massive majorities in the House and Senate.
Either way, the beginning of the end starts today.