Health care the day after - now what?

Everyone knows what happened last night in Massachusetts. Rather than spend time commenting on that, this post will focus on what it means for health reform. There are five remaining options for health reform to pass:


1 Ram it through. This would require the Senate and House negotiators to finish negotiations to merge their bills (which have been going on for months), as soon as possible. They would then need to send the merged bill to the Congressional Budget Office, who would take 5-10 days to score the costs of the probably 3,000 page bill. Then the House and Senate would both need to vote on the merged bill, before Senator-elect Brown is sworn in.

This is probably impossible. Not only is there a lack of political will (many members are now afraid they will lose their seats if they vote for health reform), but the timing seems unrealistic. There had been speculation that Massachusetts Secretary of the Commonwealth William Gavin would drag out certifying the election for 15 days in order to buy time, and that U.S. Senate Majority Leader Harry Reid would delay swearing Brown in. However, both have refuted that notion and the process has already begun. Further, Senator Jim Webb (D-VA) made a statement last night that no action should be taken on health reform until Brown is seated. Therefore, this may be an option, but it is effectively dead.

2 Reconciliation. This is the process in which a bill could be passed in the Senate by a simple majority – 50 votes, with Vice President Biden to break a tie. It would entail sending the bills back to Committee where they would again be amended, debated, etc. There is just about zero will to do this. Worse, many provisions in the bill (for instance, a ban on pre-existing condition exclusions) could be stripped from the bill by a simple 1-Senator objection. Worst of all, the non-tax provisions of a reconciliation bill could expire in 5 years, meaning this entire endeavor would have to be repeated.

There have been some House members who have enjoyed making threats to do this, but in the Senate this seems an incredibly unlikely choice of paths, one fraught with problems that would enrage the populace.

3 Cross the aisle. With Senator-elect Brown promising to be the 41st vote against the bill, Majority Leader Reid would need to convince a Republican to join the remaining 57 Democrat and two independent Senators to pass a new bill. The obvious targets would be Voinovich, Collins, and Snowe – all of whom have been pretty clear that they will not support. Voinovich staff insist that his visit to the White House yesterday had nothing to do with health care, they were only discussing ways to lower the deficit.

4 Roll the House. Since the Senate already passed one bill, and since they may not be able to pass another, the last resort may be for the House to pass the Senate bill verbatim, with no changes. This would mean all of the negotiations that have happened over the past month would be thrown out, and many House members would have to vote for a bill they literally hate. Remember, many House Democrats believe the Senate bill was actually written by insurance companies. However, House Majority Leader Steny Hoyer may have best summed up the position of many House Democrats: “The Senate bill is better than nothing.” But Bart Stupak, an influential pro-life Democrat in the House, had another view on the Senate bill this morning: “There is no way that bill is going anywhere…. I bet it wouldn’t get 100 votes.” Note that it would need 218.

5 Start Over.