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Democrats Prepare For Tough Senate Healthcare Battle

Posted on: Monday, 9 November 2009, 06:30 CST

After squeaking through a narrow victory in the House of Representatives Saturday night, Democrats braced themselves on Sunday for next battle in their push to pass a comprehensive overhaul of the nation’s healthcare system. 

The bill faces a difficult path in the Senate, with divisions among Democrats on how to best move forward with the most sweeping healthcare legislation in half a century.

After 12 hours of bitter debate, the bill was passed late Saturday in the House of Representatives with a 220-215 vote, which included the support of one Republican and opposition from 39 Democrats.

The 10-year, trillion-dollar plan would extend health coverage to roughly 36 million uninsured Americans.

"Given the heated and often misleading rhetoric surrounding this legislation, I know that this was with a courageous vote for many members of Congress," President Barack Obama said Sunday from the Rose Garden.

"Now it falls on the United States Senate to take the baton and bring this effort to the finish line on behalf of the American people. And I'm absolutely confident that they will," he said.

However, the Senate is not likely to accept a bill like the one passed in the House, which includes a government-run health insurance plan that some moderate Senate Democrats find unacceptable.  And Democrats now need all of their 60 senators to support the legislation if they have a hope of passing the bill through the 100-seat Senate. 

If a government plan is included in the bill, then "as a matter of conscience, I will not allow this bill to come to a final vote," said Senator Joe Lieberman of Connecticut, an independent whose vote Democrats need to defeat a Republican filibuster.

"The House bill is dead on arrival in the Senate. Just look at how it passed," said Senator Lindsey Graham (R-SC) in a comment that went unchallenged by Democrats.

"You had 40 -- 39 Democrats vote against the bill. They come from red states, moderate Democrats from swing districts. They bailed out on this bill. It was a bill written by liberals for liberals," Graham told CBS’ Face the Nation.

The bill "was rejected by one in seven House Democrats and a majority of Americans," said Senate Republican Leader Mitch McConnell, referring to the narrow passing of the House bill.

"It should serve as a stark reminder that Americans don't want a 2,000-page, trillion-dollar government experiment-they want common sense reforms," he said in a statement.

Senate Majority Leader Harry Reid (D-NV) has not yet scheduled a floor debate, and suggested last week that senators may not be able to complete a health care bill this year.

"We're not going to be bound by any timelines. We need to do the best job we can for the American people," said Reid.

Nevertheless, the House vote offered an important lesson on how to succeed in the absence of party unity. 

House Democrats overcame their internal disputes and broke through an impasse that threatened the bill after liberals reluctantly accepted stricter limits on federal funding for abortion.

In the Senate, the primary stumbling block is a government health plan that would compete with private insurers.  Liberals may have to make painful concessions on forgoing the public option in order to keep the legislation alive.  

Republican Senator Olympia Snowe of Maine, who voted for a Senate committee bill, has offered the Democrats a potential way out.

Snowe proposed a so-called “trigger option”, which includes having a government plan enacted if after a few years private health insurance premiums continue to rise and local health insurance markets remain dominated by a few large corporations.

It’s an approach that appeals to moderates such as Senator Mary Landrieu (D-LA).

"If the private market fails to reform, there would be a fallback position," the Associated Press quoted Landrieu as saying last week.

"It should be triggered by choice and affordability, not by political whim."

Lieberman said he opposes a government-run health insurance plan because it could turn into a vast, expensive entitlement program.

"I believe the debt can break America and send us into a recession that's worse than the one we're fighting our way out of today," he said.

For now, Senate majority leader Reid is scrambling to secure the votes for a government plan in which states could opt out.

But the Senate is not likely to move forward this week on health care. Instead, Reid will continue meeting with senators to see if he can work out a compromise that will give him the 60 votes needed to begin debate and bring the bill to a final vote.

The Congressional Budget Office may report back by the end of the week with costs and coverage estimates on Reid's bill, which is based on legislation passed by the Finance Committee and the Health, Education, Labor and Pensions Committee. The Finance Committee version does not include a government-run health insurance plan.

Reid has promised President Obama that he will get the bill done by the end of the year, and remains committed to doing so, according to an Associated Press report quoting a Senate leadership aide.

Both the House and Senate bills would steadily extend coverage to nearly all Americans by providing government subsidies to help fund health insurance premiums.

The bills would also prevent the practices of health insurance companies such as charging more to those in poor health or excluding them from coverage altogether.

Both the House and Senate bills mandate that all Americans purchase health insurance.

To contain costs, the government subsidies and consumer protections do not go into effect until 2013.   But both bills provide $5 billion in federal funding during the transition period for coverage for those with medical problems who are excluded by private insurers.  Both bills also substantially expand the federal-state Medicaid health program for low-income people.

The majority of those with employer-provided coverage would not see immediate changes. The primary beneficiaries would be those without employer-provided coverage who purchase health insurance on their own.   For them, the legislation would create a federally regulated marketplace where they could shop for coverage.

Some of the major discrepancies between the House and Senate bills include:

- The House bill mandates that employers provide coverage, while the Senate bill does not.

- The House bill would fund the coverage expansion by raising taxes on upper-income earners, while the Senate version uses a combination of taxes and fees, including a levy on high-cost health insurance plans.

- The House plan is estimated to cost about $1.2 trillion over 10 years, while the Senate version comes in at under $900 billion.

If, as many expect, the House and Senate pass competing versions of health care legislation, they will need to work out a compromise bill and approve it before sending it to President Obama to sign into law.

Source: RedOrbit Staff & Wire Reports

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