Health Care Reform Moves to the Senate

Senate Majority Leader Harry Reid (D-NV) has unveiled his health reform bill, and it will face its first vote on Saturday night. This will be a vote to bring the bill to the floor for debate. As with all procedural votes, the Republican party is working for delay by threatening a filibuster, thus requiring 60 votes to proceed. One delaying tactic we will not see is a demand for a full reading of the bill. Senator Tom Coburn (R-OK) has decided not to press this. Senator Reid is likely to have his votes at this stage, since the Democratic Caucus is fairly united in wanting the bill open for debate and amendments.

What is in the bill? There is a public option that is similar to the House version. It is one national plan that will allow the Secretary of Health and Human Services to negotiate fees with providers of goods and services. It gives the board that currently oversees Medicare more power, and fairly effectively works to cut waste out of Medicare, including requiring negotiating drug costs. It provides for exchanges to be established in the states which would include both public and private plans.

It does not open the exchanges to those whose employers provide coverage presently, nor to large businesses. Senator Ron Wyden (D-OR) will introduce an amendment that will allow workers who earn up to 400% of the poverty level to take a voucher from their employers rather than buying into their employers' plans, and going into the exchange. This is the first attempt to open the exchanges to individual workers. If it passes, it will open the exchanges to about a million workers who might not otherwise be covered. (Workers who earn less than 400% of the poverty level are not required to buy into their employer-provided plans if their premiums would come to a certain percentage of their income.)

Senator Ben Nelson (D-NE) is still trying to get stronger abortion language into the bill, which already has language affirming the Hyde Amendment standard of not using federal money to pay for abortions. Senator Olympia Snowe (R-ME) is still trying to tie the public option to a trigger. Triggers, it should be noted, historically do not get pulled, so a trigger essentially kills the public option. She is joined by Senator Tom Carper (D-DE) who has put forward a triggered co-op plan. He and Senator Snowe have discussed their amendments, but these remain separate plans. No one seems quite sure what kind of co-op is actually meant.

In question still are the votes of Senators Mary Landrieu (D-LA), Blanche Lincoln (D-AR), and Joseph Lieberman (I-CT). If these three and Ben Nelson do not vote with the caucus, and choose to support a Republican filibuster, there will be no plan coming from the Senate. Some are calling for consequences if they do so, and recommend stripping Senators who support an opposition filibuster of leadership positions, such as committee chairmanships. This would especially afftect Lieberman, who chairs the Homeland Security Committee. He was allowed to keep this chair after winning reelection as an Independent. If he refuses to vote with the party on procedural votes, there is a strong case for taking it away.

Note that the filibuster applies only to decisions to proceed. There will be one to bring the bill to the floor, and then there will be a cloture vote, bringing debate to a close and proceeding to a vote on the bill. The bill itself will only require a majority vote. In the normal course of events, the vote for cloture to proceed to the floor would not be necessary.

And if that is not confusing enough, it is still possible to separate the bill, and move some of the more controversial parts of it, such as the public option, to reconciliation, where they become exempt from filibuster. Senator Charles Schumer (D-NY) is a strong advocate for this if it becomes necessary. In reconciliation, these sections will become part of appropriations bills, rather than remain part of the health care bill itself. This procedure is not new. The previous administration used it twice to pass their tax cuts.

Hopefully this will be helpful in following the bill as it moves through the Senate. Once the Senate passes a bill, there will be a conference to combine the House and Senate versions. The conference bill then needs to pass both Houses before it can be sent to the President for his signature.

Addendum: This had not been published when the Senate voted to proceed to debate. The decision was 60 to 39 votes, with all Democrats and Independents voting yea, and all Republicans voting no except Senator George Voinovich (R-OH) who would have been the 40th no. There are no surprises here, though some disappointment that Senator Snowe voted no. Senator Voinavich's non-vote is interesting, though. The debate of amendments will begin after the Thanksgiving recess.