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Democrats Seek New Way to Finish Health Care Overhaul

By Alex Wayne and Edward Epstein, CQ Staff

January 20, 2010 -- Democratic leaders say they will continue to press forward with legislation to overhaul the health system, but after a demoralizing Senate loss in Massachusetts, they haven't yet settled on how to finish the effort.

There's no easy answer, and no guarantee of success. Pressed on whether he was confident that Congress would send Obama a health care overhaul this year, Senate Majority Leader Harry Reid, D-Nev., ducked. "I'm confident that health care is an issue in the country, and we're going to do everything we can to alleviate the pain and suffering of people who can't afford health care and who want to maintain what they have," he said.

Republican Scott Brown's win means that Democrats no longer hold 60 votes in the Senate and cannot break unified Republican filibusters against health legislation. No Senate Republican voted for the Democrats' health bill (HR 3590) in December, and none is likely to do so after an election that Brown and other Republicans repeatedly cast as a referendum on the overhaul.

Republicans say that both the Senate bill and the House version (HR 3962), which passed narrowly in early November, should be abandoned.

"This was in many ways a national referendum, principally on the major issue we're wrestling with here in the Congress, which is whether or not the government should take over one-sixth of our economy, slash Medicare by half a trillion dollars, raise taxes by half a trillion dollars and drive insurance rates up for most of the rest of our country," said Senate Minority Leader Mitch McConnell, R-Ky. "And I think we heard a large and resounding message yesterday in one of the most—if not arguably the most—liberal states in America."

Democrats fear that failing to enact the health care bill could cost them politically even more than passing the measure. The bill is Obama's top domestic priority and is strongly backed by important Democratic-aligned interest groups, notably labor unions. Should Democrats abandon the measure, despite their still-formidable majorities in Congress, their supporters would be demoralized heading into the 2010 elections.

Reid said, "We're not going to rush into anything. As you've heard, we're going to wait until the new senator arrives before we do anything more on health care."

Reid noted that "the bill we passed in the Senate is good for a year. There are many different things that we can do to move forward on health care, but we're not making any of those decisions now."

Reid said he had spoken to House Speaker Nancy Pelosi, D-Calif., Obama and White House Chief of Staff Rahm Emanuel about potential paths forward but would not elaborate.

Sen. Christopher J. Dodd, D-Conn., one of the architects of the Senate bill, said, "There is no decision about how to go forward, except there's a general agreement that we ought to take a few days just to relax, calm down and begin to think about this in a cooler environment than today."

He added, "To abandon the effort because of a loss in Massachusetts last night would be the worst possible option."

Senate Bill, Plus?
The best option for Democrats would appear to be for the House take up the Senate-passed health bill (HR 3590) and clear it, despite their distaste for many of its provisions. Some House Democrats endorsed that approach Tuesday evening, and others have not ruled out voting for the Senate bill even though they dislike it.

But House Democratic leaders have not undertaken a count to determine if they could muster the 218 votes needed to clear the bill, according to a spokeswoman for House Majority Whip James E. Clyburn, D-S.C.

House Majority Leader Steny H. Hoyer, D-Md., said at an appearance Wednesday morning that Democrats were still discussing how to proceed with the health legislation. "We do believe there are some very good things in the bill that we can get passed," he said at a forum hosted by the centrist group Third Way.

But four centrist Democrats at the forum expressed concerns about clearing the Senate bill.

"My sense is the Senate bill is a tough sell," said Rep. Joe Courtney , D-Conn. "There is a high burden of proof the leadership would have to argue" to get it through the House, he added.

In any deal to clear the Senate bill, Democratic leaders—including Obama and Reid—would likely have to promise House Democrats that they would simultaneously move a "corrections" bill through Congress, probably using expedited budget reconciliation procedures. That measure would amend the health bill with provisions negotiated to meet concerns of the House. Any bill advanced under reconciliation procedures would move on a fast track and require 51 votes to pass the Senate, instead of a filibuster-proof 60 votes.

At a minimum, the second measure would include a deal Obama agreed to with labor unions to reduce the impact of an excise tax on high-cost insurance plans that is the main source of revenue for the Senate bill.

Labor unions and many liberals dislike the proposed excise tax, which they believe many middle-income workers would have to pay.

"We're trying to find a way to move very quickly . . . that satisfies both the concerns of the Senate and the House," said Senate Finance Chairman Max Baucus, D-Mont. "We've got to figure out how we put those two pieces together."

Senate Budget Committee Chairman Kent Conrad, D-N.D., said Wednesday that he's not opposed to using reconciliation for the fixer bill. "It's very dependent on what the details are," he said, adding it had to be paid for, reducing the deficit.

Alternatively, Democrats could use the same expedited reconciliation process to try to pass an entirely new health bill. That would be fraught with problems, however, because policy provisions unrelated to revenues and entitlement spending could be stricken on a point of order.

"Whatever went to the floor would end up coming out looking like Swiss cheese, I suspect," said Sen. Judd Gregg of New Hampshire, the senior Republican on the Budget Committee.

Drew Armstrong and Kathleen Hunter contributed to this story.

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