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Health Overhaul Stuck in Legislative Limbo

By Alex Wayne, CQ Staff

February 5, 2010 -- President Obama and congressional Democratic leaders are still vowing to finish a comprehensive health care overhaul and make good on their top domestic priority. But the legislation has stalled as Democrats sort through a thicket of procedural and policy problems.

The bill made no evident progress last week, in spite of assurances by some senior Democrats that they would move quickly to decide how to finish the measure. Perhaps the only viable plan—a two-step strategy that entails the use of budget reconciliation to avoid a Senate filibuster and amend a Senate-passed health bill (HR 3590)—is being viewed with increasing skepticism.
"When you start dealing with reconciliation in this context and you have another bill, a main bill, it is a good deal more complicated than people have been led to believe," said Senate Budget Chairman Kent Conrad, D-N.D.

Such sentiments have left the future of the health overhaul more uncertain than ever. Though Senate Majority Leader Harry Reid, D-Nev., has said there is no rush to finish the health legislation — House and Senate health care plans are alive until the end of the current session — there is no political advantage in waiting. Many Democrats are anxious to put the health debate behind them. And incumbents facing competitive races this fall will be increasingly wary about casting difficult votes as Election Day approaches.

There is unlikely to be much progress on health care this week, as the Senate focuses on passing a bill aimed at reducing unemployment and Democrats look forward to regrouping during the weeklong Presidents Day recess.

Yet many in the House and Senate remain optimistic that they will somehow complete the legislation. Among them is Rep. Chaka Fattah, D-Pa., who has been urging his colleagues and leaders to clear the Senate's health bill since Jan. 20 — the day after Republican Scott P. Brown won the Massachusetts Senate seat formerly held by Democrat Edward M. Kennedy, D-Mass., casting the health bill into political and procedural limbo.

"I am confident that that's how we're going to proceed," Fattah said. While he acknowledged that only a minority of House Democrats support clearing the Senate bill, "I think the minority's growing."

Congressional Democrats often take their cues on the health bill from the president. The day after Brown's win, Obama said in an interview with ABC News that Democrats should focus on passing only the "core elements" of the health overhaul. That sentiment has been echoed by many rank-and-file Democrats, particularly in the House, who proposed abandoning the larger health bill and passing a series of narrower, less contentious measures instead.

Democratic Reps. Tom Perriello of Virginia and Betsy Markey of Colorado on Feb. 5 introduced one such bill that would repeal health insurers' exemption from antitrust laws — which Democrats contend limits competition in the health marketplace.

But beginning with his State of the Union speech Jan. 26, Obama has pivoted back to advocating passage of complete, comprehensive legislation. "We've got to finish the job on health care," he told Senate Democrats Feb. 3, during a policy retreat.

"I think the president accomplished yesterday what he needed to do," Sen. Ron Wyden, D-Ore., said Feb. 4. "The president was very resolute. That was a question that I think was on senators' minds: is the president willing to go the distance?"

Fattah suggested that there has been little obvious progress in recent weeks because Democrats were waiting for Brown to take his seat.

Before his election, some had suggested that his swearing-in could be delayed so that Democrats could finish the health bill while they still had a 60-vote majority in the Senate — enough to stop a filibuster.

But that idea was widely panned, and immediately after Brown won, Sen. Jim Webb, D-Va., said the Senate should take no more health care votes until after he was seated. Reid agreed. And even though Brown's election had no impact on the political makeup of the House, Democratic leaders there may have avoided criticism by also waiting to act on health care.

"To move in haste absent him being seated would give the opposition — even though it would be ridiculous — the chance to say 'oh, we are ignoring the views of the voters in one state,' " Fattah said.

Reconciliation Rules
Now that Brown has been sworn in, Democratic leaders can move forward, once they resolve a procedural question: can the Senate pass a reconciliation bill that amends legislation that is not yet law? The answer is important, because House Democrats would prefer that the Senate pass the reconciliation bill reflecting their preferences before the House takes up the Senate-passed health bill. House members view the Senate's health bill as inferior to a plan (HR 3962) they passed in November and want assurances the Senate bill would be changed before they vote.

Energy and Commerce Chairman Henry A. Waxman, D-Calif., said procedural questions are less important than the policies Democrats ultimately decide to embrace. "A lot of the policy issues are related to what can or cannot be done under reconciliation in the Senate," he said.
Meanwhile, Democrats are adjusting their messaging by arguing that their health overhaul would itself be a jobs bill — a point they have made in the past, though without as much emphasis.

Speaker Nancy Pelosi, D-Calif., claimed on Feb. 4 that the overhaul would create 4 million jobs. At a Feb. 3 hearing on Obama's health budget, Democrats and Republicans on the Senate Finance Committee sparred over whether the health bill would create or destroy jobs. The committee's chairman, Democrat Max Baucus of Montana, used his first question to Health and Human Services Secretary Kathleen Sebelius to tout the job-creation properties of the health bill.

Sebelius said that with expanded health insurance coverage, workers would take fewer sick days. "You'd not only have more productive companies, but we'd be more globally competitive," she said.

But Finance member Michael B. Enzi, R-Wyo., said that by reducing the growth of Medicare spending over the next 10 years, the overhaul would hurt health providers. "How many jobs will be lost if one in five health care providers go out of business?" he asked Sebelius.

She did not directly respond to his question. Unless Democrats figure out soon how to pass the legislation, it may be of little concern.

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