What Comes Next for Health-Care Reform?
The first of Harry Reid's meetings to merge the Finance and HELP Committee bills and create one compromise bill able to survive the Senate floor happened Wednesday. The participants in the room were a high-powered bunch: Reid, of course; Max Baucus, chairman of the Senate Finance Committee; Chris Dodd, who led the HELP Committee's health-care reform effort. The White House sent Rahm Emanuel, Peter Orszag, Nancy-Ann DeParle, Kathleen Sebelius and Phil Schiliro. And then staff. Lots and lots of staff. Contrary to reports from earlier this week, it no longer looks like Olympia Snowe will be a constant presence.
Reid's office is serious about ensuring the process blends the two existing bills, rather than develops a whole new bill. That means that on an issue like the public option, you could see a new policy emerge, as one bill has a public option and one doesn't. Creating some sort of compromise would fit into the "blend" framework. But on issues that only are addressed in one of two bills -- revenues are only in the Finance bill, for instance, and biologics are only in the HELP bill -- you'll see a variant of what's already written into the bill. The negotiators aren't likely to dream up a whole new tax and plug it into the legislation. They feel that would be a perversion of the committee process.
Tautological as it sounds, chief among the questions is which questions will be answered in the negotiations, and which questions will be left for the floor. It's not an idle debate. Take the public option. If Reid decides to put a public option, or some sort of public option compromise, into the bill, then it would require 60 senators to remove it on the floor, and only 41 senators to defend it. Conversely, if he decides to leave the public option fight for the floor, then it will take 60 senators to add it into the bill, and only 41 to block it. That means that groups who see an issue decided in their favor during the blend have a huge advantage over groups that are left to fight it out on the floor.
Some issues, however, will be left for the floor because the two bills don't have the raw material to solve them in negotiations. Most Democrats agree, for instance, that you need more subsidies to ensure affordability, which means you need more revenues. The excise tax is also controversial, and many want to see it softened. That, too, will require replacement revenues. But since the HELP bill doesn't have revenues, and the Finance bill has little beyond the excise tax, the question of affordability might have to be solved on the floor. In that case, the negotiations might focus on working out a compromise amendment that can be brought to the floor and supported by the whole caucus.
The negotiations should take a week or two, and the CBO will then take a bit more time to score the product. Reid's office would like the bill on the floor in two weeks, but that's a tight deadline when you need to wait for a score. After that, Reid's office would like floor debate to close after two weeks, but that's ambitious, to say the least.
Photo credit: Brendan Hoffman/Bloomberg.