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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.

By Ezra Klein  |  October 16, 2009; 1:29 PM ET
Categories:  Health Reform  
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Next: Joe Lieberman (Probably) Won't Support a Filibuster Against Health-Care Reform


So we are saying, before Thanksgiving, the bill comes to the floor and after that the floor debate. So the floor vote in Senate may happen in Mid December.

What about House? Then conference and then final vote? Which means earliest the whole show can wrap up is Jan end. Most likely in Feb.

Is that correct?

Posted by: umesh409 | October 16, 2009 1:52 PM | Report abuse

Good reporting.

Shouldn't you be saying something about your sources, i.e. who they are, how many?

Posted by: wisewon | October 16, 2009 2:45 PM | Report abuse

Ezra, if the merged bill includes a public option, if I understand correctly it will take 60 floor votes to amend that feature away. But won't *any* bill that emerges from floor debate need 60 Senators to get cloture, i.e., bring it to a vote?

Posted by: sprung4 | October 16, 2009 3:34 PM | Report abuse


Ezra, if the merged bill includes a public option ..


Also in the running --

COMMIE-CRATS LOSE Va. and NJ governorships, MESSIAH get FRIGHTENED, ECONOMY keeps LOSING REAL JOBS -- Messiah seeks any deal possible to avoid egg-on-face.

Messiah moves back to Chicago in 2012, having PERMANENTLY SCREWED UP JOB MARKET with his STUPID THEORIES.

Posted by: russpoter | October 16, 2009 5:47 PM | Report abuse

so we'll find out just how serious the democrats are about ending pre-ex and covering the uninsured. If they slip the public option in a merged bill they care less about those they claim to care about and jeopardize the entire bill instead of ensuring to get done what everyone knows that can get done like a more moderate bill. So in the end it will be the fault of the democrats and the democrats alone if the status quo remains. Sure they'll still blame republicans politically but that won't be the truth.

Posted by: visionbrkr | October 16, 2009 9:14 PM | Report abuse

A public plan can offer the same benefits for 15-20% less dollars than insurance companies charge. Many large corporations and groups pay for health care by "self funding" and hire a claims administration company. They are not buying insurance but are spreading their risk for health care needed through their very large populations or risk pools. This is how their cost of care is determined, by use, not by uncontrolled administrative, profit and stock inflation charges. These savings can be used to buy more care and/or cover more people.

Insurance companies limit access to care through pre-existing condition exclusions and other administrative limitations, excessive co-payments and deductibles. These denials and diversions all increase insurance company profits, while reducing your access to the care you need.

Insurance companies are rationing your care. Insurance companies are spending millions lobbying congress trying to stop a public option that would eliminate some of their profits. Their monopolistic hold on the marketplace must be ended with a public option.

The fight is on with the insurance companies as they try to save their profits versus our needs.
CEO Health care administration.

Posted by: tideman1 | October 16, 2009 11:58 PM | Report abuse

We, the people, MUST take our country back from corrupt oligarchs, such as insurance company and financial institution executives and their Washington puppets, NOW!
FOX lies notwithstanding, 2/3rds of AMERICAN CITIZENS WANT A PUBLIC OPTION NOW!

Posted by: rooster54 | October 17, 2009 6:24 AM | Report abuse

What Comes Next for Health-Care Reform?
Better hope for a miracle! Something like this group of "government ruling aristocrats"
get some sensitivity to what they are about to force on the masses and scuttle the whole thing!
A sudden burst of real American ideas and truly caring about the citizen would help!
The true irony of this whole issue is the communists/democrats who want the United States revised to a communist/socialist state lose everything too!
Their quality of life and opportunity will be destroyed too!
The big difference is they are too stupid to see it coming and in fact lobby for their own destruction!
We are witnessing the fundamental destruction of a great nation under Obama.
Real life is stranger then fiction!

Posted by: USDefender | October 18, 2009 12:31 AM | Report abuse

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