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Conference vs. Ping-Pong

Barring any last-minute surprises, health-care reform will pass the Senate early tomorrow morning. But as much as this feels like the end of the road, it isn't. The House and the Senate still need to settle the substantial differences between their bills and pass a common piece of legislation. They can do this through an extended conference, in which negotiators from both chambers meet over a matter of weeks to tweak the bill and come up with new ideas, or it can be done through "ping-ponging," in which the Senate passes amendments that mollify the House, and the House simply passes that bill unchanged, or adds its own amendments that are passed by the Senate.

The virtue of ping-ponging is that it's quicker, and Democrats, at this point, want to pass this bill and move on to other things. The virtue of conference is that it's more flexible, and it gives people time to think through the bills as currently constituted and, in theory, develop a more appealing synthesis. That's not to overstate the power of the conference committee: The final bill would still need 60 votes in the Senate, and so none of the delicate political compromises could be undone. But it's safe to say that more changes could be, and would, be made.

At this point, I'd probably side with those who want a conference committee. As the expert wish lists I've been publishing for the past few days show, there's much that could yet be done to improve the bill, and not all of it is controversial. The most popular response, by far, was to substitute the House's federal exchange model for the Senate's state-by-state exchange model. Other ideas included adding Ron Wyden's voucher option, explicitly freeing medical data, and much more.

There's much that could be done to this bill that's off the path of political controversy but could really better the underlying legislation. The conference won't get all of it done, nor can it wait until perfection, but now that the bill's passage looks almost assured, spending a couple of weeks letting smart and decent negotiators from the two chambers talk some of this out has the potential to do a lot of good. Though I'm sympathetic to the more pessimistic take that letting people talk this out for a few weeks will harden disagreements and give both the right and the far left more time to whip up opposition to the bill. Like a lot of things, it comes down to exactly how broken you think our political system is.

By Ezra Klein  |  December 23, 2009; 6:41 PM ET
Categories:  Health Reform  
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Your writing has been extremely helpful for me in navigating this murky debate filled with demagogues and ideologues and every other -ogue you could imagine. Thanks for all the hard work! I know I couldn't write a bunch of substantial posts like this all day. :) Happy Holidays!

Posted by: aawiegel | December 23, 2009 7:27 PM | Report abuse


Assuming the Senate bill is the base bill, here would be my top priorities in conference:

1. Increasing the actuarial value of the subsidies from 150-300 percent FPL

2. Eliminating the "young invincible" policy, and increasing the minimum actuarial value on the Bronze Tier from 60 percent to 70 percent; 70 percent to 80 percent for the Silver Tier; 80 to 85 percent for the Gold Tier; and 90 to 93 percent for the Platinum Tier. Forbid plans from offering discounted gym membership, dental coverage, eye care, and other benefits attractive to young and healthy people on the Exchange.

3. Adopting the House's (and Massachusetts's) rating rules (2:1 age rating and no smoker rating) and apply to *all* insurance markets

4. Increasing the income exemption for the individual mandate from 8 percent to 14 percent, and starting the $750/person or 2.5% of income tax penalty once the community rating goes into effect (The former must be done if 2 and 3 are done, or too many young, healthy people will be exempt from the mandate)

5. Improving the Senate's noxious pay-or-play provision

Basically, it's about affordability, affordability, affordability, and risk selection, risk selection, and risk selection.

Posted by: BradGabel2002 | December 23, 2009 7:46 PM | Report abuse

Since no repiglicans voted for the bill, is the conference democrats only? Just sayin'

Posted by: srw3 | December 23, 2009 7:53 PM | Report abuse

Just when everyone thought it was over.

My sense is this is going to be an impossible square to circle in a conference, and that the House of Representatives oughta swallow hard and have a vote on the Senate bill, and move on. Of course, easy for me to say, I dont have to convince the Progressive Caucus to walk back their rhetoric of the last six months, or get the pro-life Democrats to not start a holy war around the abortion language.

Posted by: zeppelin003 | December 23, 2009 8:19 PM | Report abuse

Ezra, I'm getting health care reform burnout. We Americans don't like long lasting drama. Ballon boy was for about a week, the White House Crashers lasted a week, Tiger Woods got maybe 2 weeks and here we are still doing this healthcare thingy. Everyone says we need to reform healthcare (the Republicans just don't want Obama's healthcare). Let's just finish the bill and move on to something else. After the town halls over the summer with old women crying about taking back our country, killing grandma, socialism and death panels, all of the drama has gotten stale.

Posted by: ATLGuy | December 23, 2009 9:21 PM | Report abuse

I for one greatly appreciate Klein's consistently intelligent, informed and minimally rhetorical commentary on health care issues in the Post, and on the Olbermann and Maddow shows on MSNBC.

Posted by: twm1 | December 24, 2009 1:20 AM | Report abuse

Ezra: thanks for addressing this issue. I've been hoping you would give us your analysis on it.

Happy holidays,


Posted by: Jasper99 | December 24, 2009 1:32 PM | Report abuse

EK: Have a great, well-deserved vacation! Thanks for helping me better understand all the shenanigans surrounding this issue.

Frankly, I think you should be the official Whitehouse spokesperson for this (and future) issues. You speak our language; too often they don't.

Posted by: onewing1 | December 24, 2009 1:53 PM | Report abuse

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