WASHINGTON - -- Even as Senate Democrats celebrated passing landmark health care legislation last week, they knew the arm-twisting and dealmaking wasn't close to being over.
The $871 billion Senate measure, which passed early Christmas Eve in a taut, party-line vote, now must be reconciled with a $1 trillion House version that passed in early November. While the two bills are more alike than different, working out the kinks won't be an entirely smooth process.
What form that process will take also remains unclear. Typically, differences are ironed out in a joint House-Senate conference committee. But last week, sentiments on Capitol Hill were moving away from such a formal structure in favor of a looser negotiating framework that could allow greater flexibility to fashion a compromise.
And because Republicans will play no role in shaping the final product, Democrats are free to do as they see fit -- which could mean a handful of leaders from both houses, along with key committee chairs, will hammer out a deal behind closed doors with the goal of sending a bill to President Barack Obama by early February. Both the House and the Senate will have to vote again on the measure before that happens.
Members of the Obama administration, including the White House chief of staff, Rahm Emanuel, will also be heavily involved in the talks.
"We've got two bills, one in the House, one in the Senate; they're 95 percent similar," White House deputy press secretary Bill Burton said Thursday. "We're going to be actively working to iron out the rest of the differences and get a bill passed and signed."
Regardless of the format, the Senate is expected to have the upper hand in any negotiations, because Senate Majority Leader Harry Reid, D-Nev., needs the vote of every one of the 58 members of his caucus along with the two independents in the chamber to ward off a Republican filibuster.
Senators such as Joe Lieberman, an independent from Connecticut, and Ben Nelson, a Democrat from Nebraska, whom Reid courted until the last minute, have already pledged to withdraw their support if the bill deviates too much from the Senate version.
For Reid and House Speaker Nancy Pelosi, D-Calif., the challenge will come in keeping Senate moderates on board without triggering defections from House liberals, who are aggrieved that the Senate bill dispensed with cherished provisions such as a government-run insurer -- the "public option" -- that would compete with private companies.
But no one on Capitol Hill seems to believe that the lack of a public option will be a deal-breaker. And Pelosi and other House leaders will have a simple message for intransigent members: Do you want to be the one who keeps a historic health care bill from the president's desk?
It's also possible that the more the final bill begins to resemble the Senate version, the greater the chance that some of the 39 centrist Democrats in the House who voted against the bill could come on board.
Both versions of the bill set up insurance exchanges, where people could buy health policies with the help of federal subsidies. Both expand the reach of the Medicaid program and both impose new rules on insurers, including prohibiting them from rejecting customers based on their medical history.
But there are some significant differences. A key sticking point in the talks may be the issue of abortion coverage and the federal subsidies. The more restrictive House bill prohibits anyone receiving subsidies from buying an individual policy that covers abortion through the new insurance exchange. The Senate bill would only prohibit the use of federal funds for such coverage and would require insurance companies to segregate public and private funds.
Another potential flash point involves how each version is financed. The Senate bill partially relies on taxes on high-end, so-called Cadillac insurance plans -- a tax bitterly opposed by labor unions. The House bill imposes a surcharge on Americans who earn more than $500,000 a year and families earning more than $1 million.
House liberals may seek to extract some other changes to the Senate bill in return for jettisoning the public option, including increasing the amount of the subsidies or moving up the date the new insurance exchanges would take effect one year, to 2013.
How those exchanges would operate is another disparity: House Democrats want that exchange to be a national one, while the Senate bill calls for a state-based system.
The talks could be heated, especially after House leaders have pledged not to "roll over" for the Senate. But it was clear at the end of last week that even the liberals weren't drawing lines in the sand and were ready to deal.
"It doesn't have to be called a public option," said Rep. Lynn Woolsey, D-Calif., co-chairwoman of the Congressional Progressive Caucus. "The main issue for Democrats in the House is affordability."
Janet Hook of the Tribune Newspapers Washington Bureau contributed to this report.
Source:chicagotribune.com
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