Some law­mak­ers are still skit­tish, but a path to pass­ing re­form has emerged

As Obama pushes for clo­sure, still no one’s cer­tain how re­form will play out

Modern Healthcare - - News - Matthew DoBias

Even with a stepped up pres­ence by Pres­i­dent Barack Obama and a mid-March dead­line for a vote, the prospects of Congress pass­ing health­care sys­tem over­haul leg­is­la­tion re­main un­cer­tain. Con­gres­sional leaders and the White House have of­fi­cially co­a­lesced around a process that would al­low for a vote in the com­ing weeks. Even so, some Democrats have proven in­creas­ingly skit­tish about vot­ing for a health­care over­haul, with many of them eye­ing trou­ble­some cam­paigns lead­ing up to Novem­ber’s elec­tion. Still, a path for­ward has emerged. Ac­cord­ing to sev­eral law­mak­ers, the pres­i­dent has com­mit­ted to a two-bill process. Un­der terms of the deal, the House would vote first on the Se­nate’s leg­isla­tive pack­age—some­thing many mem­bers are loathe to pass be­cause of dif­fer­ences over af­ford­abil­ity, gov­ern­ment over­sight and a wide range of so­cial is­sues.

If the House does pass that bill, then a sec­ond pack­age—drafted by the White House with Demo­cratic leaders—would emerge, car­ry­ing with it pro­pos­als House mem­bers want to see added that were not in the Se­nate bill. This sec­ond bill would move un­der a process known as rec­on­cil­i­a­tion, which would al­low the Se­nate to pass it on a sim­ple ma­jor­ity vote, ac­cord­ing to a num­ber of House mem­bers.

“ It’s two-piece leg­is­la­tion,” con­firmed Rep. Raul Gri­jalva ( D-Ariz.), co-chair­man of the Con­gres­sional Pro­gres­sive Cau­cus. “ It’s joint leg­is­la­tion.”

Gri­jalva, who leads a siz­able chunk of lib­er­als up­set over the lack of a pub­lic op­tion and taxes on high-val­ued health plans found in the Se­nate’s ver­sion, has with­held sup­port of the two-bill strat­egy.

But af­ter get­ting as­sur­ances from the pres­i­dent that he would sup­port leg­is­la­tion in the fu­ture to es­tab­lish a pub­lic op­tion and nar­row health dis­par­i­ties, Gri­jalva said that he and his cau­cus mem­bers were in­clined to vote for the Se­nate’s bill.

“It’s be­com­ing that way,” he said, speak­ing to re­porters just off the House floor.

Gri­jalva and other House mem­bers were part of a heavy White House push late last week to try to sway party hold­outs into vot­ing for the re­form bills. More con­ser­va­tive mem-

bers of the party also met with the pres­i­dent.

In a can­did mo­ment, Obama pressed the law­mak­ers on the im­por­tance of the votes. “To main­tain a strong pres­i­dency, we need to pass this bill,” Obama told the mem­bers, ac­cord­ing to Gri­jalva.

Still, many mem­bers of Congress say that many ques­tions re­main. Even with pro­gres­sives on­board, Democrats could find them­selves shy of the 217 “yea” votes needed to pass a bill.

Last Novem­ber, House Democrats ral­lied to pass their leg­is­la­tion on a 220-215 vote, with only one Repub­li­can, Rep. Anh “Joseph” Cao of Louisiana, vot­ing with the ma­jor­ity. Cao, how­ever, has said he would not vote for the Se­nate’s pack­age this time.

Sep­a­rate of that one GOP vote, 219 Democrats voted for the bill and 39 voted against it.

Since then, Democrats have lost three mem­bers who pre­vi­ously sup­ported the bill. Rep. Robert Wexler (D-Fla.) and Rep. Neal Aber­crom­bie ( D-Hawaii) both re­signed ear­lier this year. John Murtha, the long­time con­gress­man from Penn­syl­va­nia, died last month.

As­sum­ing Democrats hold all of the “yea” votes they gar­nered the last time, those three ef­fec­tively leave them with 216 in fa­vor of the bill—one shy of the needed ma­jor­ity to pass the bill.

In ad­di­tion, cer­tain fac­tors are in play this year that were not in 2009. For starters, this is an elec­tion year, and many in­cum­bents say they are feel­ing more vul­ner­a­ble this year than ever be­fore.

At the same time, polling shows that a Repub­li­can-led ef­fort to kill the cur­rent bills in process has gained trac­tion among the gen­eral pub­lic. Some law­mak­ers who showed up in the “yea” col­umn the first time around could back­track and vote against the bill this time around.

The long sim­mer­ing is­sues over abor­tion and im­mi­gra­tion lan­guage also con­tinue to play a role, with Rep. Bart Stu­pak (D-Mich.) say­ing that he and about 11 other Democrats would vote against the Se­nate’s bill be­cause it doesn’t pro­vide a fire­wall be­tween fed­eral dol­lars and abor­tion ser­vices.

Stu­pak, who held a bloc of vot­ers at bay last Novem­ber un­til he got—and won—an amend­ment that strength­ened the lan­guage in the House bill, said he’s will­ing to do so again. Only this time, the bill the House would be vot­ing on can’t be changed without it hav­ing to go back to the Se­nate, where it would likely die.

Stu­pak has called the Se­nate’s lan­guage “un­ac­cept­able,” and said that adding a pro­vi­sion that mir­rors his amend­ment to an­other piece of leg­is­la­tion wouldn’t work.

Short of an of­fi­cial whip count—the leg­isla­tive term used to de­scribe a pre-count on votes—it is dif­fi­cult to dis­cern which Democrats are ac­tu­ally will­ing to scut­tle health re­form and which are merely try­ing to gain lever­age. “Stu­pak’s been say­ing that all along,” said Rep. Diana DeGette, a pro-choice Demo­crat from Colorado. “Ten or 11 votes is not go­ing to kill the bill.”

DeGette added: “A num­ber of peo­ple he’s say­ing will vote no voted no the last time. And some who voted no have had a change of heart.”

Cao, a Repub­li­can, said he would not vote for the Se­nate bill.

DeGette: “Ten or 11 votes is not go­ing to kill the bill.”

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