Senate health reformers work toward consensus bill during break

The upper chamber recessed without forging an agreement on health system reform, but negotiators will continue meeting throughout August.

By Chris Silva — Posted Aug. 17, 2009

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As Congress broke for its August recess, a bipartisan group of six key Senate Finance Committee members were unable to hammer out a consensus health system reform proposal, despite some intense last-minute discussions and face time with President Obama.

That leaves the Senate with just half of a comprehensive bill and breaks the Democratic leadership's original deadline for holding a floor vote on a measure. The Health, Education, Labor and Pensions Committee approved its version of a reform measure July 15 by a party-line vote, and leaders initially hoped to marry that bill with a bipartisan Finance product before the recess.

But that doesn't mean the work stops until lawmakers return.

"Senators have arranged to continue talking, and staff will continue their hard work," said Jennifer Donohue, a Finance Committee majority aide. "They will spend valuable time in their home states, listening to and learning from their constituents."

Health policy experts said the core group of Finance members negotiating a potential consensus bill have their work cut out for them during the break and when they return. Some observers predicted that an agreement by the committee might not come until the end of the year.

"Senate Democrats will have a difficult time this August as they return to their districts and work to convince their constituents to buy into the president's ambitious health reform agenda," said Erica Suares, Senate relations deputy director at the Heritage Foundation, a conservative think tank based in Washington, D.C.

A lack of agreement on key reform issues keeps forcing Democratic leaders to push back their deadlines. When it became clear that the Senate would recess without the committee producing a bill, Finance Chair Max Baucus (D, Mont.) suggested a new deadline of Sept. 15 for agreeing on a proposal for committee consideration.

But the mention of a new deadline received a cool reception from Republicans, who insisted that Congress cannot rush such a major undertaking. "I have not and will not agree to an artificial deadline, because I am committed to getting health care reform right, not finishing a bill by some arbitrary date," said Sen. Mike Enzi (R, Wyo.).

Baucus and Enzi are two of the "gang of six" committee members who are working toward a bipartisan agreement. The other members of the group are the panel's ranking Republican, Charles Grassley (Iowa), and Sens. Olympia Snowe (R, Maine), Jeff Bingaman (D, N.M.) and Kent Conrad (D, N.D.).

Members from both sides of the aisle report progress in their talks, but they acknowledge several major sticking points remain. Most Republicans, for example, are strongly opposed to a public insurance plan option. As a result, centrist Democrats have proposed replacing that option with private, consumer-owned insurance cooperatives. Both a public plan and co-ops are part of the HELP committee's bill.

Other key issues Finance is debating include how to structure a Medicaid expansion, what level of savings to squeeze from Medicare and how to use tax provisions to raise revenue.

The six senators had an opportunity to update President Obama on all of the outstanding issues during an Aug. 6 meeting at the White House just before the recess. While no agreements were reached at the meeting, congressional aides described it as a helpful listening session with the president in which he encouraged them to continue their efforts.

A long haul

Some observers said it was not a surprise that the gang of six was unable to cobble together an agreement before the August recess given the complexity of the unresolved issues. The Heritage Foundation's Suares said not having a bill introduced before the break will be a mixed bag for Democrats.

"It is politically smart to not have a bill hanging out over the August recess for people to rip apart," she said. "In other ways, the public will think it weak that there is no product for them to see."

Lawmakers may have more to discuss once they hear from the people they represent back home. Some town-hall meetings and other lawmaker events held early in the recess were disrupted by protesters opposing congressional reform plans.

"I think you can say this is not a typical August," said Craig Orfield, minority communications director for the HELP committee, of which Enzi is the ranking member. Enzi is "always busy when he goes home, but he expects health care to be a top item on the agenda this time. There are a lot of concerns and comments coming from constituents."

A quick turnaround by the Finance panel in the fall is looking unlikely, said Joseph Antos, a health care scholar at the conservative American Enterprise Institute in Washington, D.C. "Unless there is a real breakthrough in August, I can't see Finance coming back and washing away all of the problems right away. My guess is Sept. 15 will come and go."

Antos said November is a more realistic target for Finance to unveil a consensus proposal, though it is "more likely to slide into December."

The partisan way

If Senate leaders decide that the gang of six cannot come to a bipartisan agreement fast enough, they may choose to pursue a Democratic bill and seek the 60 votes necessary to end debate on the legislation. If that is not possible, Senate Majority Leader Harry Reid (D, Nev.) might opt to use a controversial parliamentary tactic known as budget reconciliation to force a measure through with only 51 votes.

Such a tactic is likely if Democrats decide to take the partisan route, Suares said. "Generally, people do not think Reid would have 60 votes for a more radical health reform bill to pass in the Senate."

Republicans have been adamant in saying that the use of reconciliation would be the nuclear option for health reform, blasting a huge rift between the parties and exposing the Democrats to potentially disastrous political consequences.

"It'll be a lost opportunity if Democratic leaders in Congress and the administration force action on health care legislation that's not ready because of the complexity of the issues and the high stakes in getting it right," Grassley said. "The public doesn't want a government takeover of the health care system, and we're working to stop it."

Enzi insisted he "won't be moved by partisan threats to misuse the budget reconciliation process."

At least for the time being, Baucus has dismissed talk of the Democrats going it alone and says he is committed to working closely with Grassley to ensure a bipartisan result.

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Timeline of health reform bills

June 17: Senate Health, Education, Labor and Pensions Committee begins marking up incomplete version of national health system reform bill.
July 14: Three House committees with primary jurisdiction over health care -- Energy and Commerce, Ways and Means, and Education and Labor -- introduce complete health system reform proposal.
July 15: Senate HELP Committee approves amended version of incomplete measure by a 13-10 vote.
July 17: Ways and Means and Education and Labor pass amended versions of House bill.
July 31: Energy and Commerce votes 31-28 to pass amended version of House bill.
July 31: House starts summer recess without voting.
Aug. 7: Senate starts summer recess without Finance Committee producing a bill.
Sept. 8: Congress scheduled to return from recess.

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