Pass or fail? Minnesota experts handicap health care bill in Senate

WASHINGTON, D.C. — Senate leaders have laid the groundwork to bring health-care reform legislation to the floor by next week, but a procedural obstacle course still stands between the landmark bill and final passage.

Senate Majority Leader Harry Reid, who is facing a tough reelection in Nevada, will have to delicately navigate extreme differences of opinion on a government-run insurance plan and abortion. At the same time, he will have to look ahead to the conference committee with the House and anticipate how that yet-to-be-written combined legislation will play out.

"This is one big chess game going on at this point," said David Schultz, a political science and law professor at Hamline University in St. Paul. "This is all a game right now. This is not about the merits of health care. It is about a series of procedural games… between the Democrats and the Republicans. It is about abortion politics… It is all about… how [Reid] can muster the votes he needs."

And there is no margin for error.

Democrats now have 58 members in the Senate and two Independents. With the Republicans threatening to vote against the bill, they will need all of those votes to bring the legislation to the floor and then to a final vote.

By comparison, although 39 Democrats in the House ultimately voted against their version of the bill last Saturday night, the legislation prevailed.

"It really puts into stark contrast the differences between the two Houses," said Kathryn Pearson, a congressional expert and assistant professor of political science at the University of Minnesota.

"I think Reid is in an incredibly difficult position," Pearson added. "He is carrying the weight of the Obama administration's goals on health care, Democrats' desire to pass health-care reform legislation, the challenges of an individualistic Senate, and at the same time worrying about re-election."

Challenges from Democrats
On the Democratic side, Reid faces challenges from Sen. Ben Nelson of Nebraska, Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana who have threatened not to allow the bill to be debated on the floor if it includes a public option.

Adding heft to their position is Independent Sen. Joe Lieberman of Connecticut, who said he would ultimately vote 'no' on a bill that includes a public plan. Sen. Olympia Snowe of Maine, the only Republican to vote for the bill in the Senate Finance Committee, also said she would not support public option without a so-called "trigger" provision that would only activate the plan under a certain set of circumstances. At the same time, Sen. Roland Burris, D-Ill., who will not run for reelection, has said that he will only vote for a bill that offers a government-run insurance option.

Reid's latest proposal includes a government-run plan that states could choose to opt out of.

On abortion, Reid might also face problems from conflicts between pro-life and pro-choice members of his caucus.

Abortion issues rose to prominence in the health care debate after the House included an amendment last weekend that opponents argued would overly restrict a woman's right to choose. The amendment's inclusion, however, was critical to the bill's passage in the House and some senators have said they would like to see similar language included in their bill.

The House-passed measure bars the government-run insurance option and any private insurance plan on the proposed exchange that accepts people using government subsidies from offering abortion coverage.

The version of the bill that passed out of the Senate Finance Committee bans abortion services from being required as part of a minimum benefits package in the exchange. It also stipulates that insurance plans that cover abortions must separate public subsidies from private money.

Minnesota Sens. Amy Klobuchar and Al Franken have said that they prefer the Senate language.

"It's like a seesaw," said Larry Jacobs, a political science professor at the University of Minnesota's Humphrey Institute. "You move one way to fix a problem and you" risk losing votes on the other end.

Thus, Reid's challenge will be balancing the legislation so carefully that at least 60 senators will vote to end debate and at least 50 will vote on the final bill. (If necessary, Vice President Joe Biden can be the 51st vote.)

Filibusters become common
Part of the problem, according to Pearson, is that the vote to end debate and the vote to pass legislation are no longer seen as different votes.

"As filibusters become increasingly common, we think of the Senate as the 60-vote Senate," Pearson said. "The norms against filibustering have almost completely broken down. It seems that the line between a vote on cloture [a vote to end debate] and a substantive vote on the bill has blurred."

Pearson added that it would be interesting to see if moderate Democrats who have expressed reservations with the legislation would ultimately break the votes apart and vote to end debate, but against the bill.

Reid could also use an arcane procedural maneuver known as reconciliation to protect certain portions of the bill from a filibuster and thus move them through the Senate on a simple majority vote. But Jacobs said that would be less than ideal and very unlikely.

"First of all, reconciliation is not easy," Jacobs said. "There will be some things that you cannot bring into reconciliation, like insurance regulations. Secondly, there is a time limit on reconciliation. Basically, Democrats would be saying, 'We will be coming back with this in five years.' It is a helpful tool, kind of like a nuclear option for Reid. But I don't think they will use it."

Pearson agreed.

"I think the bill would be changed to satisfy 60 senators before that would happen," Pearson said.

Another possible strategy could be for Reid to force Republicans to filibuster the bill by making continuous speeches from the floor. In current practice, senators only need to threaten a filibuster to delay voting.

By forcing the Republicans to filibuster, Democrats could possibly "tag them with an image of shutting down the Senate," Schultz said.

According to Jacobs, however, it would not be politically smart.

"The Democrats are the governing party," Jacobs said. If the Senate shuts down, "that is their problem."

Minnesota's senators
Klobuchar and Franken have been working to change the Medicare reimbursement formula to benefit states like Minnesota that provide high quality low cost care. In addition, they are working to reduce or eliminate a proposed $40 billion fee on the medical device industry over the next 10 years.

While Franken has indicated that he will support the legislation, Klobuchar has withheld her approval pending the outcome of certain measures.

"I think they are both going to vote for it, they ran on health care reform as Democrats, so they are locked in" Jacobs said. "[But] the way in which Senator Klobuchar is handling this is masterful… she is holding out [to gain] leverage because she is trying to help out some important Minnesota interests."

Despite all of these issues, Senate leadership has put forward an optimistic timeline: introduce bill next week, debate and vote on it in December, pass conference bill around mid-January.

In interviews this week, Klobuchar stuck by leadership's proposed timeline, while Franken said he could not speculate on how the bill was likely to proceed.

"It is a little above my pay grade right now," Franken said.

Cynthia Dizikes covers Minnesota's congressional delegation and reports on issues and developments in Washington, D.C. She can be reached at cdizikes[at]minnpost[dot]com.