Dems begin process of reconciling Congress’ two health-care bills

Speaker of the House Nancy Pelosi
REUTERS/Yuri Gripas
Speaker Nancy Pelosi will meet with committee chairs today, and with the president tonight.

Let’s hazard a few guesses about New Year’s resolutions for leaders of Congress as they begin to slog through thousands of pages of health-care reform legislation.

1. Don’t let Republicans get in the way again.
Today, House Speaker Nancy Pelosi will meet with the Democratic chairs of four committees “to start setting the parameters for negotiations with the Senate,” Politico reports. Tonight, Pelosi and House Majority Leader Steny Hoyer, D-Md., will meet with President Barack Obama at the White House. Senate Majority Leader Harry Reid of Nevada and Democratic Party Whip Dick Durbin of Illinois are expected to participate via conference call because they haven’t returned to Washington yet.

The New Republic’s The Treatment blog broke the story Sunday that Democrats were “almost certain” to use informal negotiations to iron out differences in bills in the House and Senate rather than convene a conference committee. The process is called “ping-pong.” (Eric Black wrote about the prospects for ping-ponging last month.)

“Doing so would allow Democrats to avoid a series of procedural steps — not least among them, a series of special motions in the Senate, each requiring a vote with full debate — that Republicans could use to stall deliberations, just as they did in November and December,” writes The Treatment’s Jonathan Cohn.

Since just one Republican voted for the House bill passed in November and no Republican voted for the Senate bill on Christmas Eve, the Democrats don’t have to invite Republicans to play this round.

“With ping-ponging, the chambers send legislation back and forth to one another until they finally have an agreed-upon version of the bill,” Cohn says. “But even ping-ponging can take different forms, and some people use the term generically to refer to any informal negotiations.”

Which isn’t sitting well with Republicans.

“Something as critical as the Democrats’ health-care bill … shouldn’t be slapped together in a shady backroom deal,” Michael Steel, a spokesman for House Minority Leader John A. Boehner, R-Ohio, told the Los Angeles Times.

“Skipping a real, open conference shuts out the American people and breaks one of President Obama’s signature campaign promises,” Steel said.

2. Keep the Democratic caucuses in line.  
The bigger headaches for Democratic leaders may come from their own party. We saw how moderate Democrats, Sen. Ben Nelson of Colorado and Rep. Bart Stupak of Michigan, held up bills in their respective chambers to ban federal subsidies from being used to cover abortion.

“Abortion remains perhaps the thorniest issue,” according to Kaiser Health News’ “The House, Senate and You: A New Guide to Health Reform.”

“The Senate bill would allow insurance plans that operate in newly created exchanges, or marketplaces, to offer abortion coverage, but enrollees would have to write separate checks for it,” reports Kaiser. “The House bill has even tighter language: Insurers in the exchanges that accept federal subsidies — which is likely to be most if not all of them — couldn’t provide abortion coverage at all.”

Besides the abortion issue, the Kaiser guide says “the biggest battles will come over how the legislation would be paid for, whether to include a government-run insurance plan and how much to spend on subsidies to help lower- and middle-income Americans afford insurance.”

3. Keep the cost of health-care reform under $1 trillion over 10 years.
As talks begin today about extending coverage to uninsured Americans and rein in costs of health care, a report from the U.S. Department of Health and Human Services offers good news and bad news about health spending.

Thanks to the recession, health spending “grew in 2008 at the slowest pace in 48 years,” according to the New York Times.

The nation spent $2.3 trillion in 2008, an average of $7,681 per person. Total spending was up 4.4 percent from 2007 compared with 6 percent in 2007 and an average increase of 7 percent a year from 1998-2008, the Times said.

The bad news: Despite the slowing rate, health spending accounted for 16.2 percent of Gross Domestic Product, up from 15.9 percent in 2007.

“By slowing the growth of health spending, the recession achieved what a generation of public officials tried unsuccessfully to accomplish,” the Times said. “But in their annual report on the topic, federal officials said the deceleration in health spending was a result of the soft economy, and they did not cite any factors that would alter the long-term outlook for continued increases in health spending as baby boomers age and doctors make greater use of new medical technology to treat patients.”

Observers predict the final health-reform bill will be closer to the Senate’s price tag of $871 billion than the House’s $1 trillion. President Obama has said he’d like to keep the cost below $900 billion over the decade.

4. Find the least-egregious ways to finance reform.
Democrats in the House and Senate both tax the wealthy to pay for reform, but they differ in their approaches.

“Both bills hit up the wealthy, but in different ways,” Kaiser says. “The House would impose a 5.4 percent income tax surtax on individuals who earn more than $500,000 a year and couples that earn more than $1 million. The Senate would increase the Medicare payroll tax rate from 1.45 percent to 2.35 percent for people who earn more than $200,000 a year and families that earn more than $250,000.”

The Senate seeks a 40 percent tax on the “portion of most employer-sponsored health coverage that exceeds $8,500 a year for individuals and $23,000 for families.” The Senate also wants to “raise the threshold for deducting medical expenses to 10 percent of income, up from 7.5 percent.”

Financing provisions could “spur a pitched battle,” Kaiser says. “… The House hates the Senate tax on high-cost policies, while the Senate opposes the House’s income-tax surcharge.”

5. Learn to live with the Senate bill.
Remember the days leading up to Christmas Eve and the last-minute concessions in the Senate? House leaders are expected to cede some ground in the ping-pong process.

“House negotiators have their work cut out for them because [Senate Majority Leader Harry] Reid — and his wavering moderates — will be reluctant to make any changes that would upset the fragile accords that paved the way for last month’s historic, hard-fought, party-line vote to approve the Senate bill,” Politico reports. “This spells trouble for the public option, but there are plenty of other substantive differences between the two bills that could give House leaders a foothold to make other changes.”

Among those changes could be heftier subsidies for the lowest-income Americans who aren’t eligible for Medicaid, Politico notes.

Casey Selix, a news editor and writer for, can be reached at cselix[at]minnpost[dot]com. Follow her on Twitter.

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Comments (4)

  1. Submitted by Gregory Stricherz on 01/05/2010 - 11:52 am.

    Didn’t realize Pelosi was a cigar smoker.

  2. Submitted by John Olson on 01/06/2010 - 07:00 am.

    My own take on this is if the Democrats choose to do the “smoke-filled room” approach, they are putting all of their chips in and taking a huge gamble. At BEST, they keep their majorities in the House and Senate, but by much thinner margins than what they have right now. Even in this case, the Republicans pick up enough seats in the Senate to effectively block any significant legislation through filibustering for the next two years–minimum.

    If the Democrats follow through with brokering this important bill in the middle of the night on their own without any opportunity for public viewing and fail, the Democrats in both chambers stand to lose very, very big.

  3. Submitted by Karen Sandness on 01/06/2010 - 10:10 pm.

    Alas, we don’t need insurance; we need care, and the price of insurance, even with the subsidies, may be enough to prevent us from getting CARE.

  4. Submitted by Rebecca Hoover on 01/07/2010 - 11:00 am.

    Karen, you are so right! I can’t understand why we have the fat cat insurance companies skimming 20% of our health care dollars right off the top. We need health care not health insurance. Insurance is basically some corporate fat cats running off with the cash and then telling the rest of us to limit our health care consumption.

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