Not Yet, But Close

It looks like Senate Democrats are starting to measure gift wrap after the significant developments that occurred this week on the Senate floor (and behind closed doors).  Following Thursday's announcement by Senator Reid that Senate leadership had reached a compromise on the issue of a public option, news agencies are reporting that Senator Reid is preparing to present cloture motions next week with the goal of securing a vote on the Senate's health care reform proposal before the weekend.  Remember that cloture is the use of a Senate rule that permits the Senate Majority Leader to end debate (and a certain filibuster attempt) with a 2/3 majority vote.  And perhaps it is just a coincidence, but House Speaker Pelosi (D-CA) has commented that she would consider committee conferencing during the weekend of December 19-20 with the hope of a full House vote on a compromised bill the following week.  That timetable is unlikely though when considering the complexity of issues involved and the notorious inefficiency of the committee conference process.

Now What?

On December 8, the Senate voted 54-45 to defeat an amendment sponsored by Senators Ben Nelson (D-NE) and Orrin Hatch (R-UT) that would have toughened language in the Senate's health care reform bill regarding federal funding for abortion.  The amendment would have banned any public option from covering abortion (except in rare cases) and precluded individuals from using federal subsidies to purchase insurance plans that cover abortion.  This development has two important political implications.  First, Senator Nelson has threatened to join a filibuster of the Senate's bill if tougher language regarding federal funding for abortion is not adopted.  And, if he does, then Senator Reid will likely no longer have the 60 votes needed to end debate and move forward on a vote for the complete bill (unless a Republican decides to support the bill).  Second, even if the Senate's bill moves to a vote and is approved without tougher language regarding federal funding for abortion, it still must be reconciled with the House's bill that contains the Stupak Amendment language, language that is almost identical to that in Senator Nelson's proposed amendment.  And if the reconciliation process does not maintain the tougher language, the reconciled bill most likely will hit another roadblock when the House, with a clear majority in favor of the tougher language, votes on it.  Federal funding for abortion is a critical issue that will continue to buckle the reform process to the end.

Further, liberal and moderate Democrats combined forces earlier this week to head off concerns that including a public option could kill any hope of passing a health care reform bill out of the Senate.  In place of the public option, Democrats have proposed an expansion of the Medicare program to cover adults ages 55-64.  Under the new compromise, a "Medicare buy-in" would open coverage to a population that has four million uninsured and is viewed as being the most vulnerable to losing health insurance and having increased chronic health problems.  While some moderate Democrats appear to be cautiously optimistic, cost remains a key concern as the Congressional Budget Office has yet to provide a cost estimate of the new proposed expansion.  The estimate is expected to be released any day.  Some liberal Democrats have voiced concern that extracting a public option from the bill is a "give-away" to the private insurers, while physician and hospital advocate groups have raised concerns that expanding coverage for a program that is already financially unsustainable would jeopardize access to care.   

Another key provision in the compromise is the expansion of national private insurer plans that would be directed by the Office of Personnel Management, which is now responsible for overseeing health insurance coverage for lawmakers under the "Federal Employees Health Benefits Program."  Currently, several private plans work together in a public-private partnership to cover nine million federal employees and their families.  Although it is still not clear how this private plan expansion will work under the new proposal, it would appear the public option model may ultimately be redefined to appease concerns that some form of a public option must be included in the final bill.  And while many of the main aspects of the Senate health care reform bill remain intact, this new proposal signals a monumental shift in the debate and also indicates that Senate Democratic leadership recognizes that increasingly creative consensus building will be key to getting the needed 60 votes to secure passage. 

Visit our Health Law Broadcast at hallrender.com/reform for a comprehensive listing of health care reform resources.  Also sign up for health care reform alerts and periodic updates as we continue to monitor this important issue.