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This was never going to be easy

Waking up today, federal health reform became a completely different beast. Seemingly inevitable legislation that would fundamentally transform the American health care system for the better is now showing signs of mortality. It would be too easy to lament on the “if only”s, and even easier to kick the can down the road. The fact is, though, both houses of Congress have already passed health reform legislation. Forever forward, regardless of the outcome, there is no escaping ‘Yes’ votes from those Congressmen that are fearful for his or her reelection as opposing candidates are going to use it against them in either case. That being said, the political risks of abandoning the plan are far greater than reaching compromise and sending a bill to the President. Substantive disagreements are debatable, but futility guarantees defeat.

So the question is, then, what are the next steps? To reduce the shock value and bring this situation back down to earth, read the latest from David Leonhardt. He posits that “the bills before Congress are politically partisan and substantively bipartisan” and explains the need to unify around an already centrist bill. How will this be done?

It’s hard to say. The day has been filled with speculation, suggestion, and prognostication. Rumors of the bill being chopped up into pieces or vastly scaled down were rampant, though a White House memo indicates this is not likely. Persuading moderate Republicans in either the Senate or House is equally unlikely.

The greatest consensus, even backed by labor in SEIU’s Andy Stern, would be to have the House pass the Senate version and attach a provision guaranteeing improvement (like the excise tax modifications and increased subsidies) through budget reconciliation from the Senate side. Kent Conrad expressed support for this as well, and Pelosi vowed the House would move forward with reform. Looking at this option, it appears that a group of House liberals (led by Raul Grijalva) are unwilling to accept the Senate bill as-is. It is quite possible that Pelosi would be willing to lose some liberals in favor of a more centrist bill if she can pick up enough moderate Dems along the way (remember that 39 Ds voted ‘No’ on the more robust House version).

We should be clearer on the chosen path in the next few days, as Congressional leadership and the White House appear committed to the cause they already own.