The recent Massachusetts special elections to fill the U.S. Senate seat of the late Senator Edward Kennedy (D) threw a monkey wrench in the health care reform negotiations. After the Senate passed the Patient Protection and Affordable Care Act of 2009, H.R. 3590, on a 60-39 party line vote on December 24, 2009 Congressional leaders agreed to bypass a formal conference, which would be subject to delaying tactics, and instead to hammer out a compromise in private. Negotiations between Congressional leaders and the White House on how to merge the Senate and House health care bills were coming to a close just before the January 19 special election. The original plan, which was dependent on the Senate having 60 votes to overcome a filibuster, was to reach agreement on a set of amendments to the Senate bill that could clear both the House and the Senate. Changes that were being considered in negotiations included amending the tax treatment of health benefits, improving health care subsidies for low- and moderate-income people, closing the Medicare Part D prescription drug “doughnut hole” affecting seniors, and altering the special Medicaid deal given to the state of Nebraska. But with the victory of avowed health care bill opponent Scott Brown in Massachusetts the political dynamics have shifted. Without any signs of a Republican supporting the health care bill, Democrats are now one vote short of the 60 vote super majority they need in the Senate.
The way forward is still unclear. Various scenarios have been considered including passing a scaled-back bill that focuses on the more popular provisions like insurance market reforms. However, many of the provisions in the health bills are intricately connected and would not necessarily work in isolation. For example, the Center on Budget and Policy Priorities explains how simply passing insurance market reforms would actually drive up premiums and raise, instead of lower, health insurance costs, since people who could not be denied insurance due to pre-existing conditions would tend to wait to buy insurance until they became ill. The pool of the insured would as a consequence be sicker and more expensive to serve.  (See the Center’s paper.)

The strategy that seems to hold the most promise is to identify changes that can be passed in a budget reconciliation bill that cannot be filibustered and only requires 51 votes for passage in the Senate. In this scenario the House would have to approve the Senate-passed bill and then both chambers would pass a reconciliation bill with provisions consistent with the compromises to be worked out between House and Senate.

House and Senate leaders are still weighing their options and assessing whether they have the votes. Meanwhile, the President reiterated how vital health care reform is in his State of the Union address and urged Congress to find a way forward.  Advocates also continue to press Congress to enact reform legislation. Over 500 national, state and local organizations from across the country sent a letter to Congress urging them to continue to move forward with meaningful health care reform. You can view the letter here. Although the current bills have their shortcomings, most advocates believe they would still make vast improvements to our present health care system. If the compromise that was almost finalized between House and Senate passed, it would extend coverage to over 30 million people currently uninsured, make health care more affordable and ensure that no one is denied coverage for preexisting conditions.

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