By Alex Wayne, CQ Staff
November 24, 2009 – The Senate will begin its long-awaited health care debate effectively at an impasse.
The Democratic leadership barely mustered the 60 votes needed to keep Majority Leader Harry Reid's bill alive long enough to bring it to the floor. It was an important victory, but one that could quickly prove hollow.
The Democratic moderates who gave Reid the support he needed on a Nov. 21 cloture vote also served notice publicly that he cannot count on them unless the bill is made more to their liking—as did at least one liberal.
When the Senate begins debate on the bill the week of Nov. 30, the Nevada Democrat's task will be to find a way to unify his disparate majority behind the legislation (HR 3590). At the moment, it does not appear there are 60 votes to either pass the bill or amend it in ways that might draw the votes needed for passage.
It will be up to Reid—and, to a large extent, President Obama—to find a way to break the gridlock. The health care debate, coming on the eve of a congressional election year, has become a test of Reid's and Obama's leadership and of the Democratic majority's ability to address significant policy concerns.
"I would think they're going to have to make some accommodation for some people on their side to get it out of here," said John Thune, R-S.D. "It's going to be a real challenge for [Reid], probably, to satisfy his left and the people he's going to need to get to 60, the moderates."
Reid has no reason to expect any help from the Republican minority. Of the 40 GOP senators, 39 voted against the procedural motion to proceed to the bill, and the one who did not vote—Ohio's George V. Voinovich—had earlier announced his opposition. Amendments are also expected to require 60 votes, since they will be subject to filibuster as well.
Some Democrats hold out hope that one or both of Maine's moderate Republicans, Olympia J. Snowe and Susan Collins, might vote for the final health care overhaul. But Snowe said she voted to keep Reid's bill from coming to the floor because she doubts she will be able to win the adoption of amendments she wants.
That leaves Reid and Obama where they were on the motion to limit debate—with no room for dissenting votes from senators in the 60-member Democratic Caucus.
"There are a number of very, very tough issues," said Nancy LeaMond, a senior vice president of AARP who directs the interest group's lobbying. "I can't imagine it's not going to take the full force of the president and the leadership of the Senate to find a path through it."
The 'Public Option' Obstacle
Reid's foremost problem is what to do about the "public option"—a government-run insurance plan most Democrats would like to create to compete with private insurers in the insurance exchanges the legislation would set up.
Four senators—independent Joseph I. Lieberman of Connecticut and Democrats Ben Nelson of Nebraska, Blanche Lincoln of Arkansas, and Mary L. Landrieu of Louisiana—who voted to begin debate on the bill have said they will likely later oppose any move to end a filibuster and pass the measure unless the public option proposed by Reid is significantly altered or removed.
On the other side of the issue, Bernard Sanders, an independent from Vermont, released a statement Sunday saying that there are a "number of senators, including myself, who would not support final passage without a strong public option."
A compromise could emerge from talks on a proposal by Thomas R. Carper, D-Del. He has suggested a public option available only in states where private insurers fail to offer insurance plans that meet yet-to-be-defined cost standards, or in states that choose to offer a public plan in competition with private insurers.
Carper says he has discussed his idea with "the usual suspects"—moderates he declined to identify.
Kent Conrad, D-N.D., who said he has spoken with Carper, said of the proposal: "I give him very high marks for the effort he has under way. It's very thoughtful."
Another potential broker of bipartisan agreementi—if such a thing is possible in the Senate—could be Ron Wyden, D-Ore., who has put together an alternative health care overhaul (S 391) with five conservative Republican cosponsors. "I continue to hope that before this is through, we're going to have some real bipartisan breakthroughs," he said.
But Thune was skeptical. "I suspect there will be efforts by the Democrats to poach some issues that can attract" Snowe and Collins, he said. "But I don't know. Talking with them, there's some pretty strong reaction in opposition right now to this bill."
Abortion and Other Issues
Reid will also have to address the abortion issue. Anti-abortion groups, notably the Democratic-inclined U.S. Conference of Catholic Bishops, are alarmed that his bill would allow insurance plans receiving federal subsidies, including the public option, to cover elective abortion. Doing so, abortion opponents say, would violate longstanding legal prohibitions—collectively known as the Hyde amendment—against using federal money to terminate pregnancies that are not the result of rape or incest or do not threaten a woman's life.
Reid, who personally opposes abortion, and abortion-rights supporters say his bill honors the principle of the Hyde restrictions by requiring insurance plans covering abortion to separate federal subsidies from the money they use to pay for abortions. Abortion opponents say that restriction is insufficient.
Nelson is the only anti-abortion Democrat who has said he may oppose the bill if the abortion language is not changed.
But Reid may be able to assuage Nelson and other anti-abortion Democrats by clearing the way for a vote on an amendment that would tighten the bill's abortion restrictions. Such a vote would allow anti-abortion Democrats to publicly demonstrate their position on the issue, but the amendment would probably not be adopted. Abortion opponents acknowledge that they do not have 60 Senate votes on their side.
There are also likely to be fights during the floor debate over the tax increases and Medicare spending reductions that would finance the bill's expansion of health insurance coverage.
Patrick J. Leahy, D-Vt., has said he will offer an amendment to partially repeal health insurers' exemption from federal antitrust law.
Republicans will likely try to win amendments that would reduce medical malpractice lawsuits, which they say needlessly drive up health care costs.
And then there is the unknown: "My sense is there is a tough issue out there that hasn't been invented yet," LeaMond said.
Passage of the bill may ultimately depend on Reid winning 60 votes, after much debate, for one or more amendments representing a grand compromise between Democratic liberals and moderates on issues as diverse as the public option, abortion, and the bill's financing and cost.
Majority Whip Richard J. Durbin, D-Ill., said he expects changes in the bill in the forthcoming debate. But he added that the leadership will not permit an endless series of amendments and cloture motions to bog down the Senate into the new year.
"If you think we're just going to sit in here, 30 hours after 30 hours after 30 hours, until it's Jan. 1, it's not going to happen," Durbin said.
Drew Armstrong contributed to this story.
November 24, 2009 – The Senate will begin its long-awaited health care debate effectively at an impasse.
The Democratic leadership barely mustered the 60 votes needed to keep Majority Leader Harry Reid's bill alive long enough to bring it to the floor. It was an important victory, but one that could quickly prove hollow.
The Democratic moderates who gave Reid the support he needed on a Nov. 21 cloture vote also served notice publicly that he cannot count on them unless the bill is made more to their liking—as did at least one liberal.
When the Senate begins debate on the bill the week of Nov. 30, the Nevada Democrat's task will be to find a way to unify his disparate majority behind the legislation (HR 3590). At the moment, it does not appear there are 60 votes to either pass the bill or amend it in ways that might draw the votes needed for passage.
It will be up to Reid—and, to a large extent, President Obama—to find a way to break the gridlock. The health care debate, coming on the eve of a congressional election year, has become a test of Reid's and Obama's leadership and of the Democratic majority's ability to address significant policy concerns.
"I would think they're going to have to make some accommodation for some people on their side to get it out of here," said John Thune, R-S.D. "It's going to be a real challenge for [Reid], probably, to satisfy his left and the people he's going to need to get to 60, the moderates."
Reid has no reason to expect any help from the Republican minority. Of the 40 GOP senators, 39 voted against the procedural motion to proceed to the bill, and the one who did not vote—Ohio's George V. Voinovich—had earlier announced his opposition. Amendments are also expected to require 60 votes, since they will be subject to filibuster as well.
Some Democrats hold out hope that one or both of Maine's moderate Republicans, Olympia J. Snowe and Susan Collins, might vote for the final health care overhaul. But Snowe said she voted to keep Reid's bill from coming to the floor because she doubts she will be able to win the adoption of amendments she wants.
That leaves Reid and Obama where they were on the motion to limit debate—with no room for dissenting votes from senators in the 60-member Democratic Caucus.
"There are a number of very, very tough issues," said Nancy LeaMond, a senior vice president of AARP who directs the interest group's lobbying. "I can't imagine it's not going to take the full force of the president and the leadership of the Senate to find a path through it."
The 'Public Option' Obstacle
Reid's foremost problem is what to do about the "public option"—a government-run insurance plan most Democrats would like to create to compete with private insurers in the insurance exchanges the legislation would set up.
Four senators—independent Joseph I. Lieberman of Connecticut and Democrats Ben Nelson of Nebraska, Blanche Lincoln of Arkansas, and Mary L. Landrieu of Louisiana—who voted to begin debate on the bill have said they will likely later oppose any move to end a filibuster and pass the measure unless the public option proposed by Reid is significantly altered or removed.
On the other side of the issue, Bernard Sanders, an independent from Vermont, released a statement Sunday saying that there are a "number of senators, including myself, who would not support final passage without a strong public option."
A compromise could emerge from talks on a proposal by Thomas R. Carper, D-Del. He has suggested a public option available only in states where private insurers fail to offer insurance plans that meet yet-to-be-defined cost standards, or in states that choose to offer a public plan in competition with private insurers.
Carper says he has discussed his idea with "the usual suspects"—moderates he declined to identify.
Kent Conrad, D-N.D., who said he has spoken with Carper, said of the proposal: "I give him very high marks for the effort he has under way. It's very thoughtful."
Another potential broker of bipartisan agreementi—if such a thing is possible in the Senate—could be Ron Wyden, D-Ore., who has put together an alternative health care overhaul (S 391) with five conservative Republican cosponsors. "I continue to hope that before this is through, we're going to have some real bipartisan breakthroughs," he said.
But Thune was skeptical. "I suspect there will be efforts by the Democrats to poach some issues that can attract" Snowe and Collins, he said. "But I don't know. Talking with them, there's some pretty strong reaction in opposition right now to this bill."
Abortion and Other Issues
Reid will also have to address the abortion issue. Anti-abortion groups, notably the Democratic-inclined U.S. Conference of Catholic Bishops, are alarmed that his bill would allow insurance plans receiving federal subsidies, including the public option, to cover elective abortion. Doing so, abortion opponents say, would violate longstanding legal prohibitions—collectively known as the Hyde amendment—against using federal money to terminate pregnancies that are not the result of rape or incest or do not threaten a woman's life.
Reid, who personally opposes abortion, and abortion-rights supporters say his bill honors the principle of the Hyde restrictions by requiring insurance plans covering abortion to separate federal subsidies from the money they use to pay for abortions. Abortion opponents say that restriction is insufficient.
Nelson is the only anti-abortion Democrat who has said he may oppose the bill if the abortion language is not changed.
But Reid may be able to assuage Nelson and other anti-abortion Democrats by clearing the way for a vote on an amendment that would tighten the bill's abortion restrictions. Such a vote would allow anti-abortion Democrats to publicly demonstrate their position on the issue, but the amendment would probably not be adopted. Abortion opponents acknowledge that they do not have 60 Senate votes on their side.
There are also likely to be fights during the floor debate over the tax increases and Medicare spending reductions that would finance the bill's expansion of health insurance coverage.
Patrick J. Leahy, D-Vt., has said he will offer an amendment to partially repeal health insurers' exemption from federal antitrust law.
Republicans will likely try to win amendments that would reduce medical malpractice lawsuits, which they say needlessly drive up health care costs.
And then there is the unknown: "My sense is there is a tough issue out there that hasn't been invented yet," LeaMond said.
Passage of the bill may ultimately depend on Reid winning 60 votes, after much debate, for one or more amendments representing a grand compromise between Democratic liberals and moderates on issues as diverse as the public option, abortion, and the bill's financing and cost.
Majority Whip Richard J. Durbin, D-Ill., said he expects changes in the bill in the forthcoming debate. But he added that the leadership will not permit an endless series of amendments and cloture motions to bog down the Senate into the new year.
"If you think we're just going to sit in here, 30 hours after 30 hours after 30 hours, until it's Jan. 1, it's not going to happen," Durbin said.
Drew Armstrong contributed to this story.