Health-care showdown looms but outcome still uncertain

McClatchy NewspapersDecember 11, 2009 

WASHINGTON — The epic Senate battle over overhauling the nation's health-care system is hurtling toward some crucial showdowns over the next week and a half, and the fate of President Barack Obama's top 2009 domestic priority remains highly uncertain.

As the Senate prepares to resume debate Monday on its $848 billion, 10-year plan, the measure's immediate future rests largely with the nonpartisan Congressional Budget Office, which is reviewing the potential costs and impact of a tentative Democratic deal.

That deal, whose details remain sketchy and which appears to be subject to ongoing negotiations, could allow 55- to 64-year-olds to get Medicare coverage and set up a national, federally regulated series of privately run insurance plans.

Many senators remained confused and frustrated over a lack of specifics, and analysts were split over what the cautious mood means.

"I think we're moving forward," said former Connecticut Democratic Rep. Barbara Kennelly, the president of the National Committee to Preserve Social Security and Medicare, a Washington advocacy group.

Kennelly said she told former colleagues, "You're not going to get everything you want, but over the next 10 years, if you're still here, you'll have the chance to improve this thing."

Michael Tanner, a health-care expert at the libertarian Cato Institute, had a somewhat different view, however.

"They want to create the appearance of momentum," he said of Democratic leaders. "This is throwing things at the wall and seeing what can get 60 votes."

If the CBO finds that the proposals don't boost anticipated federal deficits over the next 10 years, the Senate is expected to proceed to four key votes, three to cut off debate and another on final passage of its bill, all before Christmas.

Democrats control 60 of the Senate's 100 seats, and 60 votes are crucial, because that's what's needed to limit debate. If the CBO's report is well received, notably by the handful of moderate Democrats who have serious qualms, the measure is a decent bet to win passage before Christmas.

If, however, the CBO raises serious questions about cost, affordability or access to care, there could be political trouble.

One flash point, abortion, appears to have cooled after last week's vote to kill a bid by anti-abortion senators to put tough limits on elective abortions.

The issue is hardly dead; the House of Representatives last month approved allowing federally funded abortions only when the woman was a victim of rape or incest or the pregnancy endangered her life. If the Senate passes its version with fewer restrictions, the two sides will have to reconcile their differences.

Seven Senate Democrats voted for the tougher abortion measure, and all indicated that they expect some compromise that will allow them to vote for the final package.

"We want a bill passed," said Sen. Bob Casey, D-Pa., one of the seven.

The bigger obstacles in the bill's path are its potential costs and reach. Moderates are nervous about a government-run insurance program, or public option, which the White House and Democratic leaders have long sought as an alternative to private coverage.

That option is in the House bill, while the Senate version allows states to opt out of a federal plan.

Senate centrists fear that could still lead to the growth of a bloated bureaucracy and further jolt the nation's already-exploding debt. The issue is particularly sensitive in more conservative states such as Arkansas, where Democratic Sen. Blanche Lincoln faces a difficult re-election campaign next fall.

"Until we hear back from CBO," she said, "it's going to be hard to see whatever I can support, for sure."

Democratic leaders have been trying to create an image of momentum. Sen. Charles Schumer, D-N.Y., one of the architects of the tentative deal, said he was encouraged because "Bernie and Joe both said good things" about it.

And they have, but with huge asterisks.

Sen. Bernard Sanders, a Vermont independent, is considered the Senate's most passionate progressive. "I think it's not fair to simply say they are abandoning the public option," he said Tuesday.

By Thursday, however, Sanders had other concerns, saying he worried that expanding existing government health programs could make it harder for people to get care, since those programs traditionally pay doctors and hospitals less than private insurers do.

"It would be a cruel hoax to tell people that they now have health insurance, Medicaid or another program, but not create a situation where they can get into the doctor's office, and I fear that may happen," he said.

Sen. Joe Lieberman, a Connecticut independent, said Wednesday that he was "encouraged by the progress toward a consensus on proposals to send to the Congressional Budget Office to review."

He added, however: "My opposition to a government-run insurance option, including any option with a trigger, has been clear for months and remains my position today." Senate leaders are considering including a government-run plan as a backup in case private insurers don't meet certain standards.

Such diverse, nuanced views illustrate why senators are reluctant to handicap the votes ahead.

"Remember how difficult this is. Sixty votes come from 60 very different parts of the country," said Sen. John Kerry, D-Mass. "All in all, we can say the bill moves us towards a very positive set of reforms."

"If they had 60 votes," Cato's Tanner said, "they'd be voting now."

ON THE WEB

Congressional Budget Office analysis of Senate Democrats' health care bill

Text of Senate Democratic health care bill

Congressional Budget Office analysis of House health bill

Sen. Joe Lieberman's health care statement

Sen. Bernard Sanders on health care

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With tentative deal, hopes grow for health care overhaul

Senate Democrats reach tentative deal on public option

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Check out McClatchy's politics blog: Planet Washington

McClatchy Newspapers 2009

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