WASHINGTON — Even after President Barack Obama gave them his blessing Wednesday to push ahead hard and fast on health care, congressional Democrats remained uncertain and divided over whether they can finally pass the legislation.
Liberals and moderates both expressed concern about "reconciliation," the fast-track procedure Obama endorsed. It strips the Senate minority of the ability to filibuster, or conduct extended debate, which usually can be limited only after 60 of 100 senators agree.
"I don't like the reconciliation idea," said Rep. Baron Hill, D-Ind., one of the moderates. "It does give the appearance of trying to ram something through."
Under the plan, the measure could be passed after 20 hours of debate with 51 Senate votes and 216 in the House of Representatives. Democrats control 59 Senate votes and 254 in the House.
Republicans object that the reconciliation process isn't intended to be used for major substantive policy legislation, but rather only for deficit reduction measures.
Obama endorsed the procedure to pass his top-priority national health care overhaul, saying that he's willing to stake Democrats' fortunes on it.
"I don't know how this plays politically, but I know it's right," the president said in remarks from the East Room of the White House, flanked by white-coated nurses and doctors nearly a year after he began his push for a bipartisan bill.
"At stake right now is not just our ability to solve this problem, but our ability to solve any problem," Obama said. "The American people want to know if it's still possible for Washington to look out for their interests and their future. They are waiting for us to act. They are waiting for us to lead."
If Democrats pass an overhaul, it's conceivable that they could do so without a single Republican vote.
Republican senators vowed to find other procedural tactics to stall the health bill, and warned that Democrats were making a big political mistake.
"History is clear: Big legislation always requires big majorities. And this latest scheme to lure Democrats into switching their votes in the House (of Representatives) by agreeing to use reconciliation in the Senate will be met with outrage," said Senate Minority Leader Mitch McConnell, R-Ky.
Obama's next task will be convincing the public and Democrats in Congress to go along. He plans to campaign for the health plan in the Philadelphia area on Monday and in Missouri on March 10.
While no timetable for action was announced, lawmakers are likely to consider the legislation this month under a two-step process that will require a House vote on the version that the Senate approved on Dec. 24.
The reconciliation process then would be used to make changes in that Senate version, and would need approval by both chambers.
Many liberals aren't pleased, since the Senate bill lacks a government-run health insurance program, or public option, which the House endorsed late last year.
"The more the bill looks like the Senate version, the less likely I am to be supportive," said Rep. Peter DeFazio, D-Ore.
Rep. Dennis Kucinich, D-Ohio, also decried the lack of a public option, saying it was eliminated "because of a backroom deal."
Moderate Democrats also were unhappy.
"I don't think I could vote for the Senate bill," said Rep. Walt Minnick, D-Idaho, one of 54 moderate-to-conservative Blue Dogs. Thirty-nine House Democrats opposed the original House version, and many of them face tough re-election prospects in November in districts that voted in 2008 for Sen. John McCain, the Republican presidential candidate.
Obama never used the term "reconciliation."
However, he said that health care deserved "the same up-or-down vote" as other major pieces of legislation that passed through reconciliation during the past three decades, including a welfare overhaul, tax cuts, and the expansion of medical coverage for children and laid-off workers.
The president also said that there's been enough debate and that several Republican ideas would be included in a final package.
"This is our proposal. This is where we've ended up," Obama said. "Everything there is to say about health care has been said, and just about everyone has said it."
Obama said that 31 million more Americans would get health insurance coverage under the plan he's outlined. He said that insurers would no longer be able to deny coverage based on pre-existing conditions, dump sick patients or massively raise premiums. He said that small businesses and self-insured Americans would be able to find affordable coverage and the middle class would get tax credits.
To not act, he said, would embolden insurance companies, cost more Americans coverage and delay a health care overhaul for a decade or longer.
Polls show that more people oppose the legislation than favor it. The yearlong political battle over health care has dragged down the president's approval rating and has imperiled many lawmakers' re-election prospects.
If Democrats fail to pass the one domestic initiative that Obama and congressional leaders set up as must-pass, however, many think they'll pay a bigger price at the polls — while delaying tighter regulation of the insurance industry for years to come.
J. James Rohack, the president of the American Medical Association, issued a statement Wednesday commending Obama for proposing that four GOP ideas be included in the final bill. Rohack also urged Congress to find a permanent fix on Medicare payments to doctors. "Let's resolve these issues and get health system reform over the finish line for the American people," he said.
Whether reconciliation can get 50 Senate votes — Vice President Joe Biden could break a tie in the Democrats' favor — remains an open question. It remains unclear if perhaps a dozen Senate centrists will go along.
"I don't prefer reconciliation," said Sen. Joseph Lieberman, I-Conn. "This is so big a change that affects every American. This ought to be bipartisan."
The process also could be subject to parliamentary challenges that could slow things down, challenges that could need 60 Senate votes to resolve.
Reconciliation has been used repeatedly in the past for policy changes, but according to the Congressional Research Service, those changes all involved direct spending and revenue. President George W. Bush's 2001 and 2003 tax cuts were considered this way. So were the 1997 Balanced Budget Act and the 1996 welfare overhaul.
Reconciliation has been used successfully 19 times since it was first used in 1980; 3 others were vetoed. Of those 22 attempts, 16 came under a GOP-led Senate. According to CRS, for the first 15 years, "reconciliation was used to reduce the deficit through reductions in mandatory spending, revenue increases, or a combination of the two."
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