WASHINGTON — Republicans Monday had new hope that they could influence health care deliberations — influence that's so far eluded them — as the debate moves to the Senate, where the rules and the politics can work to their advantage.
Some Republicans are trying to win Democratic support for more help for small business, different medical malpractice policies and changes in how the health care overhaul would be funded.
Sen. Susan Collins, R-Maine, one of three GOP senators to vote for the Democratic-authored economic stimulus plan earlier this year, said moderates from both parties are discussing potential areas of agreement.
The odds are still long, and probably insurmountable, against the Senate's 40 Republicans having significant input into the biggest decisions, notably mandates on employers and individuals and the plan's funding. They continue to complain that, as Sen. Bob Corker, R-Tenn., put it, the bill "is being drafted behind closed doors."
Democrats control 60 of the 100 Senate seats, but as many as 12 moderate Democrats have expressed serious concerns about the package's cost, now estimated at $829 billion over 10 years, as well as about the government-run insurance plan, or public option.
It takes 60 votes to cut off debate and move to a vote, and Democrats probably will need GOP help on certain parts of the bill. Full Senate consideration could begin later this month.
Collins was optimistic about the GOP role, saying, "I believe we can put together a bipartisan bill that could cover so many areas where there's agreement on what should be done."
The biggest controversy is likely to involve the government plan; the Senate version now includes a provision that would let states opt out of it. Sen. Joseph Lieberman, a Connecticut independent who caucuses with Democrats, has said that he won't vote to end debate on that plan, and at least two Democratic moderates are undecided. That means Democrats may have to seek votes among Republicans to shut off debate on the public option.
The most obvious choice is Sen. Olympia Snowe, R-Maine, the only GOP member of the Senate Finance Committee who voted with Democrats last month to approve that panel's health care plan.
Snowe, however, said she's "deeply disappointed" with the opt out plan and prefers instead the idea of a "trigger" that would allow a government option only if private insurers don't meet certain benchmarks, notably making policies more affordable.
Whether Democrats can pick up any other Republican support for a public option is doubtful — Collins is opposed — but GOP influence could extend further, in small but meaningful ways.
"Senate Republicans have more clout because the rules of the institution mean they get taken more seriously," said Darrell West, director of Governance Studies at Washington's Brookings Institution, a center-left research group.
In the House of Representatives, Republicans were shut out of any meaningful deliberations. Under House rules, most proposals can get a floor vote only if they're first approved by the Democratic-dominated Rules Committee, which made it impossible for the GOP to get votes on specific amendments. Republicans there were allowed only to offer an alternative comprehensive plan, which lost on a largely party-line vote.
In the Senate, though, anyone can bring up an amendment that leads to a full vote.
Already, there've been signs of bipartisanship. When a public option plan similar to the one the House passed on Saturday came up in the Senate Finance Committee earlier this year, Democrats joined Republicans to defeat it.
To the surprise of Senate Democratic leaders, the committee approved a plan by Sen. Orrin Hatch, R-Utah, to provide $50 million annually through fiscal 2014 for abstinence education. Two moderate Democrats, Arkansas' Blanche Lincoln and North Dakota's Kent Conrad, voted with all 10 Republicans on the panel to approve the funds.
Once full Senate debate begins, it's expected to last at least a month and feature votes on almost every controversial aspect of the bill.
"Senate Republicans will be offering amendments that . . . target the real problem, which is the cost of health care," said Minority Leader Mitch McConnell of Kentucky.
Details of specific amendments haven't been decided, but Republicans hope to eliminate or alter the Democratic-authored tax on high-end insurance policies. Most GOP senators say they fear that the tax would be passed on to consumers, and they're looking for ways to change or replace it.
In addition, GOP lawmakers think they can get Democratic support for small business changes. On Collins' list: Making it easier for small businesses that operate across state lines to offer all employees health insurance policies, and thus expand risk pools. Currently, such pools are subject to each state's rules and regulations.
Moderate Republicans also are expected to seek more incentives for disease prevention, such as provisions to encourage people to lose weight or stop smoking. They also expect to make a big push to revamp medical malpractice policies, a longtime favorite issue for Republicans.
Collins was optimistic. "I'm talking with moderates on both sides of the aisle," she said.
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