Health-Care Reform: Senate Bill Turns to Harry Reid

Health-Care Reform: Senate Bill Turns to Harry Reid

Now that the last of the five congressional committees with jurisdiction over health care, Max Baucus’ Senate Finance Committee, has passed its much anticipated reform bill, it falls to majority leader Harry Reid to cobble together something that can pass the Senate.

That is no easy feat. Senate majority leader is a strange job, unlike that of any other figure in Washington. Lacking the powerful rules of the House speaker or the bully pulpit of the presidency, the majority leader’s chief job is to herd cats, in this case Senators, each of whom is a powerful figure in his or her own right. When it comes to health care, nearly every Senator in Reid’s own party has a provision or a version he or she would like included; Reid’s goal is to keep enough of those cats happy and moving in the same direction so that he can pass something before Thanksgiving.

The notion that anyone is now actually in control of this process is an illusion. But to the extent that anyone’s hand is on the tiller, it is Reid’s. Over the next four weeks, it is Reid who will decide whether to permit votes — and in what order — on amendments that could make the final version look very different from the one approved Tuesday afternoon by the Finance Committee. There will be fights over the lack of a public option in the bill, and efforts to reinstate one. Reid is expecting a battle over the size of the subsidies to help people pay for the new individual mandate, and clashes about whether and how to make that mandate apply to everyone. And those are just the fights inside his own party. Of all five bills, only the Senate Finance Committee’s garnered any GOP support and that came in the form of the single vote of Maine’s Olympia Snowe. And Snowe made it clear that her support on final passage is by no means assured, rattling off a laundry list of changes she’d like to see made. Other Republicans are also expected to offer amendments to reinstate some or all of the $500 billion in cuts to Medicare, especially the $100 billion–plus cut from Medicare Advantage, which subsidizes private insurers; to weaken or do away with the mandate; and to strip out any form of the public plan.

Reid’s staff have been working for two weeks to match up the Finance bill with one passed earlier this summer by the Health, Education, Labor and Pensions Committee and to resolve second- and third-tier issues, such as administrative streamlining, preventive measures and reinsurance. Over the next two weeks they will finish merging the two measures and begin counting votes on some of the hundreds of amendments expected to be filed. Some losing proposals will have to be raised, debated and then defeated before winning provisions are adopted. For example, 30 members advised Reid last week that the Senate must take up a robust public-plan amendment before they will consider voting on a reform package without one. Reid hopes the amendment process will last just two weeks, but it is likely to take longer. Such an old-fashioned debate on the Senate floor where the final outcome of a bill isn’t a foregone conclusion hasn’t happened in many years.

A quiet but tenacious leader, Reid has built his career on building consensus — cajoling members and sweetening deals with pet projects. The right disparages him for his occasional gaffes. He is often condemned by progressives for not calling Republicans’ bluffs on threatened filibusters and rarely, if ever, using his 60-seat majority to ram through legislation. “I’m not so sure we have very many sticks available to us,” says Jim Manley, a senior adviser to Reid. Reid is “an expert at the gentle art of persuasion. The members of his caucus see him as an honest broker and a straight shooter.”

Watching over Reid throughout — and applying pressure when needed — will be Rahm Emanuel and his team at the White House, which, in addition to the chief of staff, will include White House legislative director Phil Schiliro; Nancy Ann DeParle, head of the White House office on health reform; Office of Management and Budget director Peter Orszag; and deputy White House chief of staff Jim Messina. Emanuel and Schiliro practically lived in Reid’s offices during the passage of the stimulus legislation and this will be a much harder lift. “This bill’s not perfect and we have a lot of difficult work ahead of us,” Obama said in Rose Garden remarks on Tuesday. “There are still serious disagreements and details ahead of us … Now’s not the time to offer ourselves congratulations. Now’s not the time to pat ourselves on the back. Now’s the time to dig in and get this done.”

Adding to the drama is the fact that Reid is facing re-election next year, and for the first time since 1998 he may face a challenge. Reid is already losing in polls to not one but two GOP challengers. Outside groups ranging from unions to business associations have spent $2 million either lauding Reid for his work on health care or demonizing him for socializing it, according to TNS C-MAG, a group that tracks political commercials. The split in the ads has been 60% negative, 40% positive. Reid has pledged to raise $25 million to defend himself.

The majority leader is also protecting his constituents. Dozens of governors have warned Congress about the bill’s plans to expand Medicaid’s rolls by millions of uninsured; most states have been strapped for cash in the economic downturn, many of them severely. But Nevada need not worry: thanks to Reid, the federal government is picking up its tab for the next four years. Such benefits for his home state have not gone unnoticed, or uncriticized. “I saw in a morning newspaper that Nevada was somehow miraculously taken care of in the provisions for Medicaid expenses,” Tennessee Republican Lamar Alexander remarked somewhat sarcastically on the Senate floor last week. “We have had governors, both Democrats and Republicans, here saying if you are going to expand on Medicaid in our state, pay for it. And somehow, amazingly, Nevada gets exactly that.”

In 2004, Senate minority leader Tom Daschle became the first leader in nearly 50 years to lose his seat. In the months before the election he was paralyzed in the Senate, afraid to do anything that might make him more vulnerable. Reid, it seems, is taking the opposite approach. “It’s always difficult being in leadership when you’re up for re-election,” says Michigan Senator Debbie Stabenow, a member of the Democratic leadership who faced a tough re-election in 2004. “But Harry’s very, very committed. He understands the important role he has in history.”

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