The State of Play for Health-Care Reform

The State of Play for Health-Care Reform

President Barack Obama did his best to keep health-care reform on track with his Wednesday evening press conference, but after months of choosing to let Congress manage the day to day details, there is only so much he can do to speed along the process. He continued that effort on Thursday, dispatching chief of staff and former House Democratic Conference Chairman Rahm Emanuel to Capitol Hill to try to ease the concerns of the group of key, fiscally-conservative Democrats known as the Blue Dogs, who are balking at what they view as the high long-term costs of House Speaker Nancy Pelosi’s health-care proposal.

Pelosi is racing to deliver at least one completed health care bill to President Obama ahead of the scheduled August recess. The House is set to leave at the end of next week, though the Speaker has said she is willing to keep them in an extra week to see the bill done. Her work was made all the more crucial after Senate Majority Leader Harry Reid Thursday confirmed that the upper chamber will not be able to meet the President’s deadline of delivering a bill before they break the week after next. “I am more confident than ever,” Pelosi said Thursday. “When the bill is ready, we will go to the floor, and we will win.”

The Blue Dogs – a bloc of 52 votes without which Pelosi cannot pass legislation unless she lures Republicans to take their place – immediately disagreed. In truth Pelosi could, with enough pressure, probably pass just about anything out of the House. But votes that rely on her playing the heavy with her own caucus come with a high price. Joked Rep. Charlie Melancon, a Louisiana Democrat and a Blue Dog, “we’re going to need some orthopedists around here to take care of the broken bones and twisted arms.”

In his most hands-on involvement to date, Obama earlier this week helped the Blue Dogs overcome one big sticking point: the formation of an independent commission to oversee Medicare payments, a role presently filled by Congress. They say, though, they have a list of nine other issues; in his meeting with them Thursay, Emanuel tackled concerns over regional disparities in Medicare reimbursements.

Pelosi faces two hurdles in giving Obama at least a partial victory before the dog days of August. She needs to get the legislation out of the House Energy & Commerce Committee, which is stacked with Blue Dogs and the only one of the three health-related committees in the House that has yet to pass a bill; on Thursday, for the third straight day this week, the committee chairman Henry Waxman postponed a meeting to work on the bill because of the Blue Dogs’ opposition. Assuming the House Speaker can get it out of the committee, she still has to convince an estimated 20 Democrats — either Blue Dogs or centrist New Dems or nervous freshmen — in order to pass the measure on the floor.

Across the Capitol campus in the Hart Senate office building, members of the Senate Finance Committee gathered to hear from Douglas Elmendorf, the head of the Congressional Budget Office who last week testified that the Democratic bills as currently constituted do little to slow down the rising cost of health care. The working group of three Republicans and three Democrats has come under fire for taking too long to reach a consensus, with Baucus in particular being criticized by fellow Democrats for bending over backwards to win some token GOP support.

“This is complicated stuff,” lamented Conrad, the Senate Budget Committee Chairman. “I’d rather we take our time to get it right.” Democratic staff also noted that it is essential to avoid another embarrassing CBO score, and so participants have been focusing on how to bring down long term costs. Reid has given the group two weeks to overcome their differences on the key remaining sticking point, how to finance the overhaul without adding to the deficit, and report out a bill. The Senate leadership will then spend the month-long summer break marrying the Finance bill with one produced by the Health, Education, Labor and Pensions Committee earlier this month to produce a final version in September.

As complicated and confusing as that sounds, it is still only the beginning. If something eventually does pass the Senate, it would have to be combined with the House version to produce a final bill. Health care reform is a messy, messy process. There are 11 committees of jurisdiction, three bills, dozens of interest groups – all of which seem totally disconnected from the actual pain and treatment of patients. It’s so complicated, in fact, that it can make one of the most eloquent guys on earth – Barack Obama – sound awkward, as he did at Wednesday’s press conference, fumbling around with generalities and jargon. As one Senate Democratic aide said to me, “Now you know how frustrated Congress has been with the Obama Administration’s lack of clarity and involvement in the process.”

— With reporting by Sophia Yan / Washington

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