Transcript: Health On The Hill

House and Senate Democratic leaders continue to determine support in their chambers for moving health care legislation by using the budget reconciliation process, which would allow the measure to be approved in the Senate by 51 votes rather than a filibuster-proof 60 vote margin. President Obama is expected to announce some changes to the health care plan he unveiled last week that is hoped to bring more support for the package. 

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JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill. The week after the President’s Health Care Summit, Democrats and Republicans are strategizing about the next steps in the health care reform debate, and here to bring us up to date, as always, is Mary Agnes Carey of Kaiser Health News. Good morning.

MARY AGNES CAREY: Good morning.

JACKIE JUDD: This does seem to be a week where both sides will be regrouping for perhaps what will be the final battle in this year long debate. Where do things currently stand?

MARY AGNES CAREY: Democratic leaders in both chambers have to figure out if they have the votes to pass their health care proposal. In the House, Speaker Pelosi has to find out if she has enough Democrats to pass the Senate package, as well as a package of fixes, which is being known as budget reconciliation. Again, this is a fast track procedure, and then the Senate allows it to pass by 51 votes rather than 60. Harry Reid, the majority leader in the Senate, also has to find out where are his Democrats, do they have enough comfort level to get this 51 vote margin, and when do they want to proceed and where are the votes? So, I think it is really about finding out where the votes are.

JACKIE JUDD: Well, over the weekend some Democratic leaders were sounding fairly optimistic, publically anyway, that they had the votes. You and I both know that a couple of months ago Nancy Pelosi was on the record as saying she could not get the votes in the House to pass the Senate bill. We are in a more volatile political time now than last December, closer to the midterm elections.

MARY AGNES CAREY: That’s right.

JACKIE JUDD: So, where would those votes come from?

MARY AGNES CAREY: A lot of it will depend on what is in this reconciliation package, what are the fixes? President Obama has laid out his proposals to try to make some changes in the bill, to accommodate gaps between the Senate and the House package.

After last week’s Summit, he said he may take some Republican ideas and incorporate them and so the next step is to see what is in this reconciliation package, and also how much does it cost? We don’t have a score from the Congressional Budget Office and the head of the Congressional Budget Office has said he can’t score the bill until there is legislative language, so they have to go to those steps and satisfy those answers and then we can take a broader look at it.

JACKIE JUDD: And what are the voting blocks in the House in particular that Nancy Pelosi has to really bring over to her side?

MARY AGNES CAREY: There are abortion rights opponents that do not like the language in the Senate bill, and that language would allow abortion services to be covered in plans in the exchanges but you would have to write two separate checks.

In the House bill, abortion services could not be covered in the underlying House bill in the exchanges, so that is one faction. There are also conservative Democrats who thought the bill was simply too big, doesn’t do enough about cost, and they haven’t necessarily changed their minds there, so that is two huge blocks she has got to go to to appeal for votes.

JACKIE JUDD: And Republicans?

MARY AGNES CAREY: I think they are pretty clear in their message. The bill is too big, you need to scrap it, you need to start over. They feel the polling numbers are in their favor and that the American public is on their side and they show really no willingness to vote for this package in any shape or form.

JACKIE JUDD: And maybe to stand back and watch the Democrats give them what some poll numbers are showing. Do they think the Democrats can implode on this issue?

MARY AGNES CAREY: I think they can and they have also said they want to fight the bill as much as possible. In the Senate, there will be lots of opportunity to amend a reconciliation package to debate the amendments, to read the amendments aloud. It will be a real slow walk there, as well as the House difficulties, so the Republicans have kind of a two prong approach. I think you have hit on it. They want to oppose the bill but they are also glad to step back and see the Democrats try to pass this.

JACKIE JUDD: The White House has suggested that President Obama may speak about the health care reform efforts later this week. Do you have any idea whether it’s going to be a statement regarding process or policy?

MARY AGNES CAREY: It could very well be both. He had said repeatedly at the Summit as did Democratic leaders that we are going to move ahead with or without you to Republicans. The President also extended an olive branch of sorts to Republicans. We have got a few weeks here. If you want to consider some of our ideas, he may very well come out and say I heard the Republicans, here is my revised package, it incorporates their ideas, will you support it, and then see where it goes from there.

JACKIE JUDD: There have been so many occasions in the past 14 months now, I guess it is 13 or 14 months, where fits and starts over the health care reform debate and you thought well certainly the Democrats have reached the end of the road this time. Is there a sense among lawmakers that this really is the last round?

MARY AGNES CAREY: Well, the window of opportunity is certainly narrowing. The hope is that they can move on the health care issue and conclude action on it by the Easter Passover recess, which is about a month away, but it’s unclear. I never thought we would be here still talking about whether or not they are going to pass their health care bill, so I think that is certainly a goal, but they are not locking themselves into that timeline because as you mentioned they have had so many stops and starts in this.

JACKIE JUDD: But I am talking more about whether they can meet a deadline. Is there another round left after this one? Is there anywhere for the Democrats to go if they can’t make this happen?

MARY AGNES CAREY: Well, that is a great point. They certainly could scale it back. In the House, for example, last week they passed one of the provisions of the health care bill, lifting this federal exemption for anti-trust laws against insurers. They could certainly decide to move some of these provisions individually and make the Republicans vote up or down each time.

Democrats could try to scale it back, to make a smaller package, perhaps focusing on subsidies, exchanges, or an expansion of the Medicaid Program, so they could certainly make that decision to scale back, but for now it seems like the push is still on this larger bill.

JACKIE JUDD: Okay, we will see. Thank you so much, Mary Agnes Carey. And thank you for joining us. This has been Health on the Hill.

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