House and Senate lawmakers are beginning to resolve differences between the two chambers’ health care overhaul plans. Those differences include the size of the bills, language governing abortion funding and how the bills would be financed. While the House bill includes a government-run health insurance option the Senate bill does not. Negotiations are expected to continue throughout January.
JACKIE JUDD: Good day. I am Jackie Judd with Health On The Hill. It’s the start of a New Year and with it we will soon see the start of final negotiations between the Senate and House over reforming the nation’s health care system. Here to discuss what’s ahead, Mary Agnes Carey of Kaiser Health News and Julie Rovner of National Public Radio. Welcome to you both and Happy New Year. Let’s talk first, what are the major disputes that you expect to see thrashed out during these negotiations between the Senate and the House?
MARY AGNES CAREY: Well, the sizes of the Bills are very different. The Senate passed a Bill that’s about $871 billion over the next decade. The House Bill is over $1 trillion so that will be a point of discussion.
There is no public option in the Senate Bill but it is in the House Bill. Abortion is another key issue of dispute, much more restrictive language in the House Bill than in the Senate Bill, and also the ways the Bills are financed are very different.
In the Senate, they would increase the Medicare Payroll Tax on some of the highest wage earners, they would place an excise tax on some of the highest cost health insurance plans and in the House they would put a tax on some of the highest wage earners, and here we are talking about individuals who make about $500,000 and couples who make more than $1 million. So, the financing is another key area of dispute they are going to have to work out.
JACKIE JUDD: And the Senate Democrats have the upper hand in these negotiations, right?
MARY AGNES CAREY: Well, the Senate, it was sure tough to get their Bill filled, and it was awfully close.
JACKIE JUDD: So they don’t have any wiggle room.
MARY AGNES CAREY: That is what they are saying. You never know what can happen in negotiations and another round of votes, but that is certainly the message that has been sent out by for example Joseph Lieberman, who is an Independent from Connecticut, and I think Ben Nelson of Nebraska has been sending the same kind of message, this is the Bill I voted for in the Senate and this is the Bill that I’ve got to see from any House/Senate negotiations and they say individually they don’t have a lot of wiggle room and that certainly is the thought with the Senate.
JACKIE JUDD: Your take on that?
JULIE ROVNER: Well yes, the Senate of course did take 60 votes to break a filibuster and obviously any final conference report, you only need 51 votes to pass a conferential report but you need 60 votes to get that to the floor. So every Democratic Senator or the 58 Democrats and those two independents will say every single one is the 60th vote, and any single member of that Democratic caucus can bring this process to a grinding halt. So you are going to have to have a scent of that final Bill by every single member of that caucus, so basically every single member is going to be defacto a conferee on this Bill.
JACKIE JUDD: And Julie, walk us through procedurally how things will go over the next several weeks during these negotiations.
JULIE ROVNER: Well, I think everyone expects this to not be the traditional “how a bill becomes a law” conference process where the House would appoint conferees and the Senate would appoint conferees and they would meet in a room and reporters would get to sit there and watch the negotiations go on, which almost never happens anymore anyway.
I think everyone expects that what will probably happen is what’s been happening more and more with these big bills anyway, which is that there will be an informal negotiation process and frankly that’s already been going on since the basic outlines of this Bill became fairly clear.
Back early part of December, you’ve had House and Senate staff starting to meet Democratic staff, starting to thrash out what they call the underbrush — sort of the easier parts of these Bills where most of the things were the same. And so you will get Democratic staff and pretty soon Democratic members sitting down together.
In fact, in an interview with the News Hour with Jim Lehrer, President Obama said he expects to have some of the Democrats down to the White House to do some of their negotiating, so actually I think the President intends to be involved in maybe some of these more difficult negotiations over some of the issues that Mary Agnes was mentioning and they would like to do this obviously as soon as possible.
Democrats want to get onto these issues of jobs and the economy. Now we have got these new issues of terrorism that are on the agenda. There had been talk of perhaps getting this done by the President’s State of the Union, that seems perhaps a little bit ambitious given how big these Bills are and how many issues there are to resolve, but certainly they want to get it done by the beginning or middle of February.
JACKIE JUDD: Is it conceivable the President would hold off the State of the Union until there is a Health Care Reform Bill?
JULIE ROVNER: It’s been muttered that that’s a possibility if perhaps there are only a few days away from getting it done by very early February. I’ve heard that mentioned, but remember the budget needs to come out the first Monday in February or the first Tuesday. The budget needs to come out in early February, that is a statutory deadline and generally the State of the Union happens before that.
The President has leeway to deliver that State of the Union. It’s usually one of those last weeks in January but I think that could be rearranged slightly if it looks like this Bill is getting very, very close at the very end of January or very early February.
JACKIE JUDD: Where does all of this leave Republicans? Without the formal conference committee and the procedural issues that go along with the committee, are they completely sidelined?
MARY AGNES CAREY: Well, Mitch McConnell, who is the Minority Leader in the Senate, made it very clear when the Senate passed its Bill that they would do everything they could to stop this Bill, so I think they will continue to talk about the elements they don’t like. They will continue to use any procedural weapon in their arsenal.
JACKIE JUDD: But will there be any procedural weapon that they can use?
MARY AGNES CAREY: Well, as Julie mentioned the difficulties in getting to the conference report, they may be able to use some procedural motions there. Once they are on the report, I think as Julie discussed, it’s a 51 vote so that’s where, before getting that conference package to the floor will be where they will try to use procedural motions, I think. That is what I would be looking for.
JULIE ROVNER: And of course it may not be, being as they probably won’t use the traditional conference to process, it probably won’t be a conference report, it will just be another iteration of the Bill, but the same thing holds true. It will simply be, a final Bill will only take 51 votes, but there will still be some sort of way to get it to the floor that will need 60 votes.
But going back to this question of the Republicans, you know there are still a lot of Republicans who would like to have some input into what this Bill says. At this point, it looks like it’s certainly more likely than not that this Bill is going to become law and there are a lot of Republicans who care a lot about this issue who frankly quietly –
JACKIE JUDD: So how do they weigh in?
JULIE ROVNER: I was going to say, who rather quietly disagree with their leaders and would like to have some input into it, and I think perhaps may prefer this back channel way of doing it, might like to quietly, certainly Max Baucus, the Chairman of the Finance Committee, still has quite the relationship with Chuck Grassley, the ranking Republican on his committee.
And even though things have gotten rather nasty and testy on the floor and in public, I wouldn’t be a bit surprised to see some, perhaps suggestions made by some Republicans that might get incorporated into some iterations at this point.
JACKIE JUDD: Are you thinking of anything in particular there?
JULIE ROVNER: Well, there have already been some things that have been, you know, that were put into this Bill in the Finance Committee to certainly try to get members like Olympia Snowe, who of course did vote for the Bill at Finance Committee, but did not on the floor. But you have to wonder if at the very end, as this Bill is going to become law, if there aren’t a few Republicans who might not want to say no to what may well be a historic vote.
This is based on what may happen at the end. Obviously, the leaderships have now made this a political line in the sand. They want the Democrats to own this issue — if things do not go well, if things go wrong and certainly if these Bills don’t take effect in large part for several years and the Republicans would like to hang that around the Democrats’ neck.
So the majority of Republicans are going to be happy, I think, to vote no on this, but there are certainly a lot of Republicans who have worked for many years on health issues who would like to have a say on this and who would like to really make what they now think is a bad Bill better, so I mean there is something to say for Republicans having some input into what is in this final product.
JACKIE JUDD: Okay, well, thank you very much. We will talk to you again next week. Thank you for joining us, Health On The Hill. I’m Jackie Judd.