Senators Steeling Themselves For Health Reform Debate

Some news organizations are examining what lies ahead for the Senate.

Roll Call: "Dozens of amendments will be considered over the next month, and Majority Leader Harry Reid (D-Nev.) must hold together all 60 members of the Democratic Conference in order to beat back politically harmful GOP amendments and ultimately clear the way for final passage. Reid successfully rallied his Democratic colleagues to vote in favor [60-39] of bringing the bill to the floor. ... Moderate Democratic Sens. Mary Landrieu (La.), Blanche Lincoln (Ark.) and Ben Nelson (Neb.) all voted to proceed to the bill, but they pledged not to vote in favor of final passage if the bill includes a public insurance option. Reid's package includes such a plan. While Members begin the amendment process to the health care bill this week, behind-the-scenes talks between Landrieu and Sens. Charles Schumer (D-N.Y.) and Tom Carper (D-Del.) on an alternative public option will capture the attention of both moderates and liberals, who strongly support having a government-run alternative" (Brady and Bendery, 11/26).

Fox News: "The debate on the Senate's version of the legislation will test the strength of a re-energized Republican insurgency and the loyalty of a fractured Democratic majority. ... The most contentious issues expected to be debated are abortion, illegal immigration and the so-called public option, a government-run insurance plan -- each of which threaten to stall the legislation. Republicans are largely opposed to the bill and the Democratic majority is sharply divided on the issues. Bridging that divide will likely prove to be the toughest challenge for Democratic leaders.

"Moderate Democrats have vowed to vote against any bill that doesn't include tougher restrictions on federal funding for abortion, allows illegal immigrants to buying insurance -- even with their own money-- or contains the public option. In return, liberal Democrats have pledged to withhold their support for any bill making those concessions" (11/27).

The Wall Street Journal: "A handful of Democratic senators are pushing to change pending health-care legislation so that it would help increase the country's stock of primary-care doctors ... More than 30 million Americans would get health insurance under the health-care overhaul that passed through the House and a similar bill moving forward in the Senate. If that does indeed happen, many previously uninsured people who haven't had a regular doctor before will need a primary-care physician." 

"Medical colleges, backed by some Democrats, want funding for 15,000 more slots for graduate medical residencies in primary care and general surgery. The government currently pays part of the cost for such residencies through Medicare. Senate Majority Leader Harry Reid co-sponsored a separate bill to do just that this spring. But when doctors pressed him to include the measure in the broader health-care overhaul he crafted, the Nevada Democrat balked because the estimated $10 billion to $15 billion cost over a decade would inflate the bill's overall price too much. ... Sen. Charles Schumer of New York plans to introduce an amendment that would add about 2,000 residency spots to the current 100,000. The amendment would give first priority to primary-care doctors and general surgeons" (Adamy, 11/27)

Politico: "Democrats searching for a compromise on health care reform may find a little Thanksgiving light in a new policy paper out Wednesday: Skip a 'weak' public option now in favor of a much stronger one that would kick in automatically if the health industry doesn't meet its promises to slow the growth in medical costs. The paper, from the Washington-based Urban Institute, offers a fresh look at the whole public option debate, casting the issue as 'one of fiscal conservatism' - more about containing health costs than extending benefits to the uninsured."

"The timing of the paper's release, just prior to the Thanksgiving weekend, makes it difficult to assess its impact. But it goes to the heart of two questions now before Senate Democrats: how best to contain health care costs and what's more important: getting a weak public option foot in the door or reserving the right to come back stronger if the private market fails to slow the rise in spending." (Rogers, 11/25).

Meanwhile, The New York Times reported that "Senator Ben Nelson, Democrat of Nebraska, has offered up an interesting explanation for his vote to move forward with debate of major health care legislation: he stopped his fellow Democrats from playing parliamentary hardball that he said would have led to a fast-tracked bill and 'sidelined' centrists like himself. In an op-ed in The Omaha World-Herald newspaper, Mr. Nelson suggested that had he not agreed to start formal debate on the health care bill, Senate Democratic leaders would have employed a tactic known as reconciliation to pass the legislation with a simple majority of 51 votes. .... 'The result of the limits on debate and content could be a convoluted bill passed by only 50 senators,' he wrote. "That's not what the Senate is about'" (Herszenhorn, 11/25).

One vote in the Senate may rest on who wins upcoming elections in Massachusetts, according to CongressDaily: "In the special election to succeed the late Sen. Edward Kennedy, D-Mass., a new TV ad from one of the candidates highlighting differences on healthcare reform among the Democratic field is stirring controversy. The ad was released on the eve of Thanksgiving by Stephen Pagliuca, a wealthy businessman who is a co-owner of the Boston Celtics and one of four Democrats seeking the party's nomination in the Dec. 8 primary. The ad targets two of Pagliuca's rivals by name -- state Attorney General Martha Coakley and Rep. Michael Capuano -- as potential obstacles to passage of healthcare legislation."

"The ad does not specify the policy difference that has divided the four Democratic candidates: Coakley and Capuano have said they would oppose final passage of a healthcare bill if it bars insurance payments for abortions, while Pagliuca and Alan Khazei, the fourth Democrat in the race, have said their support is not contingent on that provision. ... The special general election is Jan. 19, although whoever emerges from the Democratic primary will become the heavy favorite to be the next senator in this Democratic-dominated state. Recent independent polls show Coakley with a significant lead over the rest of the Democratic field"  (11/27).

Kaiser Health News has a new cartoon satirizing congressional debate on the health care bills. (11/27).

Finally, The Associated Press has a Q & A on "understanding the pros and cons of health overhaul," which includes such questions as "If Congress makes history and puts a bill on President Barack Obama's desk by Christmas, how long before the uninsured get medical coverage?" and "How many people would be covered?" The answer: "The Senate bill would cover 94 percent of eligible Americans under age 65; under the House bill, it's 96 percent. That's a major improvement over the 83 percent now covered, but the safety net would have holes. Some 16 million eligible people would remain uninsured under the Senate bill and 12 million under the House bill, according to the Congressional Budget Office. That's not counting illegal immigrants, who would not be eligible for government assistance under either bill. Both bills would eventually require Americans to get health insurance, or face fines" (Alonso-Zaldivar, 11/28).