All the draft bills are now on the table. What comes next is the public struggle to meld those efforts together into a product that Democratic leaders hope will attract enough votes to pass.
Given the importance of the subject, the complexity of the various pieces of proposed legislation, and the sheer number of powerful lawmakers involved, it promises to be a difficult process.
“This is going to be changed, nuanced, and played around with until the very last vote,” says Stephen Hess, senior fellow in governance studies at the Brookings Institution. “Students will be writing dissertations about this for decades to come.”
The fluid nature of the proceedings on healthcare reform can be seen in the fact that on Tuesday Senate Finance Committee chairman Max Baucus (D) of Montana announced major changes to the draft bill, or chairman’s mark, that he’d introduced just last week.
In general, Senator Baucus’s moves seemed aimed at making his bill more appealing to Democrats who felt his original draft was too austere.
His most significant change would add more generous subsidies to help the middle class buy health insurance, by increasing government aid to families and individuals with incomes up to four times the government’s poverty level. He also scaled back a proposed excise tax on high-cost health insurance plans, so that it would hit fewer people.
“This is our opportunity to make history,” said Sen. Baucus as he outlined his plan.
Finance panel members have proposed more than 500 amendments to the Baucus’ basic bill. If nothing else, that means the committee may face some late nights as it works to meet its chairman’s goal of producing a finished bill by the end of the week.
Early debate revealed a stark philosophical divide between most GOP and Democratic committee members. Republicans described the core of the legislation -- its mandate that US residents purchase health insurance -- as a big government intrusion.
To this point, Sen. Baucus’s long months of engaging in bipartisan talks with a so-called “Gang of Six” Senators has not paid off with any Republican support.
Sen. Olympia Snowe (R) of Maine, however, might yet sign on. She called the chairman’s mark “a solid starting point -- but we are far from the finish line.” Sen. Snowe would like any finished healthcare reform bill to include more generous US Medicaid payments to states -- such as Maine -- that incur high costs for the joint federal-state program.
The Senate Finance Committee is the fifth, and last, congressional panel to take up President Obama’s proposals for sweeping legislation to expand healthcare for the uninsured, protect those already insured, and curb fast-rising healthcare costs.
As the Senate committee with jurisdiction over how to raise money to pay for the expensive effort, it is one of the most important players in this grand legislative game.
If it approves a bill, Senate leaders would then have to meld its finished product with the legislation already passed by the more liberal Senate Health, Education, Labor and Pensions Committee. The House, for its part, has three different committee versions of legislation to stitch together.
Both House and Senate leaders say they are aiming at floor action later this year.
If the two chambers pass versions of a health bill, a House-Senate conference committee would then try to reconcile them into a single piece of legislation. That resulting product would then be subject to another vote in both chambers before it could be sent to President Obama for a signature.
Given all the work to come “there are still horrendous battles to be fought” over what might go in, and come out, of any finished bill, says Stephen Hess of Brookings.
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