Democrats Struggle to Find A New Way to Proceed with
Health Care Reform

In light of the Republican victory in the January 19 special election in Massachusetts, negotiations to reconcile the differences between the bills passed by both the U.S. House of Represenatives and the U.S. Senate have been put on hold. Congressional leaders must reassess both their goals and strategies to successfully pass health care reform as Democrats lost their supermajority in the Senate. Several strategies were presented and rejected last week.

One option considered was to hurry the Senate-passed bill through the House of Representatives before Senator Scott Brown (R-MA) is seated. This option was rejected when President Barack Obama and several key Senators indicated they did not want to rush the bill; in addition, Speaker of the House Nancy Pelosi (D-CA) stated that the 218 votes necessary to pass the Senate’s health care bill in the House without changes were not available.

Options to move health care reform forward currently being considered:

• Starting over with a new, scaled-down bill or bills focused not on universal coverage but on incremental insurance reforms
• Passing several smaller stand-alone bills which address various aspects of reform, such as:
  • preventing insurance companies from rejecting customers based on pre-existing conditions
  • removing antitrust protections for insurers
  • closing the “doughnut hole” in Medicare prescription drug benefits
  • providing tax credits for buying insurance;
• Pursuing a budget reconciliation bill that would pass significant pieces of the health care reform bill with a simple majority vote of 51 votes in the Senate. However, Senate procedural rules would prevent a budget reconciliation bill from including important policy changes that do not directly affect the federal budget, such as insurance market reforms to eliminate pre-existing condition exclusions. The budget reconciliation path could also be used to effectively amend the Senate’s health care bill.

Each of these option would take at least a month or two, and possibly much longer, to be negotiated in Congress.

Congressional leaders are waiting until after the President's State of the Union address, 9:00 p.m. EST, January 27, 2010 to make any decisions about the next steps in health care reform.