The Alan Katz Health Care Reform Blog

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House and Senate Health Care Reform Bills Mark the Beginning of the Endgame

Posted by Alan on November 18, 2009

Senate Majority Leader Harry Reid is unveiling his health care reform plan after it received passing grades from the Congressional Budget Office. Whether he has the 60 votes he needs to bring the bill to the floor is still an open question, but odds are he’ll have the votes when he needs it, perhaps by this weekend.

Then the fun begins. Senators will debate the bill, offer amendments, vote on those changes, and finally craft a bill. If Senator Reid and his allies play their cards well, they’ll have the 60 votes needed to allow a vote on the legislation. (Yes, before there’s a vote there’s a vote on whether to have a vote – you’ve gotta love democracy). Only then will the Senate make history and pass health care reform.

Of course, what the Senate passes and what becomes law are two different things. Just as passage by the House of Representatives of HR 3962 was only a prelude to what will be the act of drafting the “real” health care reform bill.

Many have tried, but only President Barack Obama, Speaker Nancy Pelosi and Senate Majority Leader Harry Reid have gotten this far with health care reform. What they’ve accomplished is historic and Herculean. Whether you support or oppose their bills, respect for their accomplishment is appropriate. But getting this far is not the end. Well, it’s the end of the beginning. And it brings us closer to the beginning of the endgame.

The legislative process involves several stages. In the beginning there’s a lot of sincere questions being asked as lawmakers seek information, float trial balloons, and generally get a lay of the political landscape and the issues. During this phase there are a lot of options on the tables, including the most extreme positions (e.g., do nothing or enact a single payer system).

This phase was also when it became clear that, for the most part, Republicans were as interested in defeating “Obamacare” as they were in reforming the health care system. By publicly declaring so early in the process they would oppose any legislation containing provisions dear to the Democrats, the GOP effectively removed themselves from the deliberations. Why, after all, would Democrats negotiate with a party that had made clear they would oppose anything other than their own proposals?

Of course, Republicans could ask the same question of the Democrats (and do). The difference is that Democrats are in the majority in Congress. So if the two parties go their separate ways, the Democrats could still, under the right circumstances, pass a bill. In other words, it’s their bat and ball, so if the Republicans stalk off the field, the game continues.

In the second legislative phase the House and Senate committees with jurisdiction on health care weighed in. General concepts became legislative language. Lawmaker’s inclinations became public votes. Options feel by the wayside. (This is the phase in which the possibility of enacting a single payer system was formally laid to rest).

What the committees produced generated a lot of concern, anger and raucous  objections. Apparently some folks thought someone in Washington really thought these bills would become law. Nope. What the committees were producing were negotiating positions, not laws. Everyone had their eye on the main battle to come in the fourth phase. They were setting up their arguments, gathering their support for the real showdown.

Before the showdown, however, we have to get through the current phase, phase three. In this portion of our program, ideology and public policy take a back seat to a very practical concern: what needs to be in the bill – and what needs to stay out of the legislation – in order to get enough votes to pass it.

Senate Majority Leader Tom Daschle describes this process as shoveling frogs into a wheelbarrow. Speaker Nancy Pelosi’s job: craft a bill that could get 218 members of the House into her wheelbarrow. She succeeded by cobbling together legislation that is an abomination to many of the House Members who voted for it.

Senator Reid’s task: to get 60 Senators into his wheelbarrow. To do that he’s pared back provisions (such as on a government-run plan) in ways that only three weeks ago liberals would have labeled a betrayal (and some still do. Of course, those progressives complaining about the compromises Senator Reid has made tend not be in the Senate. Because liberal Senators understand the process. If they need to accept a weakened public insurance program to help Senator Reid keep 60 frogs in the wheelbarrow, so be it.

Why do liberal House members vote for a bill they consider an abomination and progressive Senators accept compromises that were absolutely unacceptable a few weeks ago? Because this is the phase where it’s about getting something passed, not public policy.

If the Senate passes Senator Reid’s health care reform legislation, the fourth phase begins. A conference committee will be created made up of members of the House and Senate. Their task: to meld together the House and Senate proposals into a single bill for which Speaker Pelosi and Senator Reid can shovel enough frogs into their respective wheelbarrows to pass.

Think about that challenge. A single bill that can get majorities in both chambers. That won’t be easy. The process won’t be pretty. Decisions will be made based on factors outside of health care reform.

Take Senator Joe Lieberman. He’s on record declaring his opposition to a government-run health plan is a matter of conscience. His history makes clear he loves being Chair of the Senate Homeland Security and Governmental Affairs Committee. Keeping the chairmanship he loves may require him to bend his conscience a bit. Yes, who chairs a particular committee has nothing to do with the substance of health care reform. But it has everything to do with the politics of health care reform.

(By the way, I’m not saying Senator Lieberman has been threatened with losing his chairmanship unless he agrees to let health care reform come to a vote in the Senate. But if it turns out he was, no one should be surprised. Hardball is a sport played by both parties. And  the higher the stakes, the harder the ball.)

Given the nature of the issue and the politics, the conference committee will forgo public policy debates and focus on fashioning a compromise that majorities of the frogs – I mean, lawmakers – in each chamber can support. This means what the House passed and what the Senate may pass are now the extremes in the health care reform debate. Compromises, after all, tend to wind up in the middle of two poles. The Congressional leaders making up the conference committee will try to establish a middle ground on which their needed majorities can stand. Their building blocks will be what it takes to get the bill passed. That the result may be messy, perhaps even unworkable is of less concern. There will be time enough to fix those problems.

Getting reform right was for an earlier phase in the process. And by eliminating some of the more extreme ideas, by establishing the boundaries of reform, those phases assured that public policy considerations would have an impact on the final legislation. But that was then. In this final phase of the legislative process it’s is about getting reform. Period.

In short, the health care reform process to date has been fascinating and important, but it’s main purpose has been to define negotiating positions. We’ll see the end of the beginning of health care reform if and when the Senate enacts its version of reform.

Only when the conference committee convenes, however, do we move into the beginning of the endgame, the point where the drafting process of health care reform begins in earnest.


7 Responses to “House and Senate Health Care Reform Bills Mark the Beginning of the Endgame”

  1. Mark said

    Very insightful and educational article Alan. Given that the Senate is poised to pass it’s bill on Monday (12/21), the conference committee will be where the action is for the upcoming week. Maybe you can go into a bit more detail about this committee. You probably could write another article. Some of my questions are the following:

    Who chooses the committee members ( Pelosi and Reid?)and on what basis?
    How many members on the committee?
    Does the committee have to be bipartisan or can there be all Democratics on the committee?
    How many votes does the committee need to pass the leglislation on to the full House for a vote?
    How many votes does the bill need to pass the full House? How many in the House and how many in the Senate are needed in order to be sent to the President for signing?
    Who is the Chairman of the Conference Committee and who selects him/or her? Will Reid and Pelosi co-chair?
    What might be the role of the President or “the White House” during the committee reconciliation process?

    Thanks Alan

    • Alan said

      Hello Mark. I don’t have answers to all your questions, but this is my understanding of the process. The House-Senate Conference committee is made up of both Democrats and Republicans. I assume the Speaker and Minority Leader appoint the House members and the Majority and Minority Leaders appoint the Senate members. I don’t think there’s any rule as to how many members of the committee there are, but the majority will be Democrats and there will be an equal number from each Chamber.

      I believe a simple majority of the conference committee is enough to send the bill the the floors of each chamber. While this means Republican votes are unnecessary (a good thing since they’ve pledged to oppose everything), the Democrats won’t just ram through a liberal bill. The goal of the committee will be to fashion legislation that can get 218 votes in the House and 60 votes in the Senate. Which means it’s likely to look like what’s emerging from the Senate.

      I don’t know who chairs the committee. There may be a protocol. The members are likely to include the chairs and ranking minority members of the relevent committees (e.g., Senate Finance, House Energy and Commerce). While I don’t believe there’s an “automatic” chair — and it could be either Speaker Pelosi or Senator Reid, I don’t know for sure how it will be done.

      The White House will be very engaged in the conference committee negotiations. In fact, this is where the Obama Administration has to get specific and forceful in defining what it wants to see in the health care reform bill. Because whatever emerges from the Conference Committee is what he’ll have to either sign or veto.

      Hope this helps,

  2. Rachael said

    about the bill increasing deficits…a good factual read is in…has pros,cons etc. Too many people are speaking without facts. the only impediment to this bill now is that insurance companies do not want the public option…why?…not because they think it will seriously compete with their profits (see electoral votes for the history of that myth)…BUT because they think it would be the “perfect propaganda for the ignorant voting block.”

    Learn the facts, shed the caustic rhetoric, and then call your congressman.

  3. If it looks like a snake, slitters like a snake, then it will bite you like a snake. Why should they proceed with this bill when it is so flawed to begin with? They need to start over and fix what needs to be fixed- one step at a time- not a monstrous bill.

  4. This bill is going to increase taxes and the deficit in a time that we can not afford either. It has done nothing to control cost which is the biggest problem we have now and is going to become a lot bigger in the future. Mandating insurance and doing nothing to control the cost of medical care is going to be a growing burden on our economy.

  5. Ron Masters said


    To say these bills are flawed is generous. Quite simply they are horrid.
    The glee that the Dems feel at this moment may be short lived. They had a chance to do the right thing but instead squandered it on a completely partisan bills that don’t reach even one of this President’s goals.
    With an estimated 25 new taxes on Americans when almost 11% are new filers for unemployment insurance and an approximate additional 6% are still unemployed, maybe the economy is a little more important.
    For an HHS that can’t even get the H1N1 vaccine out in time,(I knnow it’s Pharma”s fault,,NOT), they are clearly unprepared for entire nation’s healthcare system!
    I cannot have faith in an administration that has lost track of an estimated $89 Billion of the Stimulus money, our money, in a little over 6 months to administer anything!
    I had hope for this President even tough I voted for the other guy, but that has waned. Both houses of congress should be ashamed!!
    Alan, I’m surprised that you seem to feel that either of these bills are any good.
    What a mess!
    Happy Thanksgiving


    (I’ll let you know what I really think in future posts.)

  6. Gary Weiss said

    Sorry, Alan, but given the quality of the House bill, what it will do for our economy, health care, health insurance, and the deficit, the ills it won’t cure and how she gave legislators and the country virtually no time to review it, I think Nancy Pelosi deserves kudos about as much as Adolf Hitler does for how he almost conquered the entire European continent. Every time I see her face, I want to throw-up.

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