Christmas Eve, early in the morning. The United States Senate came together to pass a comprehensive health care reform act in a historic and dramatic session. After a century of inspiration, months of hard negotiations, and twenty-five straight days in session (almost a new record), the Senate came up with a compromise that passed the sunrise session with a vote of 60-39 (retiring Republican Jim Bunning of Kentucky decided not to show). Thus, as with all legislation, the package moves to conference committee with the House of Representatives before final votes in Congress on whether to send the agreed compromise to the President for his more-than-willing signature.

As the legislation moves to conference committee (a process that completely excludes Congressional Republicans), Democratic leaders have to keep the balance between the moderates and the progressives in a process that will almost surely be dictated by the White House. President Obama, who has generally left Congress to their own devices over the past year, has announced that he will actively participate in the negotiations between Harry Reid’s Senate caucus and the House Democrats under Speaker Nancy Pelosi. Moderates, such as the Blue Dogs in the House and the small group in the Senate led by Ben Nelson of Nebraska and Joe Lieberman of Connecticut, will try to tone down the sweeping changes that reform calls for. Meanwhile, the liberals, defined by the Congressional Progressive Caucus in the House (most visibly represented by Raul Grijalva, Barbara Lee, Louise Slaughter, and others) will join well-known Senate liberals such as Bernie Sanders and Russ Feingold, will push for stronger, more sweeping changes.

With the Republicans excluded, debate in conference committee will center on the differences between the liberals and the moderates in the Democratic caucus. The liberals have been pushing all year for the inclusion of a government-funded insurance plan (the “public option”), a component that moderates have strongly opposed. The public option is the most effective controller of costs, but moderate opposition has all but doomed the plan for this year’s package. Prominent liberals such as Iowa Senator Tom Harkin, having given up on the fight for the public option, are no longer pushing for the public option, instead promising to revisit reform after this package is passed. Thus, it seems probable that a public option will not be included in the conference report that emerges from committee. Another alternative to expand options and cut costs–the buy-in to Medicare for those 55 and older–has also been nixed by the moderates such as Lieberman, although it could emerge in negotiations if liberals decide to get aggressive.

Another contentious issue to emerge in conference negotiations will be the issue of abortion. The House package contains the controversial Stupak-Pitts Amendment, pushed by anti-choice advocates and Blue Dogs, which goes further than any law in restricting a woman’s right to choose. Ben Nelson, one of the few anti-choice Democrats in the Senate, attempted to include such language in the Senate bill. But Nelson’s attempts were met with hostile resistance from the large pro-choice caucus in the Senate, led by Barbara Boxer and Patty Murray. Conference negotiators will have to strike a delicate balance between the pro-choice Democratic caucus in the Senate and the Blue Dogs in the House, although it’s likely that the standing law–the Hyde Amendment–will merely be reaffirmed. Look out for the Catholic Church sticking its nose into the debate in an attempt to influence the abortion language in the final product. The Catholic Church, empowered by pushing Stupak-Pitts into the House bill, will also attempt to use its influence to change the language on illegal immigrants. The House version bars federal money from assisting illegal immigrants, but allows them to use their own money to buy plans in the health insurance exchange. The Senate bill bars illegal immigrants from both using federal money and using their own money. This will likely be a flare-up between negotiators that will receive major press coverage.

However, there is a lot of language that the two houses of Congress will instantly agree upon. The House and the Senate bills both contain language initiating an individual mandate for health insurance–a provision that was popular when the public options were included. Some argue that, without the public option, the mandate makes no sense and should not be included. However, it is likely that it will remain. Both bills also contain provisions barring insurance companies from denying coverage based on pre-existing conditions or charging more for premiums based on gender or pre-existing conditions. The Senate bill also extends the coverage for children, allowing them to remain on their parents’ plan until age 26. That provision was something that GW College Democrats personally lobbied for on Capitol Hill earlier this year.

The House and Senate will also have to pay special attention to the cost of the final bill, as there are major concerns about spending. The House bill costs just over $1 trillion over ten years, whereas the Senate bill costs $871 billion over ten years. Both bills are also conscious of the deficit and work to reduce it over time. President Obama has set a personal goal of $900 billion over ten years, but the cost could fluctuate anywhere within this range. Many of the swing votes in the Senate are budget-hawks, such as Kent Conrad, and creating a deficit-neutral bill will be an imperative task for the conference committee.

As negotiations begin after the winter holiday, the health care debate will be entering the final stretch. Although the final bill isn’t due to be completed until mid-February, after President Obama’s State of the Union Address, Democratic leaders will work quickly to resolve the differences between the two bills and come up with a compromise that appeals to the entire Democratic caucus. Although the bill passed by the Senate does not answer all of the problems with health care in America, it is a substantial step forward and will likely be remembered in history as an equivalent of Social Security under President Roosevelt or Medicare under President Johnson. After all, health care has been a definitive struggle over the 20th century, ever since President Theodore Roosevelt pushed for health care in 1912. Likewise, other liberal icons such as Wilson, FDR, Truman, Kennedy, Johnson, and Clinton made substantial attempts to achieve what is being accomplished under the Pelosi-Reid Congress.

Congratulations today to Leader Reid for his hard work in ensuring today’s vote. The Leader is often attacked by the left, but he has done a terrific job as Leader to build this compromise, given the sixty senators he’s working with. Reid took the time to reflect on the lifetime passion of Senator Ted Kennedy, whom was sorely missed during the debate after his August death and deserves much credit for his push in favor of this legislation. Speaker Pelosi also deserves praise for the job she did in the House earlier this year. It will be interesting to see the compromises between the two bills, sending us forward to next year when, one bright day, President Obama will sign the greatest reform of health care in America since Johnson’s Medicare in the 1960s.

This entry was posted on Saturday, December 26th, 2009 at 8:34 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.