Health Bills Curbed after Senate Shift

With Legislation Stalled, Reformers Regroup

Confronted with public opposition, a unified minority party, and an election loss that changed the balance of power in the US Senate, healthcare reform efforts have entered a new phase featuring talk of bipartisan cooperation and a healthcare summit at the White House. Democrats continue to hold majorities in the House of Representatives and the Senate, but after months of debate and several narrowly won votes, their voluminous healthcare bills may no longer be viable. The opposition is calling for reformers to toss out the current House and Senate bills and start with a clean slate, but majority leaders say they will work to enact the most widely supported aspects of existing proposals.

This winter, the reform debate has revolved around the Senate healthcare bill, titled the Patient Protection and Affordable Care for America Act (S.AMDT.2786 an amendment in the nature of a substitute to HR 3590), and the House bill, titled the Affordable Health Care for America Act (HR 3962). Earlier versions of reform legislation that made headlines in 2009 include S 1796, the America’s Healthy Future Act of 2009, and HR 3200, the America’s Affordable Health Choices Act of 2009.

A copy of HR 3962 downloaded from Senate.gov is just over 2000 pages, and the bill narrowly passed the US House of Representatives by a vote of 220 to 215 on November 8. HR 3590 as amended by the Senate is more than 2400 pages, and the last major action for this vehicle for healthcare reform legislation occurred on December 24 when the bill passed with a vote of 60 in favor and 39 opposed. Since the Christmas Eve vote, a process that appeared to be nearing completion has stalled as the House majority decides whether to pass the Senate bill in its current form or proceed with an amendment process that would necessitate another Senate vote.

Public opinion polls released at the beginning of the year reported varying degrees of opposition to the House and Senate bills. A CNN/Opinion Research poll conducted by telephone from January 8 to 10 found 57% of the 1000+ respondents generally opposed to the House and Senate bills with 47% generally in favor. By January 22, only 38% of respondents polled by the same group were in favor of the bills while 58% were opposed. The same poll, conducted December 2-3, 2009, had 61% opposed to the Senate bill and 36% in favor. At press time, a RealClearPolitics Poll average of 7 major polls reported 38.6% in favor of the Democrats’ healthcare plan and 53.1% opposed.

Democrats were forced to address opposition to their healthcare proposals after losing the Senate seat formerly held by the late Senator Edward M. Kennedy (D, Massachusetts) in a special election. Regardless of whether or not Massachusetts voters were specifically rejecting Democrats’ handling of healthcare reform, they awarded Republicans a key vote allowing them to filibuster Senate legislation. After winning the election, Republican Scott Brown, who campaigned against the current bills, called for a fresh start. “One thing is clear, voters do not want the trillion-dollar healthcare bill that is being forced on the American people,” he said.

A Rasmussen Reports survey of 1000 Massachusetts voters in the special election, conducted on election night, found that healthcare was a top issue. Among those who voted for Senator Brown, 52% said healthcare was the most important issue in determining their vote compared with 63% of those who voted for Massachusetts Attorney General Martha Coakley, the Democrat candidate. In addition, 78% of voters who selected Senator Brown said they strongly oppose the healthcare legislation before Congress.

Following the election, the Associated Press reported that, “A simpler, less ambitious bill emerged as an alternative only hours after the loss,” which “forced the Democrats to slow their all-out drive to pass Obama’s signature legislation despite fierce Republican opposition.”

Despite opposition to the House and Senate bills, there is evidence that Americans still favor of some form of healthcare legislation. After the first week of the year, Gallup reported that support for passage of a healthcare bill stood at 49% in favor and 46% opposed. But a Gallup poll conducted on January 20, the day after the special election in Massachusetts, asked how President Obama and the Democrats in Congress should proceed with their existing healthcare bill. Of the 1010 respondents, 39% said the lawmakers should continue working on the bill and 55% said they should suspend work and consider alternatives.

On the night Senator Brown was sworn in, Mr. Obama told attendees at a Democratic National Committee (DNC) fundraising reception that lawmakers should not “let the moment slip away” but admitted that existing healthcare proposals could fail to win passage in the Congress. “If Congress decides we’re not going to do it, even after all the facts are laid out, all the options are clear, then the American people can make a judgment as to whether this Congress has done the right thing for them or not,” he said.

In an interview broadcast just before the Super Bowl, Mr. Obama suggested to Katie Couric from CBS News that leaders from both parties participate in a bipartisan healthcare summit to be televised from the White House on February 25. Days later the president listed his priorities for the healthcare reform summit in a White House news conference.

“I’m looking forward to a constructive debate with plans that need to be measured against this test,” Mr. Obama said. “Does it bring down costs for all Americans as well as for the federal government, which spends a huge amount on healthcare? Does it provide adequate protection against abuses by the insurance industry? Does it make coverage affordable and available to the tens of millions of working Americans who don’t have it right now? And does it help us get on a path of fiscal sustainability?”

In the briefing, Mr. Obama agreed that, “the public has soured on the process that they saw over the last year,” adding that this “contaminates how they view the substance of the bills.”

Responding to President Obama’s announcement of bipartisan healthcare reform negotiations, House Minority Leader John Boehner (R, Ohio) said that opposition to House and Senate reform bills has increased along with public awareness of the proposals. “A majority of Americans oppose the House and Senate healthcare bills and want them scrapped so we can start over with a step-by-step approach focused on lowering costs for families and small businesses,” he said.

“Obviously, I am pleased that the White House finally seems interested in a real, bipartisan conversation on healthcare,” Representative Boehner added. “The American people have overwhelmingly rejected both of the job-killing trillion-dollar government-takeover-of-healthcare bills passed by the House and Senate. The problem with the Democrats’ healthcare bills is not that the American people don’t understand them; the American people do understand them, and they don’t like them.”

Noting that legislation to opt out of the Democrats’ healthcare proposals has been introduced in 36 states, Representative Boehner and Republican Whip Eric Cantor (R, Virginia) sent a letter to White House Chief of Staff Rahm Emanuel asking that the invitation to the healthcare summit be extended to governors and state legislators. Governors of both parties have raised concerns about the additional costs that will be passed along to states under both bills.

In addition, Republicans asked the president to eliminate the possibility of relying solely on Democratic votes or using the reconciliation process, which requires only 50 Senate votes, to pass healthcare legislation. Ruling out these options “would represent an important show of good faith to Republicans and the American people,” the letter said.

At the DNC fundraiser, Mr. Obama was asked how healthcare reform can be passed and about his strategy going forward. The president said that Democrats in the House and the Senate have been in discussions to finalize legislation “that represents the best ideas of both the House and the Senate.” He emphasized the importance of “a methodical, open process over the next several weeks.”

Still, it may be difficult for the political parties to cast aside differences and establish common ground. Although Democrats say they have no intention of casting aside proposals set forth in the House and Senate bills, Representatives Boehner and Cantor said Republicans would be “rightly reluctant to participate” in the president’s healthcare reform summit “if the starting point for this meeting is the job-killing bills the American people have already soundly rejected.”

Senate Republican Leader Mitch McConnell (R, Kentucky) also issued a statement asserting that there are a number of healthcare reform measures with bipartisan support “that we can start with when the 2700-page bill is put on the shelf.”—Charles Boersig