Having moved their health overhaul bill to the debate stage, Senate Democrats now face a minefield of issues that threaten to squash the reform effort altogether.
A break, then debate
Abortion, public option still divide reform efforts
Rifts over abortion, immigration, the public option and affordability—there since the law-writing process began but renewed recently after the House passed its bill and the Senate moved on its own—will challenge lawmakers in the coming weeks as the fight for health reform moves to the floor and the amendment process begins.
And the hospital industry also will be working hard to influence legislators to change the bill. The American Hospital Association opposes inclusion of a national public option, wants to increase the number of people who would be covered under the bill and seeks to change a provision that would charge a financial penalty to hospitals for certain readmissions (Nov. 23, p. 9).
Debate on the $848 billion bill is expected to begin this week, with a final vote expected by late December. If it passes, it will then be melded with a bill passed in the House on Nov. 7.
One of the biggest issues is abortion. Last week, the influential U.S. Conference of Catholic Bishops said that while it supports the overall effort to reform the healthcare system, it could not back the Senate bill because of language over abortion that it sees as too lax. Richard Doerflinger, associate director of pro-life activities at the USCCB, said that the bill doesn’t provide a fail-safe way to prevent federal dollars from flowing to insurance plans that cover abortions. The group played a major role in shaping the House’s abortion language, which pro-choice advocates said go far past current laws on the matter.
The bishops’ group also cited areas where the cost of care remains too high and a lack of access for immigrants in the U.S.—here legally or not—as problems, too. “There are a number of problems throughout the bill where these things just need to be brought up to conformity with current law, current policy,” he said.
Several anti-abortion Democrats have said they will likely try to change the abortion language through the amendment process, but how successful they’ll ultimately be is still uncertain. Sen. Robert Casey Jr. (D-Pa.), an anti-abortion Democrat, highlighted some of the challenges now facing the Senate when it comes to the controversial procedure.
“Look, there’s no template for this,” Casey said, adding that the creation of a health insurance exchange and a public option complicated the issue. “There are a lot of folks in the Democratic Party and even in the caucus who think that the bill as it stands now is consistent with keeping federal dollars out of abortion,” Casey said.
Indeed, the provision that allows for a national public health plan has divided Democrats from day one and even threatened until the last minute to scuttle a vote to move the bill forward. At issue are lawmakers who see such an option as a move to eventually phase-out private health insurance providers. While the government estimates that enrollment in such a plan would ultimately be low, others, however, see it as the first step in what could eventually lead to a broader government role in healthcare.
“Our caucus has known this is a real serious issue for us from the beginning because a third are for a public option, a third are adamantly against and a third are in the middle,” said Sen. Mary Landrieu (D-La.). “And I am adamantly against it, but would consider a principle compromise because I understand that this is one of the issues that we have to find a solution for or it could blow up the whole effort.”
Regardless, lawmakers tried to tamp down the controversy, instead highlighting other problems in the bill. Sen. Joseph Lieberman, an independent from Connecticut who caucuses with Democrats, said that he would offer amendments to bolster the provisions that deal with healthcare costs and the overall affordability of insurance.
The amendment phase should begin this week, with lawmakers returning from their weeklong Thanksgiving recess.
When asked when he thought he could get 60 votes again on the bill—the number needed to pass legislation of this size in the Senate—Majority Leader Harry Reid (D-Nev.) paused briefly before answering. “That’s a simple answer,” he said. “We’ll get 60 votes again when we have a bill we’re going to want to send to the president.”
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.