View from Washington: Washington Report

Inching closer to health reform on Capitol Hill

After months of debating and wheeling/dealing, healthcare reform moved forward in the U.S. Senate on December 24. Democratic leaders patched together a political deal allowing passage of H.R. 3590, the Patient Protection and Affordable Care Act. The bill passed on party lines by a vote of 60-39.

While this vote signifies major progress on health reform, the legislation still must clear several hurdles before reaching President Obama’s desk. The Democratic leadership in both bodies of Congress must now conference together to resolve substantial differences in their respective legislation. Major differences include overall cost of the legislation, Medicaid expansion, abortion, tax subsidies and the inclusion of a public health insurance option.

Based on the latest intelligence, a formal Congressional conference seems unlikely to occur. Democratic leadership in the House and Senate will work closely during the month of January with members of the Administration to reach agreement on the major differences between the House and Senate passed versions, as well as all other outstanding issues. Several scenarios are being discussed to avoid what many predict will be a contentious House and Senate conference. One potential scenario is for House Speaker Nancy Pelosi to call up the Senate passed health reform bill and call for a vote. This would avoid a long and drawn out conference effort. Such a vote would be an up or down vote on the Senate passed version as well as a manager’s amendment, which might include agreements on certain provisions reached by the Democratic leadership and White House. After all is said and done, expect the final bill to more closely resemble the Senate passed version of H.R. 3590.

The backdrop for all of this maneuvering continues to be polling data, which indicates that support for H.R. 3590 continues to slip with the majority of the public seemingly opposed to what Congress has developed. With the start of the mid-term election cycle beginning in January, many incumbents who are somewhat wavering on H.R. 3590 will now face the reality of an electorate that apparently wants health reform, but just not the bill that Congress has come up with.

The Democratic leadership is hoping that final legislation will be passed by Congress and sent to President Obama’s desk by the President’s State of the Union Address. Many feel this to be a very aggressive deadline. There is a real possibility, the legislation will not go to the President until after his speech, or until early February.

About the Author

Robert Betz Ph.D.
Robert Betz, Ph.D., is president of Robert Betz Associates, Inc. (RBA), a well-established federal health policy consulting firm located in the Washington, D.C. area. Additionally, Dr. Betz is an adjunct professor teaching at The George Washington University where he specializes in political science and health policy. For more information about RBA, visit
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