Political Hotsheet
By

Stephanie Condon /

CBS News/ March 15, 2010, 6:11 PM

A Big Week for Health Care Reform: What Could Happen Next?

health care

If all goes according to plan, the Democrats could have a health care bill ready to send to President Obama by the end of the week. It's impossible to say, of course, whether all will go according to plan, or whether Democrats are even entirely sure what the plan is yet.

There are three paths the Democrats' comprehensive legislation could take this week. Here is a look at those three possibilities, starting with the most ideal scenario for Democrats.


The House Passes the Senate Bill; Both House and Senate Pass a Reconciliation Bill

House Speaker Nancy Pelosi (D-Calif.) indicated on Friday that she expects to pass health care legislation by Sunday. Mr. Obama pushed back his trip to Asia to Sunday, suggesting he expects to sign a bill before leaving. Here's what this would entail:

First, the House would pass the health care bill passed last year by the Senate. The House would then immediately pass a "fix it" bill that would amend the Senate bill to achieve some compromise between House and Senate Democrats -- for instance, it would take out the "sweetheart deals" that have tainted the Senate bill, such as Sen. Ben Nelson (D-Neb.)'s provision that exempts the state of Nebraska from having to pay for any expansion of Medicaid.

President Obama may then have to sign the original Senate bill. Last week, Republicans said the Senate parliamentarian -- a congressional official who acts as a sort of Senate referee -- ruled that Mr. Obama must sign the Senate bill into law before Congress can try to change it with a "fix it" bill. Pelosi acknowledged as much on Friday, though there is still some question as to whether the parliamentarian's ruling has been interpreted correctly.

After the president signed the Senate bill, the Senate would then pass the "fix it" bill via a process called reconciliation, which can bypass a Republican filibuster with just 51 votes. Then the president could sign the reconciliation bill, completing the process.

Congress could accomplish all of this in some round-about ways. House Democrats are not keen on the idea of having votes on the record for the Senate bill, since it is filled with politically damaging provisions like Nelson's Medicaid deal. To avoid voting directly on the Senate bill, the House is considering writing a rule allowing them to vote on a reconciliation measure that would automatically pass the Senate bill.


Confused about health care reform? Email us your questions and CBS News will try to answer them in the days ahead.

As of Friday, House Democratic leaders had not decided whether to use the process to avoid taking a direct vote on the health care bill, according to a memo to Democratic staffers from Rep. Chris Van Hollen (D-Md.), who is Pelosi's assistant.

White House Press Secretary Robert Gibbs affirmed on CBS' "Face the Nation" on Sunday that the White House expects the voting to be finished by next week: "We do believe that a week from today we'll be talking about a bill that has passed the House, not being considered by the House," he said.


The House Passes the Senate Bill; The Senate Fails to Pass the Reconciliation Bill

Once the House passes the Senate bill, Democrats can breathe a short sigh of relief -- they will have a bill President Obama can sign into law. And if interpretations of the Senate parliamentarian's ruling are correct, the president must sign it then.

At this stage, however, there is still another huge hurdle to overcome -- the passage of the reconciliation bill in the Senate. Republicans in the Senate plan to use every rule and tradition possible to obstruct the passage of the measure.

For instance, as the New York Times reported, GOP senators like Tom Coburn of Oklahoma plan to offer unlimited amendments to the bill to try and draw out the debate as long as possible.

Furthermore, only items that impact the federal budget may be passed using reconciliation, meaning Democrats will be very limited in what they can do. All 41 Republican senators sent a letter last week to Senate Majority Leader Harry Reid warning him that they would not allow any violations of the rule.

Republicans want to stall the process, and if Mr. Obama leaves Sunday for his Asia trip, the bill's most important advocate may not be there to keep Democrats from breaking before the reconciliation measure passes.

"I don't think we should simply assume Mr. Reid has 51 votes," Rep. Bill Pascrell (D-N.J.) said, according to Politico. "I don't know what the hell is going on over there in the Senate."

The parliamentarian, Alan Frumin, rules on what amendments are germane to the bill and what provisions are related to the budget; however, the presiding officer of the Senate -- Vice President Joe Biden or whatever senator is sitting in as the presiding officer -- has the final say. Yet there is very little, if any, precedent of a presiding officer overruling the parliamentarian.


The House Fails to Pass the Senate Bill

While the White House and Democratic leaders have built up a sense of inevitability around their health care bill, the fact remains that the Senate bill will be very hard to pass in the House.

As of Sunday morning, House Democrats did not have enough votes, Rep. James Clyburn (D-S.C.), the House Democratic whip, said on NCB's "Meet the Press."

"No, we don't have them as of this morning," he said. "But we've been working this thing all weekend, we'll be working it going into the week. I am also very confident that we'll get this done."

There are a number of issues that continue to divide Democrats, such as the abortion language in the Senate bill. A group of anti-abortion rights House Democrats, led by Rep. Bart Stupak (D-Mich.), have said they will not vote for the Senate bill unless they can be assured the language will be amended to place more restrictions on the use of federal money for abortions. The issue cannot be addressed via reconciliation, however, and House Democratic leaders said Friday they are no longer negotiating with Stupak on the issue.

Obama Makes Closing Argument for Health Care Reform
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CBSNews.com Special Report: Health Care

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143 Comments Add a Comment
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noloyalisti says:
Of course the reason we don't have jobs are the typical and easily foreseen result of the costs of the Bushoccio Crime Family wars.

In addition it was the result of the implementation of the Government of Pigs party disastrous Reagan wet dream of deregulation and privatization to enrich the already rich with our tax money.

Now that was what Mission Accomplished meant.
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infantryman1968 replies:
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You know, you should really try to shave and put on a dress once in a while......
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xl500 says:
Obama has not united this country at all. He is doing everything pelosi wants him to do. what good is health reform when there are no jobs. 2010 these dems are going to be out of a job
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John_Galt_ says:
Get the hell out of my way!
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Cattzen says:
It's been a long and very tough road for this legislation. The Republican Party will own the part they played (or, refused to play) in obstructing beneficial regulation of the HealthCare Insurance Industry.
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jt92202 replies:
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It's not the HealthCare insurance industry it's heath Insurance Industry, the insurance company doesn't give you healthcare your health providers give you heathcare. Talk to them about how much they charge and why! People really need to understand Insurance before they spout!! They are one of the highest regulated industries in the US and make a 4% profit compared to the 29% profit drug companies make. CBS nightly news showed the numbers last Tuesday!
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jt92202 says:
I thought it was HealthCare reform not Health Insurance Reform!! Health Insurance is just that Insurance but Healthcare is doctors, hospitals, drugs, tests, lawsuits, on and on!!!! Let?s reform HEALTHCARE along with Health Insurance Companies!!!!

This Congress doesn't want to do this right because of special intrests on both sides.

Do it right for the people not the corporations or don't do it at all!!!
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Petepilot62 says:
I see my post was erased, all I asked was why Americans feel that they are not getting good healthcare unless it bankrupts them? The USA is the only western 1st world country that does not have universal access healthcare.
Cuba and Mexico take better care of their citizens, I never thought I would see the day when I would say that seriously, I am 63 years old and I thank god for the healthcare we have in Canada where every one has the same access to 1st class treatment, your controlled press rants not withstanding.
Look at the money wasted on kickbacks, expenses, greed, fraud, wars, and then say with a straight face that healthcare is too expensive. The only argument against healthcare is the profit position of insurers and big Pharma. Even Spain and France have heavily subsidized 1st class healthcare.All this debate about Democrats & Republicans and socialism and Obama ad nauseum is just a big red herring. The powers that be want you to be subservient and to bleed profit for them. Wake up people.
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jt92202 replies:
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Yes but the system you have in Canada is Healthcare, I believe most people in the US would take this better if we were voting on HeathCare Reform. That is not what they are voting for in Congress, they are voting for shutting up the Insurance Industry and not looking at what really drives HeathCare costs up!

In Canada does your Heathcare pay for anyone other than Citizens? Most do believe that in the end our HeathCare Reform will pay for anyone that steps into the doctors office or hospital that needs care. We already do that in the Hospitals but for those Americans that don't have Health Insurance they can't get more than just emergency care. My Ex right now needs care but makes 30,000 per year and can't afford the care they say he needs.

I agree to a point that we need heathcare reform BUT HealthCare comes from the doc's, hospitals, drug companies and so on not the Health Insuance Companies they pay the bills that are giving to them and pay what the contract stipulates they have to pay! YES we need to regulate Health Insurance Companies more but you can't do one without the other!!!
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noloyalisti says:
Don't like women' right don't use them. Don't like freedom of choice, don't support it. Just keep your narrow-minded, old fashioned religious beliefs off of our bodies and out of our bedrooms. The awful pope can kiss me where the sun don't shine.
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rocketjl says:
Why can't a new fit-it bill be drafted now, to eliminate 90% of the bad stuff in Obama's bill. Separate bills can be made to reform health care. It is time to use Pelosi, Reid, and Obama's tactics against them. Get rid of the democrats and begin the 'fix-it' process against Obamacare.
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noloyalisti replies:
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All the bad stuff in the bill was supported by the Republican party and put in there by their corporate masters.
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tsigili says:
Next, Obama will declare martial law, and enforce it with the military......like other dictators.
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alancontact replies:
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You are a paranoid idiot. Put down that bong and get out of your mom's basement. The fresh air might wake you up.
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lbsghd says:
After reading the proposed healthcare bill, I am convinced it will lead to the decline of quality healthcare in this country. The only thing I can't decide is whether I am more scared and concerned as a patient or as a doctor.
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