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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.

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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.

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