With the Senate Finance Committee on the verge of approving a sweeping health overhaul bill Tuesday, the path might appear open for action by the full Senate.
Not so fast.
First the Finance Committee bill must be combined with a more liberal version that the Health, Education, Labor and Pensions Committee wrapped up this summer. This merger is so rare that Senate Majority Leader Harry Reid has never attempted it on any piece of legislation _ much less one as complex as President Barack Obama's top legislative priority. The senator from Searchlight, Nev., will need plenty of guiding light.
Sen. Maria Cantwell, D-Wash., had a one-word description of Reid's task: "Tough."
Said Democratic Sen. Jeff Bingaman of New Mexico: "He's on the hot seat."
"I don't even want to think about it," said Sen. Kent Conrad, D-N.D. "What a daunting challenge."
Everything about health overhaul legislation seems to be unusually complicated, but this process is particularly so because of the disparities between the bills and Obama's goal of keeping the cost at $900 billion over 10 years. Reid won't go it alone; he will get some help from the White House and the committee chairmen.
"It's not going to be one silver bullet," Reid said. "There isn't any one thing, there are lots of things we're going to have to work on."
The two bills diverge on some of the thorniest issues, perhaps most notably on the question of whether the government should sell insurance to compete with private industry. The health committee bill has the government-run plan; the finance bill does not.
The health committee bill offers substantially more generous subsidies to low-income people to help them buy coverage than the finance committee bill.
The finance committee bill proposes a new tax on high-value health insurance plans that the health committee bill doesn't include, since the health committee didn't have to deal with paying the bill.
Reid must resolve all those issues and more over the next week or so to come up with a single bill to bring to the Senate floor. In its broad contours, the legislation would expand coverage to about 95 percent of Americans with a new requirement for individuals to purchase insurance. The costs would be borne partly by hundreds of billions of dollars in cuts in projected Medicare and Medicaid spending. Policies would be available _ for those who have coverage and those who don't _ through so-called insurance exchanges.
But many of the details are unresolved and it's Reid's job to decide. Every step of the way he must ensure that the choices he's making keep 60 senators happy, or at least on board. That's how many votes it takes to advance legislation in the 100-member Senate.
Any one change could lose a senator, and losing even one could be fatal.
Move too far to the left and a moderate Democrat like Ben Nelson of Nebraska could rebel. Too far to the right, and a liberal like Ron Wyden of Oregon could be alienated.
And then there's perhaps the most important senator of all, Olympia Snowe of Maine, virtually the only Republican seen as a possible "yes" vote on the health care bill. Reid will need to bring her along every step of the way.
The process has already started in the congressional and White House staffs. Beginning this week it will shift into high gear with Reid personally involved with a handful of key senators including Finance Chairman Max Baucus, D-Mont., health committee chairman Tom Harkin, D-Iowa, and Sen. Chris Dodd, D-Conn., who led the health committee consideration of the overhaul bill.
Snowe is expected to be closely consulted, and White House Chief of Staff Rahm Emanuel likely will participate in the meetings. They'll meet in Reid's stately office on the second floor of the Capitol and elsewhere. Obama will likely call wavering Democrats nd shore up support, as he did all last week with members of the Finance Committee.
It's still not clear what the product will look like finally, including whether it embraces any version of a government-run plan. Whatever it looks like, it will face a barrage of amendments once it gets to the Senate floor, and it could easily go down in flames like former President Bill Clinton's attempt at a health care overhaul in 1994.
"There is no model for success that exists, there isn't one and if you do it you're going to have to create the first model for success," said Lawrence O'Donnell, who was chief of staff for the Finance Committee during the Clinton effort. "Congress doesn't know how to do things it hasn't done before," O'Donnell said.
Even if the Senate passes a bill, which would only happen after weeks of debate, there would then have to be another excruciatingly difficult merger: this time with whatever emerges in the House.