Senate struggles to pass health care bill

In the wake of President Obama's announcement this week that the Senate is on the verge of passing the health care reform bill, a time line and vote are still up in the air.

The Senate, under pressure from Obama, hopes to pass what they can agree on by next week. The Democratic party has been divided over how to cover uninsured Americans, with liberal Democrats promoting a public option and others proposing to enroll ages 55 to 65 into Medicare.

"Really, we are only looking at 20 percent of the bill they are not agreeing on," Sen. John Kerry's policy adviser Steven Meunier said. "Realistically, we are looking at the public option and the Medicare buy-in being dropped."

If the health care reform bill were to pass, there will be little impact on those who are already on Medicare or who are insured through private insurers, Meunier said.

"If they pass a bill they can agree on, which perhaps is not as far-reaching as they originally wanted, it will still be a step forward," Meunier said, noting the reforms in the bill have not dominated headlines but will still mean a strengthening of the system for Americans. "There will be mandates to have stricter regulations on insurance companies so they can't drop people or drop coverage based on pre-existing conditions."

For the Americans who are on and off insurance year to year, the new bill will affect them the most, Meunier said.

"For people in Medicare or privately insured, not much will change right away, but their coverage will be strengthened and their benefits will improve," he said.

This week, lacking enough votes on either option, Senate Democrats said they decided to focus on what they can do to pass something by the end of the year.

"The bill could be more restrained than originally thought and in political standards, less progressive," Meunier said. "The White House is pushing to say 'let's just pass the 80 percent of true reforms and whatever we get through the Senate we can merge with the House bill."

Kerry, who once pushed for the public option, is motivated to pass whatever version of the bill that is agreed upon as soon as possible, according to his staff.

"In the past, every time Congress came close to making health reform a reality, the details and the old divisions got in the way," Kerry said yesterday. "Health care's greatest champion, Senator Kennedy, said his single greatest regret in a triumphant Senate career was holding out for perfection when significant reform was possible in the 1970s. But we are on the verge of a breakthrough in the United States Senate. We will not pass a perfect bill in 2009. But we can, and we will, pass significant reform that will improve the lives of Americans for decades to come."

Interim Massachusetts Sen. Paul Kirk, who took the late Sen. Edward M. Kennedy's seat, told the Senate last week he has received countless call from constituents in support of health care reform.

"It's comparable to Social Security in terms of its importance to our people," Kirk said. "All Americans who look forward to their golden years know what Social Security means, and I'm confident that the impact of this legislation will rank in the same category in terms of its impact on people's lives."

Kirk went on to tell fellow lawmakers, "I've only been in the Senate for a brief time, but I'm impressed by the number of constituents in Massachusetts who have contacted me about this issue. In 2006, our state enacted its own health reform, and many of its aspects are included in the bill we're now debating."

With the special election next month to fill Kirk's seat, Kerry's office says the person elected, either Attorney General Martha Coakley or state Sen. Scott Brown, may be voting on the bill their first week in office.

"The Senate race could not come at a more critical time. It is quite possible that the very first vote of our new Senator will be on health care reform," Kerry said. "As our next U.S. Senator, Martha Coakley has vowed to support comprehensive health care reform now because she knows that America cannot afford to wait. We can and we must build upon the Massachusetts model and build a health care system that equals the character and compassion of the American people, and that builds on the best lessons Ted Kennedy helped bring to reform in Massachusetts."

Meunier said the next few weeks will likely be a tightrope walk to get the bill on the president's desk after the first of the year.

With an unofficial deadline to vote in the Senate by Dec. 23, the bill will then go into the legislative process, where the Senate version of the bill will be merged with the House version.

Congressman John Tierney, D-Salem, said it's too early to tell what the reception may be to the bill once it reaches the House.

"If the Senate approves their health care legislation, then it is assumed it will go into what is referred to as 'conference,' a process by which members of both chambers work to reconcile the differences in the two bills," said Tierney's communications director, Catherine Ribeiro. "Beyond process, I don't think it would be appropriate for us to speculate on anything else at this time."

According to political analysts, the bill could be killed once the bill gets to the House and the battle begins to meld the two. Alternatively, the House could vote to accept the bill quickly — called "ping pong" in Washington — and the Senate bill could be approved without changes, thus sending the bill to the president's desk in early January.

With all members of the House up for re-election next fall, the decisions on whether to pass the health care reforms could hinge on constituent votes.

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