Senate Debate to Begin on Healthcare Reform Legislation

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30 November 2009 :: J.E. Robertson

The United States Senate will begin deliberations on comprehensive health insurance reform legislation this week. Already there is intense criticism of the Senate’s health reform bill, from both ends of the ideological spectrum. A number of pro-business conservatives argue it is too costly and will hamper free enterprise and pro-patient progressives argue the bill is already too watered-down and needs a stronger public option, to expand coverage and reduce cost.

The Democratic leadership in the Senate has a daunting task ahead, just to reconcile differences in their own caucus and reach consensus among liberal and conservative members. The Republican party has, for the most part, taken such an obstructionist stance that most observers expect no more than a couple of Republican senators will be able to contribute constructively to the deliberations.

Senators Olympia Snowe and Susan Collins, both of Maine, are two Republican moderates —from a state whose House membership is now 100% Democratic and whose Republican governor favors gay marriage rights— who are expected to be potential allies in negotiating a Senate compromise that could both save the public option and pass the bill through to Conference Committee, where it will most likely be dramatically altered in order to reconcile the House and Senate versions.

The House of Representatives, under the leadership of House Speaker Nancy Pelosi (D-CA) saw a similar tug of war among conservative “Blue Dog” Democratic members and the party’s more liberal base, but it became clear by the time of passage that there was no way to pass the legislation without a relatively strong public option. One Republican, from Louisiana —a state in dire straits regarding lack of competition, uninsurance, and per-capita health insurance costs as compared to income— joined 219 Democrats in passing the bill.

The House Democratic caucus continues to say it will not be able to approve a final bill for Pres. Obama’s signature that does not include a “robust” public option. The Senate bill, however, is already assumed to be heading for a compromise proposal that could see the public option pushed back a number of years, or banned in certain states.

The “trigger” option has lost favor, due to concerns it would simply eliminate the public option and fail to lower costs. The “opt out” option for states would see a public option implemented, with states determining through legislative process (or possibly referendum) if they want to refuse their citizens access to the federal program. Proponents of the public option favor this approach, because it would require opponents to strip their constituents of a service already passed into law.

With the summer heat of town hall meetings and astroturf anti-reform rallies cooled, the Senate leadership hope to have a more sober, more deliberative debate. But Democratic leaders have warned that attempts at obstruction could simply lead to decisive parliamentary tactics that force opponents to choose between prolonged debate and immediate passage.

The Senate process will be heavily procedural. 60 votes are needed to end debate and call a floor vote, but the ultimate floor vote requires only a majority of 50 votes plus one. That one could be the vice president, who sits as president of the Senate, under Constitutional provisions, and is called on to break ties.

There are more than 50 senators who would vote for passage, and some progressives are already arguing, any attempt at a filibuster should be met with an immediate move for “budget reconciliation”, which would allow a simple majority vote to pass the bill, without needing to clear the 60-vote hurdle to end debate. Tensions are rising, as liberal groups organize to raise millions of dollars in campaign funds to stage challenges to any senator voting against the bill, and Sen. Lieberman threatening to lead a filibuster if the bill is not to his liking.