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Sunday, November 8th 2009

Saturday Vote

The U.S. House of Representatives passed its version of healthcare reform yesterday. The amended and chopped up bill, as it came out of its three committees, was H.R. 3962.

The House bill has some key points. It has both a limited individual and an employer mandate. It sets up a national health insurance exchange. It has a public option, without an opt out clause; the public option exists as a free standing market institution (it must survive on its premiums alone) within the exchange and has no eligibility levels although no employer is required to offer the public option. It severely limits insurance companies, including when/if they can cancel policies and the maximum allowable out of pocket costs/yearly for anyone covered. It places a 5.4% tax on individuals earning at least $500,000 and families earning at least $1,000,000 to help fund the bill. It lacks an SGR fix, which makes it a surprise the AMA supported it. Here is a fine plain language summary of the bill. The WSJ has a summary as well about how the Bill plays to various staked groups in healthcare.

Pelosi lost nearly 40 Democrats and gained a single Republican in passing the bill. The New York Times has a great interactive graphic looking at the Democrats who opposed the bill.

This is a big step, no doubt but if reform is to happen much remains.

The path ahead remains shaky – for the bill and for many of the Democrats who voted to approve it. Party leaders need to mend the bruised feelings that will linger from this debate before they can address whatever legislation the Senate can produce.

And in the Senate, Majority Leader Harry Reid is still struggling to find 60 votes for Senate legislation and made clear he might not meet the White House’s Christmas deadline to pass a bill. Obama said in his statement, however, that he expects to sign a bill this year.

I don’t know what to make of the Senate situation. I’m not even sure the people in the know know what to make of the Senate situation. Certainly all the pressure is now on Reid.

Even before Saturday’s House vote, senators had begun to question why Reid suddenly embraced a public health insurance option – one that he didn’t yet have the 60 votes to pass.

In the process, the Senate debate over health-care has stopped dead, raising the possibility the Senate won’t even begin floor debate until after Thanksgiving. Reid himself recently left open the chance the final bill could slip until early next year.

That remark earned him a visit from White House Chief of Staff Rahm Emanuel, who showed up in the majority leader’s office a day later to press him on the urgency of the Christmas deadline, according to two Senate aides.

But it’s not just timing. Reid’s first task is finding a way to bridge the divide in his caucus between liberals pushing for a public option and moderates who have resisted the most ambitious version of that plan.

I’ll refrain from making a prediction that Reid will never get a full fledged public option, as appears in the House bill. Not after declaring the public option, in any form, dead earlier and being shown up. But obviously it isn’t likely that the Senate is liberal enough for such a public option. Even if Reid gets some form of the public option, such as with the opt out provision, it remains to be seen what happens when the Senate and House try to reconcile their bills; how far the Senate pulls the public option to the right.

We’ll see I suppose. My bet: A public option with an opt out, the tax increase is killed and Reid gets it passed sometime between Thanksgiving and Christimas. And the conference committee puts something out that looks a lot more like the Senate bill than the House bill.