The Senate kicked off its debate on the health care reconciliation bill Tuesday, but without the tension that characterized its consideration of a health care overhaul in December and the spellbinding drama that marked the House's high-stakes passage of a package Sunday night.
While far from dull, the Senate's final stretch in the health care debate is anything but a nail-biter. Democratic Senators already had to take tough votes on unsavory provisions such as the "Cornhusker Kickback" that covered Medicaid costs for Nebraska when they approved the original reform package. Plus, the House has already voted on the Senate-passed bill, which the president signed into law Tuesday.
And there is little doubt that Senate Majority Leader Harry Reid (D-Nev.) has the 51 votes needed to pass the budget reconciliation package of fixes the House passed late Sunday.
"We went through our Armageddon in December when we passed this bill. And so we've been through this, and this is fixing things, and a lot of us are more than happy to get rid of that Nebraska deal," Sen. Amy Klobuchar (D-Minn.) said, referencing the controversial Senate deal that was added late last year to win over support from Sen. Ben Nelson (D-Neb.). The reconciliation bill eliminates that provision and enhances Medicaid payments for all states.
The primary concern for Senate Democrats this week will come during what Klobuchar described as the "vote-a-rama drama" when Democratic leaders will ask their rank and file to vote against amendments they may support in an effort to keep the bill as similar to the House-passed version as possible.
Sen. Tom Coburn (R-Okla.) announced Tuesday that he would force a vote on an amendment that would bar insurance coverage of erectile dysfunction drugs for sex offenders. But given the Democrats' promise to oppose any and all amendments, most will have to vote against the politically charged proposal that could be used against Senators in campaign ads.
Additionally, Senate Democrats such as Sen. Claire McCaskill (Mo.) said the expectation of long nights and even the possibility of overnight sessions is daunting to Senators.
"That's drama, you know, for this body," McCaskill said. At press time, it was unclear whether Senate Republicans and Democrats would come to an agreement that would prevent such late-night sessions.
Still, Democrats on Tuesday were feeling increasingly confident that Republicans will not be able to use budget points of order to poke holes in the bill, or that if those problems arise they will be so minor as to make few substantive changes to the measure overall.
[IMGCAP(1)]"I think some of the wind has already started to blow out of [Republicans'] sails, in the main sense because the president signed the [comprehensive] bill. Health care reform is now law, and that says a lot right there. In fact, it's all over," Senate Finance Chairman Max Baucus (D-Mont.) said.
Baucus, along with Senate Budget Chairman Kent Conrad (D-N.D.), said Tuesday that they believe reconciliation will survive Republican challenges to provisions. But they held out the possibility that a small number of items could be nixed if the Senate Parliamentarian rules in the GOP's favor on any specific item in the bill. Sixty votes — one more than the 59 members of Senate Democratic Conference — are needed to retain reconciliation provisions that violate budget rules, and all 41 Republicans have vowed to uphold any parliamentary rulings that come down in their favor.
"We think we're pretty much in the clear all the way around," Baucus asserted Tuesday. "There's one or two that might have to be changed. ... In the whole scheme of things, they're not going to defeat the bill. They're not poison pills, they're not game-changers. They're minor, and we can deal with minor changes."
Conrad said his staff had recently found new precedents to defend the few provisions that Republicans were likely to challenge. As of press time, however, it was not clear whether the Parliamentarian had ruled on any GOP challenges to the bill. Republicans lost one major challenge Monday, when the Parliamentarian ruled that the bill did not violate rules barring reconciliation bills from making changes to Social Security.
Besides the sense of inevitability Senate Democrats have tried to create about the debate, Baucus hinted that the main reason Senate leaders are taking up the bill is because of their commitment to House Democrats to make fixes to the original Senate overhaul, not out of groundswell of desire among Senators to pass it.
"It's very important to the House," Baucus said when asked if it was important to pass the bill at all after the Senate bill's signing.
"It's important. We made a commitment to pass it. We're going to pass it. But still the most important public policy that was done was in the bill that was signed by the president today," Senate Democratic Policy Committee Chairman Byron Dorgan (N.D.) echoed.
Meanwhile, Senate Republicans spent Tuesday afternoon firming up their strategy for combating the package.
The GOP has three goals: poke procedural holes in the legislation to try to strip a provision or two and force the House to revote on it, amend the bill to improve the substance, and advance a broader midterm campaign message that involves building public opposition to the new law.
Despite the fact that Obama signed the bulk of the Democrats' health care reform agenda into law already, Senate Republicans appeared committed to trying to change the reconciliation legislation.
"I think it's still important that Democrats have committed to the House Democrats that they'll pass this bill that has even greater Medicare cuts, even greater tax increases — even more special deals. I think the American people need to focus on this second bill as well," McConnell told reporters. "We're going to treat it as a serious legislative exercise, and will have, as Sen. [Judd] Gregg [R-N.H.] indicated, a number of amendments that are important that people go on record on."
Republicans used their weekly Tuesday luncheon to prepare their floor and political strategy for the week, and rank-and-file Senators suggested afterward that they are still energized and committed to fighting the Democrats. Sen. Saxby Chambliss (R-Ga.) said the Conference would continue to show resolve as the battle over reconciliation got under way and would proceed in a "very controlled, very methodical" way.
"I think we've got our act together," he said.
Despite the Democrats' professed confidence, Republicans still believe they can force the House to revote on the bill by winning a budget point-of-order challenge. At press time, Republicans were still attempting to schedule a meeting with the Parliamentarian and the Democrats to present the points of order they plan to raise.
Republican leaders declined to discuss many details but said they would raise one point of order over an appropriation in the package they say doesn't fall within the confines of reconciliation rules.
But they did begin to reveal some of the several dozen or more amendments they would offer.
"We can still raise — because we have not had an opportunity to — some of the substantive policy questions which are out there and should be discussed in an amendment-type atmosphere," said Gregg, ranking member on the Budget Committee.
Gregg said the Republicans would propose "a whole series of amendments," starting with one that addresses a proposed cut in Medicare funding. Gregg conceded that Republicans couldn't reshape the bill enough to support it but said some amendments might reverse some of the legislation's "fundamental flaws."