Health care reform remains idling at a crossroads in the House after a stop-and-go week that ended on stop when Democratic leaders failed to gather enough support for a liberal version of a public insurance option.
Democratic top brass huddled Friday afternoon to try to forge a path forward but ended without a decision. Deliberations were expected to continue in phone calls over the weekend and in person at the start of the week. Its a lot closer than people think, but its still very tough, said Rep. Xavier Becerra (D-Calif.), who said they still hope to have a bill next week.
Speaker Nancy Pelosi (D-Calif.) had hoped to freeze the design of the package last week, but moderate pushback to her preferred approach to the public plan one that would reimburse doctors and hospitals at rates pegged to Medicare forced another delay. Pelosi said no decision has been made on the issue, even as she made the case that her focus is on getting some form of the public option out of conference negotiations with the Senate. This is about the endgame now, she said.
With debate over the shape of the public insurance option continuing to hamstring progress, Pelosi signaled new flexibility to deal on the issue. She pointed to momentum behind including some form of the public option in the Senate as evidence that the House could settle for a version of the plan in which the federal government would negotiate reimbursement rates with health care providers.
The atmosphere has changed, Pelosi said at a Friday news conference. When we were dealing with the idea that the Senate would have nothing, it was really important to go in again with the most muscle for the middle class with a robust public option.
Pelosi for weeks has made clear that she prefers the liberal approach, since it would save an estimated $85 billion more than a plan with negotiated rates. But she said last week that theres no philosophical difference between the robust public option and negotiated rates. Its just a difference in money, and money is important.
After spending the week surveying their Members on the issue, Democratic leadership gathered their colleagues Friday morning for another whip count. In that meeting, leaders methodically went through their rosters, putting those in attendance on record about how they would vote if a bill including a plan pegged to Medicare hit the floor. The count was inconclusive, however, since a sizable chunk of the Caucus was absent.
There is no easy fix, since about 60 liberals have vowed to oppose a public plan with negotiated rates. And if Pelosi folds on the Medicare-based public plan, she will lose one of the most powerful tools in the House bill for cutting the medical cost curve. That could cause her heartburn given that 36 moderate House Democrats threatened last week to bring down the bill unless the Congressional Budget Office says the measure would bring down health costs and reduce the long-term deficit. One Democratic aide warned that they would not be able to pass a bill that did not have the CBOs blessing, which has not yet been forthcoming.
And as if she didnt have enough problems, there are an array of smaller issues such as abortion that threaten to cost her even more votes and have not been resolved.
Democratic aides also pointed to the White House as unhelpful, given President Barack Obama has not weighed in to back the Medicare-based public insurance option or push it with Members. And there was frustration in their ranks Friday after Obama appeared to be leaning toward a trigger for a public option backed by Sen. Olympia Snowe (R-Maine) just as House Democrats were pushing aggressively to round up support for the most robust plan. It doesnt help. Theyve spent all year being hands-off and then get involved in the 11th hour in a very unhelpful way, said a Democratic aide.
The delay on the public option is threatening to roll back the leadership timeline for moving the measure Pelosi has said she wants a bill signed into law by Thanksgiving. But one top Democrat said leaders will take all the time they need to build support. Theres no rush to bring this to the floor until we have the votes we need, Ways and Means Chairman Charlie Rangel (D-N.Y.) said. And the Speaker is very, very patient.