Health reform facing a tough test in the Senate

What happened

The House of Representatives passed a landmark $1.05 trillion health-care bill last weekend, setting the stage for a high-stakes showdown in the Senate. The bill passed 220–215, with only one Republican supporting it and 39 Democrats, virtually all from swing districts, opposed. The bill, which would provide health coverage to 36 million uninsured Americans, requires most people to obtain insurance; creates both a public-option government plan and a market exchange where consumers can shop for policies; and provides subsidies to help low-income families and individuals obtain coverage. The bill cuts $440 billion from Medicare over 10 years, in part by reducing payments to hospitals and other health-care institutions, and imposes a 5.4 percent surtax on individuals making more than $500,000 and couples making more than $1 million. President Obama said he is “absolutely confident” that the Senate will also pass a health-reform bill, which he hopes to sign before the end of the year.

Getting health reform through the Senate, however, will prove far more difficult. Majority leader Harry Reid will have to overcome overwhelming opposition from Republicans, a skittish group of moderates in his own caucus, and Senate rules requiring 60 votes to proceed with legislation. Senate Republican leader Mitch McConnell has vowed to go all-out to defeat what he calls a Democratic effort “to take over one-sixth of our economy,” with other Republicans saying “reform” is a Trojan horse to usher in a “European-style social-welfare state.”

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What the editorials said

The House legislation ends the worst abuses of our current health-care system, said The Philadelphia Inquirer. Insurers would no longer be able to deny coverage for “pre-existing conditions” or drop coverage when people get really sick. And in its “boldest move,” the bill creates needed competition with a public-option government plan. But the legislation’s most glaring weakness is that it provides no effective mechanism for curtailing the soaring cost of health care.

In fact, this “mess” will actually increase costs, said The Detroit News. The House bill overshoots the goal of extending health care to the uninsured by diverting billions to “community health programs” that are likely to achieve nothing; sets up an HMO-type management system in which government bureaucrats will determine “what treatments and procedures are covered”; and interferes with the right of employees and employers to negotiate health plans to suit their own needs.

What the columnists said

“The House has passed what is arguably the most significant piece of domestic-policy legislation in a generation,” said Jonathan Cohn in The New Republic Online. Is it perfect? No. But after decades of failure, we’re on the threshold of guaranteeing that “the vast majority of Americans would have health insurance” and thus be protected from financial disaster, regardless of whether they lose their jobs or develop a serious, chronic illness.

A couple of grouchy senators could scuttle the whole thing, said Timothy Noah in Slate.com. The House’s 2,000-page bill will surely be scaled back in the Senate, where a handful of Democrats, including Ben Nelson, Blanche Lincoln, Mary Landrieu, and independent Joe Lieberman want to “water down” provisions like the public option and the surtax on the wealthy—or kill them altogether. With Democrats needing 60 votes, said Robert Costa in National Review Online, Republican senators have a good chance of stopping ObamaCare. They’re planning “a strong amendment strategy that they hope will overwhelm Democrats,” forcing them to cast unpopular votes on specific provisions like abortion coverage that may split the caucus.

That strategy just might work, said Steven Pearlstein in The Washington Post. In the Senate, simple majorities do not suffice, and Reid will need 60 votes just to get a motion debated. Then the bill will be subject to arcane points of order and who knows how many amendments. By December or January, Reid “will need to break out the cots and announce that he’ll keep the Senate in session day and night until a bill is passed or defeated.