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Health overhaul moves to Senate

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By JANET HOOK

Los Angeles Times

Published: November 9, 2009

WASHINGTON - With the struggle over health care entering another difficult phase, President Barack Obama has hit both a milestone and a speed bump in his dual pursuit of a major overhaul of the nation's medical system and a rebirth of progressivism in America.

House approval of the legislation Saturday - even if Democrats can move it no further - was an accomplishment that has eluded presidents for decades. But the close vote and the exertions it took to secure a majority were laden with warning signs as the issue moves to the Senate.

The health care overhaul was a tougher sell than expected in the liberal-leaning House, and the bill turned out to be more conservative in its price tag, more limited in the scope of its government-run insurance option and tighter in its restrictions on abortion funding than many had hoped.

Moreover, the narrow victory - 220 to 215 in a chamber where Democrats hold 258 seats - was unsettling for liberals because moderate Democrats have a louder voice in the Senate and Republicans have more delaying power.

The White House, growing concerned that the congressional timetable for passing a health care overhaul could slip into next year, is stepping up pressure on the Senate for quick action, with Obama appearing Sunday in the Rose Garden to call on senators to "bring this effort to the finish line."

Obama's remarks came just 14 hours after the House narrowly approved a landmark plan that would cost $1.1 trillion over 10 years and extend insurance coverage to 36 million uninsured Americans.

"Given the heated and often-misleading rhetoric surrounding this legislation, I know that this was a courageous vote for many members of Congress," Obama said, "and I'm grateful to them and for the rest of their colleagues for taking us this far."

But the votes had barely been counted when the White House began turning its attention to a bigger hurdle: getting legislation passed in the Senate.

In the Senate, where proposals differ substantially from the House-passed measure on issues like a government-run plan and how to pay for coverage, the bill is stalled while budget analysts assess its overall costs. The slim margin in the House - the bill passed with just two votes to spare, and 39 Democrats opposed it - suggests even greater challenges in the Senate, where the majority leader, Harry Reid of Nevada, is struggling to hold on to all 58 Democrats and two independents in his caucus.

"But I honestly believe the House vote gives us momentum that Sen. Reid is going to use when he talks to his colleagues about the legislation this week," said Jim Manley, spokesman for Reid.

There was a sense inside the White House and on Capitol Hill that the hardest work is yet to come. The House debate highlighted the pressures that will come to bear on senators as they weigh issues like federal financing for abortion, coverage for illegal immigrants and the "public option," a government-backed insurance plan to compete with the private sector.

In the Senate, Reid has merged two bills into one.

The Senate bill will have major areas of overlap with the House's: Both will expand Medicaid coverage for the needy, provide private-insurance premium subsidies for people of modest means and set rules to make it harder for insurance companies to deny coverage or charge higher rates to people based on their medical status or history.

Both bills would require everyone to have health insurance and set up an insurance exchange to offer affordable policies for small businesses and individuals not covered by their employers.

Both bills would include one government-run public option among the choices. However, Reid has said that his bill - in a concession to moderates - would allow states to opt out of offering the government plan.

Apart from substantive hurdles, the Senate bill faces procedural ones; Reid cannot bring it to the floor for debate until he gets an analysis, or "score," from the nonpartisan Congressional Budget Office, expected later this week. The delay could push Senate consideration of the bill until after Thanksgiving, which could in turn make it very difficult for Congress to meet Obama's goal of signing a health bill into law by the end of this year.

A big question is whether Reid has the 60 votes that will almost certainly be necessary to permit debate to begin.

As the Senate vote draws closer, the fight on the airwaves, where groups for and against the health bill are already spending millions of dollars on advertising, will only intensify.

Timing is crucial. But White House officials also know that the closer the final vote comes to the November 2010 midterm congressional elections, the more difficult it will be to pass legislation.

Information from The New York Times was used in this report.

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