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July 18, 2019

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Health Care:

Road to health care reform still has obstacles

Often contentious relationship between House, Senate will be put to test

Health care overhaul

Manuel Balce Ceneta / AP

Senate Majority Leader of Harry Reid, D-Nev., center, accompanied by Senate Democrats, speaks during a health care news conference on Capitol Hill in Washington, Wednesday, Dec. 23, 2009. From left are, Senate Banking Committee Chairman Sen. Christopher Dodd, D-Conn,, Senate Health, Education, Labor and Pensions Committee Chairman Sen. Tom Harkin, D-Iowa, Sen. Patty Murray, D-Wash., Sen. Debbie Stabenow, D-Mich., Reid, Senate Finance Committee Chairman Sen. Max Baucus, D-Mont., Sen. Barbara Mikulski, D-Md., Senate Majority Whip Richard Durbin of Ill., Sen. Arlen Specter, D-Pa.

Even if today’s Christmas Eve vote in the Senate on health care legislation succeeds after a marathon 25 days of debate, the end is not quite in sight.

Any bill that emerges from the Senate still must be merged with one approved by the House. This sets up potentially difficult negotiations led by House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid — the two Democratic leaders who have learned to work with each other since rising to their posts in 2007.

The more liberal elements of the House bill would not likely survive another vote in the Senate. And the more conservative Senate bill is being rejected by progressives in the House.

“We have a ways to go,” said Democratic Rep. Shelley Berkley, who represents Las Vegas.

The negotiations will test the stormy relationship between the two houses of Congress.

House members joke that the Senate is the enemy, the place where their hard-fought legislation often goes to die or be altered beyond recognition. Senators, meanwhile, see the House’s ability to pass legislation with a simple majority as a luxury they cannot afford in the Senate, where 60 votes are typically needed to pass legislation.

This friction has played out over the past several years between Pelosi and Reid, as Pelosi sends to the Senate bills that Reid has often been unable to pass without substantial changes.

With Republicans’ unified opposition, Democrats must stick together to pass the bill.

The margin for dissent is greater in the House, where Democrats number 257 but Pelosi needs 218 votes to advance legislation. With a 60-member Democratic caucus in the Senate, Reid cannot afford to lose one vote.

Most experts expect the bill will look more like the Senate version when it eventually emerges from negotiations.

Reid has refused to weigh in on the challenges ahead, saying repeatedly this week that he was focused on today’s vote.

“We’ll worry about next steps at a later time,” Reid has said.

But two members of the Democratic caucus who have left imprints on the Senate bill, Sen. Joseph Lieberman of Connecticut and Sen. Ben Nelson of Nebraska, have said they will withhold their votes on the merged bill if it is substantially different from the one they supported in the Senate.

“I know there is a natural tendency in House-Senate conferences to split the difference,” Lieberman told reporters after a pivotal Monday morning vote. “But I’m afraid a splitting of the differences here will mean that you won’t have 60 votes.”

That is the kind of talk that infuriates House members, including Berkley.

“Maybe if there’s any change they’ll lose my vote,” Berkley snapped. “The last time I checked Joe Lieberman and Ben Nelson were not elected” to represent the 1st Congressional District in Nevada, she said.

The bills are similar in their overall approach — requiring all Americans to carry health insurance and providing subsidies to help low- and middle-income families afford it. Both bills would ban insurance companies from denying coverage for pre-existing conditions.

But the two bills take different approaches on key provisions:

• The House bill includes a public option as an alternative to private insurance for the uninsured, a component that was dropped from the Senate bill. The Senate instead would set up a menu of private insurance options offered under the umbrella of government management, much the way members of Congress shop for insurance.

• Neither bill would allow federal money to be used to cover abortion, except in the case of rape, incest or a threat to the health of the mother. The House bill would prohibit even those who use their own money from buying insurance that covers the procedure on the new government-run exchange. The Senate bill would allow private money to be used to purchase policies that cover abortion through the government menu as long as it is segregated from public money.

• To pay for subsidies for the uninsured, the House bill would raise taxes on those earning $500,000, or $1 million for couples. The Senate bill would tax high-end insurance plans and impose a 0.9 percent payroll tax.

The different approach to taxes is a particularly vexing problem for Nevada’s Democrats in the House.

Rep. Dina Titus voted against the bill in committee because she opposed the initial proposal to raise income taxes on those earning $280,000 annually, or $350,000 for couples, to pay for subsidies for the uninsured.

The House bill eventually abandoned that approach in favor of a tax on individuals earning $500,000 or couples earning $1 million, and Titus supported the bill as it passed in the House this month.

The Senate bill returns the tax issue to the forefront, which could prove difficult for Titus, whose Southern Nevada district includes high-wage households and small-business owners who could be snared by the tax similar to the one she once opposed.

“I am carefully reviewing the provisions of the Senate’s health care bill, including the revenue provisions,” Titus said in a statement.

“Although there are many differences, both the Senate and House health care bills include important reforms that I support such as lowering prescription drug prices for seniors on Medicare and ending the insurance companies’ practice of denying coverage because of pre-existing conditions,” she said. “I will continue to advocate for a final bill that reduces health care costs for families and small businesses, improves access to health care services, and strengthens Medicare.”

Berkley, too, has problems with the revenue provisions, particularly the tax on high-end insurance plans — those valued at more than $21,000 for family coverage. Unions have opposed the tax.

The tax would snare many union households in Las Vegas, where workers on the Strip often have so-called “Cadillac” benefits.

“I’m going to have to see how those are resolved,” Berkley said.

The Senate is scheduled for a final vote at 7 a.m. today on the bill — one of the rare times in Senate history the chamber has convened on Christmas Eve to vote.

The 25-day health debate marathon, which began Nov. 30, is the second-longest consecutive meeting of the Senate since 1917.

“It’s been a long road,” Reid said Wednesday after the Senate crossed a final 60-vote procedural hurdle.

“We stand on the doorstep of history,” Reid said.

Republicans have maintained strict opposition to the bill they say will raise taxes, increase health insurance premiums and unduly insert government into the health care industry. Republicans did not stick around for the tally Wednesday, as Democrats remained in the chamber for the final count, 60-39.

When pressed on how he planned to merge the House and Senate bills in what could be a thorny process, Reid said he would take a few days off in Searchlight before tackling that question.

“For a few days, I’m going to just sit back and watch my rabbits eat my cactus,” he said.

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