Initially there was talk about an attempt to rush an agreement through on a bill before Senator-elect Brown could be sworn in and seated in the Senate. However, that option has been effectively eliminated for a number of reasons: 

1. The congressional Democrats are still far from coming to terms on the contentious parts of the two bills.
2. Even if an agreement were somehow quickly reached, the Congressional Budget Office (CBO) would still need a week to 10 days to determine the cost of the bill to the federal government, along with a 72 hours before a final vote.
3. Despite initial threats to delay certification of Senator-elect Brown until all absentee ballots from overseas were counted, which could take several weeks, the margin of victory was so large (more than five percent) and the public pressure has been so great, Massachusetts officials have agreed to process the certification quickly.
4. Bowing to pressure from both the public and several of his moderate colleagues, Senate Majority Leader Reid publicly promised earlier this week to delay any further action on health reform until Senator-elect Brown is seated.
    

This leaves the Democrats with several different political options, all which have their problems. They include:

Attempting to quickly pass the Senate-passed legislation through the House, thereby avoiding another Senate vote. While this was initially the option favored by congressional leadership and the Obama administration, it has become clear in the last few days that it isn’t a politically viable one. House Speaker Nancy Pelosi (D-CA) announced yesterday that she does not have the 218 votes to do this, due to the political concerns of many in her caucus.

Getting the House to approve the Senate-passed bill, along with a separate pre-negotiated bill to “fix” all of the problems House members see in the current legislation. This idea is being touted by Families USA President Ron Pollack and others, but it could be very difficult to achieve. First of all, House and Senate Democrats would have to come to terms on the substantial differences between their two bills, which they have been unable to do thus far. Both bills would need to be scored, and then the “fix” bill would need to be virtually guaranteed to pass the Senate. That means Senate Majority Leader Reid would either need a 60th vote that he doesn’t have or the budget reconciliation process would have to be used to pass the “fix” bill, which is problematic for reasons described below.

Attempting to pass legislation through the Senate using the budget reconciliation process, which would only require 51 votes. While lots of Democrats and pundits continue to throw around this option, it is one fraught with political perils. It would require that the bill go back to the Senate committees of jurisdiction to be reworked because only provisions directly related to the federal budget can be considered under these rules. This would effectively eliminate most of the insurance reforms, abortion language, language on undocumented immigrants and other key elements Democrats feel are essential for passage and it would limit the authorization of most provisions to just five years. Also, even though debate would be limited and just 51 votes would be needed for passage, any senator could challenge any provision at any time and send it to the parliamentarian for a ruling. Sixty votes are needed to override the ruling of the parliamentarian on any issue, which could lead to lengthy and embarrassing votes on the Senate floor that the Democrats could lose. Another obstacle is that  a number of Democrats, including Senators Byrd, Baucus and Conrad, have been steadfastly and publicly opposed to the use of this option for months and Reid, who is the fight for his political life in 2010 at home in Nevada, publicly stated in December this option was off the table. For more detailed information on how the budget reconciliation rules work, check out this article by the Kaiser Health News.

Trying to “pick-off” a Senate Republican to serve as the 60th vote. This would probably be an impossible task for the Democratic leadership at this point. Potential targets like Senators Olympia Snowe and Susan Collins of Maine have stated in recent days they will not go at it alone, and Senator Reid insulted Senator Snowe in December by publicly stating that past negotiations with her had been a waste of time. In addition, the Massachusetts election has strengthened the GOP's hold on its members and their resolve for true bipartisan negotiations.

Negotiating a limited health insurance reform bill and/or pivoting to a jobs bill and trying to include some of the more popular health insurance reforms. This seems to be the option that many Democrats and the Obama administration are leaning toward at the moment. However, it does involve some admission of political defeat and loss of political capital. Plus, the Democratic leadership still will need to obtain 60 votes for Senate passage, as well as deal with the 2010 election and related concerns of politically vulnerable Democrats in both chambers. Also, there is some question as to whether or not members of the GOP would hand Obama and Democrats even a limited victory before the 2010 election.

At least in the House, taking up several smaller “rifle shot” health care bills that break the package into smaller, easier-to-digest and easier-to-sell chunks, which may be pursued along partisan or bipartisan lines. Republicans would be wary of engaging in this process unless they have an iron-clad agreement in public with House leadership that it would be truly bipartisan and both sides would have policy input on what gets considered. Otherwise, they are likely to see this as a partisan exercise that does not take into consideration a holistic approach to the problems in the health care system. In addition, these bills would still need to achieve the 60 vote standard to win passage in the Senate. 

A final option would be scrapping the current bills and starting from scratch on health reform. In addition to the political blow to the administration, which has in recent days repeatedly reiterated that they don’t want to lose complete momentum on health reform and has been reluctant to move back to the political center in the past, this course of action would certainly damper core Democratic voter enthusiasm going into the 2010 election. If they really did go back to the drawing board and work openly with the GOP, the Democrats might win political points for bipartisanship. They also could turn more attention to jobs and the economy. But it would be unlikely that a new bill would be finished before the mid-term elections—neither side would want to give the other anything to tout—and bipartisan cooperation could certainly blow up, as it has many times in the past in Washington. 

As the course for health reform shakes out over the next few days, NAHU will continue to work with our allies in the agent and broker, carrier and business communities. Our staff and members also continue to meet with lawmakers and congressional staff on our key issues relative to the two bills that are still technically on the table. Our plan is to keep advancing NAHU’s American Solution policy agenda  and the role and value of health insurance agents, brokers and consultants no matter what course of action Congress and the administration ultimately take on reform. 

NAHU has issued a press statement calling for bipartisan, responsible and affordable action on health reform that brings down the cost of medical care and makes needed improvements to our system. This week we are encouraging all of our members to call for responsible bipartisan reforms as well, by sending a message to their lawmakers through Operation Shout. Now is not the time to stop our grassroots activity—it’s the time to ramp it up!

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The schedule this year will feature a full day of training and information sharing on Monday, March 8, and speakers and Capitol Hill visits on Tuesday, March 9 and Wednesday, March 10. Planned speakers and sessions include:

• Health Reform and the 2010 Election Cycle with Stuart Rothenberg
• The Economic Impact of Health Reform, a discussion with Douglas Holtz-Eakin, President of DHE Consulting, LLC and Former Director, Congressional Budget Office and Len Nichols,  Director of the Health Policy Program at the New America Foundation
• How Health Reform Could Impact The States—Views of a Governor, Legislators and State Insurance Commissioners
• Public Opinion and Health Reform: A Media Perspective
• 2010 Health Policy Priorities in the House and Senate Presented by Key Members of Congress
• The Obama Administration’s Expectations Going Forward
   

We need as many NAHU members in Washington as possible this year to make our voices heard. We look forward to seeing you at Capitol Conference 2010 this spring!

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