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Health Care Reform Could Skip Final Step, Roll Right Through House

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The health care reform bill that passes the Senate might be the one that ends up on President Obama's desk, bypassing the usual House-Senate conference committee and avoiding another 60-vote threshold to end a filibuster.

There is increased chatter on Capitol Hill about a possible "ping-ponging" of the Senate health care bill: that chamber would pass its health care bill, send it to the House and the House would be asked to pass it with no changes and send it directly to the president.

That limits the options of congressional critics -- under the usual procedure, lawmakers dissatisfied with the bill pushed through their chamber can win changes through adroit political maneuvering in conference committee negotiations.

"It's the only scenario by which we could actually get this whole thing done before the New Year. The House has indicated they'd consider it, depending on what the final bill looks like over here after we finish with the sausage-making," said a senate Democratic aide involved in the health care fight.

Senate Majority Leader Harry Reid (D-Nev.) is currently negotiating what's known as a "manager's amendment." That amendment includes large and small concerns that senators want worked out before voting to end a filibuster. If Democrats decide to ping-pong the bill, the manager's amendment becomes, in effect, the only place to work out differences.

"I've started hearing about it in the last week or so," said Jim Kessler, head of the group Third Way. Kessler, a former senior aide to Sen. Chuck Schumer (D-N.Y.), is working closely on health care negotiations and said he's heard talk of the ping-pong plan coming from the Hill.

"You would need pre-conference negotiations. That pre-conference negotiation would be what ends up in the manager's amendment," he said. "Essentially, the manager's amendment becomes the new conference."

Kessler said that if it can be done, it should be done. "You've got to keep your eyes on the prize, and the prize is health care reform," he said. "I think it's a great idea if it means health care reform gets passed... Eventually, they're going to have a bill that passes both houses. If you can do it without the long, arduous process, why not?"

Spokespersons for both Senate Majority Leader Harry Reid (D-Nev.) and House Speaker Nancy Pelosi (D-Calif.) declined to comment.

Reid and President Obama, of course, do not run the House. They would need the sign-off of Pelosi, who would need the approval of her caucus. To get such approval, the manager's amendment would need to sufficiently address House concerns. Pre-conference negotiations -- or, in this case, pre-manager's amendment -- are not currently ongoing at the staff level, said Jim Manley, senior communications adviser to Reid.

The plan risks infuriating the party's progressive base, which is much happier with the House bill than the Senate effort.

"As it stands, the House bill makes health care much more affordable for people than the Senate's bill. And right now, there is a real possibility that the House will be expected to swallow the Senate's bill without making these improvements. There are two legislative bodies and both have a say in what reform looks like -- this shouldn't be news to members of the Senate," said Lori Lodes, a spokeswoman for the Service Employees International Union, which is heavily involved in health care negotiations.

The differences between the House and Senate approaches are legion and House sources say the lower chamber is very unlikely to rubber stamp a bill agreed to by the White House and Senate. The House relies, to a significant extent, on a tax increase on the wealthy to fund reform; the Senate instead taxes some health insurance plans. The House allows the government to negotiate for lower drug prices and otherwise requires a greater commitment from drug makers than the Senate bill does. The House plan covers more people and includes a public option; the fate of a government plan on the Senate side is uncertain. Major parts of the House plan kick in a year earlier -- in 2013 -- than in the Senate bill. And then there's abortion.

Those difference, among others, will need to be bridged at some point, whether it's in conference or earlier. If they're not -- and if House progressives think they've been rolled -- then they might bail. The House bill only passed with a margin of five votes.

"The whole point is we tolerated negotiated rates and tolerated having to watch the Senate work its machinations, with the whole hope that in conference the House will go in strong," said Rep. Raul Grijalva (D-Ariz.), co-chair of the Congressional Progressive Caucus. "For a lot of progressives that have relied on conference as the vehicle to save the public option, it becomes a very, very difficult vote."

Grijalva told HuffPost that the strategy would require progressives to back down so that the president could get a symbolic win. "Progressives will be jammed into a corner and once again asked, 'You've got to do this for the president so he can give a State of the Union address,'" he said. "As much as the State of the Union becomes critical, this is not something we can get beaten up on to vote for."

Grijalva noted other significant differences in the way that the bills treat the pharmaceutical industry and that the Senate bill lacks a revocation of the insurance industries' anti-trust exemption. "It becomes a conscious call," he said. "That would be a vote that I could not take."

Regardless of when those differences are hashed out, said Kessler, they have to be addressed at some point. Better sooner than later, he said. "You'd have to do it with the concurrence of the House. This has to be a two-step process," said Kessler. "If you can do it now, why not do it now?"

If the House refuses to play along, it could either amend the bill and send it back for an up-or-down vote in the Senate, or go to a conference committee. "If the House doesn't like it, they'll send it back with changes. Then it truly is ping pong," said Kessler.

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