Yesterday, Nancy Pelosi spoke with a handful of reporters about the House's intent on moving forward with healthcare reform, causing a bit of confusion along the way.
Politico's John Harris creates some of the confusion, by using this as his lead:
House Speaker Nancy Pelosi on Wednesday floated the idea of a two-track plan for health care reform — with Congress pursuing easier-to-pass incremental changes now and comprehensive reform later.
That appears to be an incorrect assessment of what Pelosi would like to happen with the bill, which seems to be a simultaneous, two-track approach, reconcilation (the majority vote, as she calls it) and the as-is Senate bill as one, as well as pieces of the House legislation that aren't included in the Senate bill passed as stand-alones. Time's Karen Tumulty has a pretty good write-up on this approach.
As I wrote yesterday, that health care legislation would be delivered to Obama in two parts: (1) the legislation that passed the Senate on Christmas Eve and (2) a set of revisions, which would skirt a Senate filibuster by passing under the budget reconciliation process, which requires only 51 votes.
Pelosi continues to insist that the Senate bill, in its current version, could not pass her chamber. But with a separate bill, passed under reconciliation (which Pelosi prefers to call "majority vote"), she predicted, "it's a whole different ball game ... We'll be able to come up with something that sufficiently addresses the concerns of the House members."
Among those concerns:
- The so-called "Cadillac Tax" on high-priced insurance policies: Pelosi says the deal that the White House reached with labor might be "a good start." But her preference, she said, would be to just get rid of the tax entirely. "Our members still don't like the excise tax," Pelosi said. "They don't like half of it; they don't like any of it."
However, that tax is one of the few provisions in the bill that economists say could have a major effect on bringing down health care costs, and President Obama has already said he wants it in there. So this is not something that either the Senate or the White House is likely to give up entirely.
- Affordability: The House is likely to demand more subisidies to help people buy insurance.
- Stripping out special deals like the Cornhusker Kickback.
The House is also eager to see a restructuring of other parts of the bill, but it is not clear that this could be done under the limitations of the reconciliation rules. Reconciliation can be used for provisions that have a direct effect on the federal deficit, but not for writing new policies, such as a repeal of the insurance industry's antitrust exemption. Aides say, for instance, they have yet to figure out how to restructure the Senate bill's health insurance exchanges, and make them national rather than state-based. As a result, Pelosi is also talking about a "separate track"--additional pieces of legislation to make these kinds of revisions.
It's unclear what precisely would qualify as those additional pieces of legislation: what is in the House bill and not in the Senate bill, would not meet the requirements for reconciliation, and could be passed as a stand alone bill. The most obvious one is the repeal of insurance companies' anti-trust exemption. Among the other differences [pdf] it's hard to know precisely what could work.
The national exchange could potentially be set up in a separate piece, though whether it could reach a 60 vote threshold in the Senate is in question. One way to make it more difficult even for ConservaDems to oppose would be to wrap the insurance reforms within it, including the House's provision that requires that all employer provided plans have to comply with reforms and quality standards. That's one of the dirty little secrets of the Senate bill--existing employer provided plans will be grandfathered out of having to comply. So many of the insurance reforms and quality standards wouldn't apply to your existing employer provided plan.
Other major differences that the House would like to see included: employer mandates; allowing undocumented workers to spend their own money to purchase insurance if they want to; a new agency for comparative efficiency research within HHS (a private, non-profit entity in the Senate bill); and possibly the Medicare donut hole fix, which would be phased out completely by 2019 in the House bill. These are all just potential elements, and where some of them are also included in the Senate bill in a different form, issues of procedure and timing would have to be worked out.
At the moment, no one, Pelosi included, wants to talk about abortion. So there's still the possibility that Stupak and Nelson blow the whole thing to pieces, again.
One thing that passing these stand-alone bills could achieve would be to keep momentum for the reform going, while the effort of negotiation the reconciliation bill continues. However, it could also make the effort more convoluted and the Senate more recalcitrant about participating in this effort. As we've seen, it doesn't take a lot to throw the Senate into an all-out obstructionist tizzy.