Senate Makes Progress on Health Care

Senators are making progress on health care reform behind the scenes with one key committee beginning to make progress on the stickiest of problems, getting the cost of a bill under control, though challenges remain. The Finance Committee, where a bipartisan product is being crafted, has found $400 billion in additional savings this week, bringing the total bill "in the range of $1.2 trillion," according to Sen. Kent Conrad, D-ND.

The nonpartisan Congressional Budget Office, which tallies the cost of legislation for members, has been working with the committee for some time, throwing a wrench into the gears just last week with an exceedingly high price tag that sent members back to the drawing board on a number of issues. Conrad said that CBO estimates that the bill will now cover 96 percent of Americans with a coverage comparable to that of Medicare.

"I am increasingly confident that we will get a bipartisan bill...We're still not there yet," Committee Chairman Max Baucus, D-MT, adding, "We're getting much closer." The chairman has set a goal of getting the final price tag under $1 trillion.

But not everyone agrees that things are going so well.

One key negotiator in a smaller, bipartisan committee group, referred to by Baucus as "the coalition of the willing, Sen. Orrin Hatch, R-UT, was more sanguine with reporters, saying, "I don't think we're anywhere near a bipartisan consensus." When asked if the committee could produce a bill by week's end, Hatch said, "Oh no. It's going to take time."

Democrats continue to wrestle, however, with whether or not they can muster up enough support for a full-blown government plan.

The system of cooperatives proposed by Sen. Kent Conrad, D-ND, as a compromise has gotten beaten up by some members of his party this week.

Conrad has said the coop plan could be set up by the federal government and be nonprofit and national in scope. The moderate Democrat, himself the Budget Committee chairman, has said his goal has been "to get 60 votes," noting that a handful of his more moderate colleagues do not favor a public option.

"The co-op proposal is alive and well. Negotiations are ongoing, and those negotiations are continuing at a high level of intensity," Conrad said. The senator said, "We're not there yet, but we've made significant progress."

This defense follows criticism earlier in the week by Sen. Chuck Schumer, D-NY, a member of the Finance Committee and Senate leadership, who declared that efforts to get Republicans to agree to a co-op plan were largely unsuccessful.

"Right now, this co-op idea doesn't come close to satisfying anyone who wants a public plan," Schumer told AP on Sunday. And in a speech on the Senate floor, Schumer made the case for government-run health care, asking Republicans, "The public plan is not about government-controlled health care, socialism or any of the buzzwords that have been tossed around as part of this debate. I ask my colleagues, do they consider medicare socialist?"

Answering critics, largely Republican, who have said any government-run plan would put the feds in between the patient and their doctor and lead to single-payer insurance system, Schumer said any public option "may not have special built-in advantages," adding, "It would be a coverage option that would compete on an equal footing alongside private insurance plans in the market for individual and small business coverage. If a level playing field exists, then private insurers will have to compete based on quality of care and pricing instead of just competing for the healthiest consumers."

The public plan could turn up in legislation as a "fallback" option.

Moderate Republican Sen. Olympia Snowe, R-ME, said she is working on just such a plan with Schumer, in fact, saying it would be"guaranteed access to coverage," that would ensure that if reforms enacted by Congress do not work in certain areas that there is "an assurance of a guaranteed safety net for those who do not have coverage."

This is known as a "trigger," though most members do not like to call it such, as Democrats are trying to work a public option into their legislation.

Schumer suggested earlier this week that perhaps Democrats should just go it alone, a reference to Democratic leaders possibly using an arcane budgetary tactic available to the Majority that allows a bill to be passed with just 51 votes, immune to filibuster.

But it is not that easy. Conrad, a budget expert, said Democrats would not be pleased with what they get under the tactic, called "reconciliation." The chairman said he had consulted with the Senate Parliamentarian, the Senate's expert on rules and procedures, and that any legislation rammed through under reconciliation would look "like swiss cheese."

"Could you do it under reconciliation? Yes you could, but there are very significant problems with that," Conrad said, noting that any plan created using the tactic would have to be paid for in five years and every year thereafter that the plan is in existence. Senators are having a hard enough time finding a way to pay for the plan over 10 years.

When asked if Democrats would not get the plan they want by using reconciliation, Conrad answered, "I think that is exactly right. I think people would be very disappointed in what kind of health reform package became law."

Schumer, meanwhile, said Republicans have not "been willing to negotiate. And so I'm losing confidence that Senate Republicans will ever agree to the types of changes to a co-op to make it a viable alternative, a viable substitute to a traditional public plan that is nationwide and available to everybody, that can go up against the private insurers and go up against the suppliers in buying power and that is formulated so that it hits the ground running on day one of the insurance exchange."

As if shutting the door on compromise, Schumer warned, "We can only bend so much to try to win over opponents of health care reform. we cannot bend so far that we break."

Senators are stuck on several points regarding cooperatives, namely, how much money the federal government injects on the front end and how a governing board would be selected. Members appear to agree that the government could be involved in setting up the board, but more liberal Democrats want to see the government continued to be involved. Conrad said the board needs to be interim, as coops usually run -- eventually leading to situation where only coop members compromise the board.

Conrad insisted that he continues to negotiate, even with Republicans, saying, "Significant Republicans, people who are major players on health care, have repeatedly indicated that the cooperative approach is the only one that they can support."

"At the end of the day, you have to have a bill that gets the votes," Conrad said.

"Anyone who thinks this is easy or a lay-up that can be done in a week or two, well, obviously not," Schumer said.