SFC acts on health reform, now what?

The Senate Finance Committee (SFC) vote, on October 13, in favor of its sweeping health reform proposal is momentous, some might even say historic. As the Washington Post comments: "not since Theodore Roosevelt proposed universal health care during the 1912 presidential campaign has any such bill come this far." Despite the historic nature of the vote it is just another step, albeit a big step, en route to the ultimate destination—reforming the American health insurance system. In the SFC vote, all 13 Democrats on the panel joined with one Republican member, Senator Olympia Snowe (R-ME), in favor of the measure. This means that all five Congressional committees with jurisdiction have now passed their own version of health reform legislation. So, what comes next?



Well, there’s a long road ahead. Sorry if this starts to sound a bit like Schoolhouse Rock and “I’m just a bill on Capitol Hill” but I think a refresher on the upcoming political process would be useful at this point.

Actually, now comes the hard part, reconciling the more conservative SFC bill with the more expansive (and expensive) version passed earlier by the Senate Health, Education, Labor and Pensions (HELP) Committee. This could be quite a difficult undertaking as the HELP and SFC versions differ substantially, including varying takes on such controversial issues as a public option, the level of government subsidies to help people buy health insurance coverage, and employer mandate, just to name a few. Sen. Majority Leader Harry Reid (D-NV) likely will hold private negotiations with Senators Max Baucus (D-MT), Tom Harkin (D-IA) (who replaced the late Ted Kennedy as chairman of the HELP committee), and Christopher Dodd (D-CT) who shepherded the bill through the HELP committee during Kennedy’s illness. When a bill will emerge is anyone’s guess, though a Reid spokesperson has said that a reconciled bill could reach the Senate floor sometime during the week of October 26.

This timetable might be overly optimistic and here’s why: the Democrats have 60 votes in the Senate, which is exactly what they’d need to defeat a Republican filibuster. To get a bill through, the Democrats would need to keep their team together, despite a wide array of political views. To score political points, they’d also love to be able to get Senator Snowe or another Republican senator or two on board. Finalizing a bill that would be acceptable to all could prove to be a challenge.

Once Senate negotiators develop a compromise health reform bill, the nonpartisan Congressional Budget Office must again weigh in with a cost estimate on the bill.

Meanwhile, back at the ranch, House leaders also have to reconcile health reform bills from the three House committees that have approved health reform measures. The goal of the House leaders is to get a bill to the floor of the House within the next few weeks.

If (and this is a lot of if’s, I realize) both the House and the Senate pass their own versions of health reform, a conference committee, consisting of members of both the House and the Senate, would meet to hammer out final details, reconciling differences between the House and Senate versions and combining them into one final bill. Again, the public option would be a major and likely, contentious, issue at the conference committee stage.

If and when the conference committee settles on a compromise bill, the House and Senate would each have to vote on the revised measure arising out of the House/Senate conference. If both the House and Senate approve it, it would go to President Obama for his signature (or his veto).

Whew!! To paraphrase poet Robert Frost, there are “miles to go before we sleep” on this health reform journey. The SFC vote is just the beginning of the fourth quarter in a closely-contested football game, with plenty of action yet to come.