Democrats Get Their 60 Votes for Health Care. Now What?


The Democrats have their 60 on health care.

Party leaders reached a deal with Sen. Ben Nelson early Saturday morning on abortion restrictions, giving Democrats a filibuster-proof voting block for the health care reform bill. After suffering through a terrible week (what, with liberals screaming about killing the bill), it now appears that we'll have a health care reform bill on the president's desk by Christmas.

Three interesting points I'm finding as I read through the deal:

Why Did Nelson Agree to the Deal?
Most stories suggest that Nelson got on board when Sen. Harry Reid included an amendment that restricts insurance coverage for abortions. It reads like this: "A state may elect to prohibit abortion coverage in qualified health plans offered through an exchange in such state if such state enacts a law to provide for such prohibition."

Wonk Room also reports that Nelson's state of Nebraska will receive extra Medicaid funds in this bill. Sen. Harry Reid says that this measure didn't factor strongly in Nelson's final decision, but it seems to me that, since Nelson's had been railing against the Medicaid expansion as an underfunded mandate for months, this was a pretty sly hand-out.

What Did the CBO Say?
The bill would cost an average of $87 billion a year for the first ten years. It would expand coverage to about 30 million Americans. It is projected to reduce the deficit by $132 billion over the next ten years. Here's the summation from CBO chief Doug Elmendorf's blog:

What Problems Still Lurk?
As the NYT observes, since no Republican is voting for this bill, each of the 60 Democrats has veto power. So with a Senate vote and another vote after the House and Senate bills are reconciled, there is still room for a conservative Democrat to make a fuss over health care to get special treatment from the bill. The NYT reported that: "Mr. Nelson issued a pointed warning that he would vote against the measure if any changes were not to his liking." So now it appears that Nelson, not Joe Lieberman, is the senatorial fellow who sees himself as the keystone in the precarious archway.

I'm interested to see how the revenue-making measures of the bills are reconciled. It will be interesting to see how House Majority Leader Nancy Pelosi reconciles her House bill -- which raises money with a surtax -- with the Senate bill -- which includes an excise tax on expensive insurance plans. If the Democrats want to get this bill to the president by Christmas Eve, I imagine there is going to be some significant wrangling on this point. Unions hate the excise tax, because they expect it to hit their own plans within the next decade or so. And conservative Democratic senators like Nelson, Baucus, Bayh and Landrieu are not going to want to see an additional surtax on the top one percent of their constituents.

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Derek Thompson is a senior editor at The Atlantic, where he writes about economics, labor markets, and the entertainment business.

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