After Passing House, What's Next for Health Care Bill?

Democrats face major hurdles in the Senate and beyond

The House of Representatives' passage of health care reform was historic, but far from the end of the story. The Senate must still vote on its own version of reform, which Senate Majority Leader Harry Reid has not released. The two bills would then be reconciled in a conference committee before reform can become law. The Senate, crippled by the need for any legislation to secure 60 votes so it can overcome a filibuster, could be far more of a hurdle for Democrats than the House. Here's what could happen next.

• What Senate Will Take Away Slate's Timothy Noah predicts how the Senate's bill will differ. "The thing to worry about the House health reform bill isn't what the Senate will add but what it will take away," he writes. "[T]he public option is likely to be watered down even more, assuming Reid has the votes to keep it in the bill at all, which at the moment is looking doubtful." Noah also thinks the "Cadillac Tax" will prevent the "Millionaire's Tax." He concludes, "[M]ost parts of health care reform that the Senate will now remove would be better left intact. Let's hope something's still left when it's done."

• Reid Will Need Every Vote The Washington Post's Ezra Klein explains why passing reform will be so much tougher in the Senate. "Harry Reid's job will be harder. Health-care reform passed the House with 50.5 percent of the vote. It will need 60 percent in the Senate. Pelosi had the luxury of losing 40 Democrats. When it comes to beating the filibuster, Reid probably won't be able to lose even one." Klein adds, "Whether or not you think Nancy Pelosi had a couple more votes in her back pocket, it's pretty clear that she didn't have 41 more votes, which is what she would've needed to pass health-care reform if the House worked by the Senate's inane rules."

• Cause For Senate's Delay Senate Majority Leader Harry Reid has yet to release the Senate's version of health reform legislation, despite persistent urgings from the White House. "The Senate has been in a holding pattern on its overhaul, with Reid and other Democrats saying Congressional Budget Office (CBO) estimates have been the biggest holdup," Congressional Quarterly reports. The CBO estimate will predict how much the legislation will cost and how much revenue it will produce. "Reid sent legislative language, along with several policy options, to CBO on Oct. 26. According to his spokeswoman, those cost estimates have not been returned, holding up Reid's ability to release the full bill."

• Conference Re-Vote Could Kill It Conservative blogger Ed Morrissey reminds us that, even if the Senate passes their version, that's not the end. "If that happens, a conference committee will have to meet to produce another bill that would then go for a full floor vote in each chamber. If abortion funding makes its way back into the bill, or if mandates or taxes increase, or if conscience protections get stripped, then all of the hurdles that Pelosi barely cleared the first time return, and without the ability to amend the bill (conference reports get straight up-or-down votes without amendments in order to have both chambers pass identical legislation for the President to sign)."

• Senate Filibuster Threat Rules All Matthew Yglesias is exasperated with the Senate and its requirement that a bill must have 60 votes to prevent a filibuster. "[I]n a unicameral United States of America, we would now have passed both a comprehensive health care reform bill and also the most important piece of environmental legislation in the history of the world," he writes, noting that the high benchmark in the Senate makes legislation extremely cumbersome. "But think back on this point the next time you hear someone say Obama is struggling with his agenda because he's not centrist enough, or else that Obama is struggling with his agenda because he's not left-wing enough."