What to Expect From Merging Health Care Bills

Challenges, pitfalls, and opportunities in reconciling the House and Senate versions of health care reform

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The Senate appears on the verge of passing its version of health care reform. All Senate Democrats must do is hold together their coalition of 60 "yes" votes between now and the final vote, which is expected on Christmas eve. Assuming that happens, the Senate and House will then have to merge their bills. The Senate version does not include a public health insurance option, while the House's does. The House bill also has tougher restrictions against abortions. The conference committee, responsible for combining the two bills into one uniform bill that both houses will then vote on, has its work cut out for it.

  • Biggest Challenge Is Abortion The New York Times's Robert Pear and David Herszenhorn write that, for Democrats, abortion is "the issue that most complicates their drive to merge the Senate and House bills and send final legislation to President Obama." They write, "In the House, advocates and opponents of abortion rights and conservative Democrats have made clear that they object, for different reasons, to the Senate's compromise language on abortion. Interest groups on both sides of the spectrum -- Planned Parenthood on the abortion rights side, Catholic bishops for the anti-abortion rights camp -- also oppose the abortion provision in the Senate bill." But any deal that brings together House Democrats could unravel the coalition of Senate Democrats, risking the entire bill.
  • Don't Get Bogged Down In These Details The Washington Post's Eugene Robinson urges Democrats to look at the big picture. "The Senate bill lacks a public health insurance option, the House bill is burdened by gratuitous abortion restrictions and the final product of a House-Senate conference will probably have both those failings. But once the idea of universal health care is signed into law, it will be all but impossible to erase," he writes. "Even if it takes years to get it right, eventually is better than never. History suggests that major new social initiatives have to be perfected over time -- and that basic entitlements, once established, are rarely taken away."
  • House Should Just Copy Senate's Bill Mother Jones's Kevin Drum asks, "should the House just skip the conference committee on healthcare reform entirely and simply vote on the bill produced by the Senate?" The public option will have to be cut from the House version, the Senate version has looser abortion restrictions, and the other differences might not be worth the trouble. "[I]t's hard to see any other substantial improvements that are likely to come out of it. So: go to conference and risk another month of squabbling and possible defections? Or take the imperfect Senate bill and get it passed for certain within a few days of returning from recess?" Drum says the latter.
  • Opportunity For Improvement The Huffington Post's Robert Hickey thinks the bill can come out even better. "I urge my fellow progressive activists (and liberals in the House and Senate) to work to improve the bill - through conference and final passage - not to kill it," he tells liberals discouraged by the sacrifices made in the Senate. "[I]f Obama and the Democratic party play their cards right, they will present this legislation not as the only legislation we will need, but rather as the first step in a series of reforms that will eventually achieve what the American people want."
  • Why Conference Is So Bizarre Congressional Quarterly's Taegan Goddard quotes Walter Oleszek. "No formal rules, such as quorum or proxy voting requirements, govern internal conference committee bargaining. The only stipulation is that the conferences must meet formally at least once in open session. The lack of rules is deliberate to foster an informal give-and-take environment conducive to reaching bicameral compromises, especially when the chambers have passed starkly different measures. As a Ways and Means chairman said of trying to meld major bicameral differences on a health bill, 'It's akin to mating a Chihuahua with a Great Dane.'"
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