Health Care Reform:
The Debate is Over – Time to Vote?

"Every idea has been put on the table. Every argument has been made. Everything there is to say about health care has been said. I believe the United States Congress owes the American people a final vote on health care reform."

President Obama, March 3, 2010

Speaking before an audience of nurses and doctors, President Obama declared that the debate is over, and that it was time to have a final vote on health care reform. He urged congressional leaders to finish their work and schedule a vote "in the next few weeks." Reports have varied as to what is intended by "next few weeks," with some reporting that the deadline is March 18, 2010, before Obama leaves for an international trip. Others have cited March 29 when Congress begins Easter recess. Still others have suggested that it will be passed "in the spring."

Since the Massachusetts special election in late January which ended the Senate Democrats' filibuster proof majority, weeks of discussions have ensued. Obama released a revised health care reform proposal based largely on the Senate bill and lead a health care summit involving key congressional representatives from the House and Senate. The president offered to include certain republican ideas in a final bill and rejected others. For example, the concept of increasing Medicaid reimbursements to physicians and additional grants for demonstration projects on alternatives to resolving medical malpractice disputes gained the president's support. On the other hand, the president flatly rejected a proposal to scrap the existing comprehensive Senate and House bills and pursue a more limited incremental approach to address specific issues. During a March 3, 2010, speech on the issue, the president said the problems in health care are interrelated and "health reform only works if you take care of all these problems at once."

The most likely procedural approach for passage of a reform bill is for the House to first vote on the bill passed by the Senate on Dec. 24, 2009. If the House passes the Senate bill, then both bodies will need to pass a "reconciliation" bill which makes the changes to the Senate bill requested by House Democrats, including, removing the special provisions for Nebraska, Louisiana and Florida and making changes to the so-called "Cadillac" tax. Through this process, the Senate could pass the reconciliation bill with a simple majority and not the 60 votes necessary to override a filibuster.

The reconciliation process has been used 22 times since it was established in 1974; however, Republican lawmakers have called it the "nuclear option" and have warned they will fight it every step of the way, including on the floor of the Senate. This strategy will likely involve introducing multiple amendments designed to slow, if not prevent, votes on the reconciliation bill.

Thus, when, or if, a vote will be called will depend on when the administration and Democratic leaders feel they have the necessary votes in the House of Representatives to pass the Senate bill. The ability to secure these votes is something which is far from certain at this point. The original House bill passed on a vote of 220 to 215. The Obama administration and House Democratic leadership are working with Democratic House members to try to line up votes. One group, which could prevent passage of the Senate bill, are 12 Democratic House members represented by Representative Bart Stupak of Michigan. Representative Stupak introduced an amendment prior to passage of the House bill restricting the use of federal funds in connection with abortion. Some House Democratic members withheld their support of the original House bill until this amendment was approved. Stupak and others have indicated that the Senate bill is less restrictive on the abortion issue than the House bill, and that he and his colleagues could not support passage of the Senate bill in the House. Recently, however, Representative Stupak has suggested that he is more optimistic that he will be able to work with House leaders on this issue. If these talks are successful, House Democratic leadership would be much closer to having the necessary votes to pass the Senate bill.

While the ultimate result is unclear at this point, what is clear is that the next few weeks are pivotal for the future of health care reform. Obama has stated that if health care reform does not pass now, it will likely not occur in any substantive way for at least a decade. We will continue to keep you advised of all developments. In the meantime, please contact Greg Pemberton or Kevin Woodhouse with any questions.

This publication is intended for general information purposes only and does not and is not intended to constitute legal advice.  The reader must consult with legal counsel to determine how laws or decisions discussed herein apply to the reader's specific circumstances.