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Battle Lines Emerge in Senate Over Health Care Reform

November 9, 2009 at 12:00 AM EDT
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After narrowly passing the House late Saturday, the focus of the health care reform push now moves to the Senate, where a range of issues, including the public option, and how the bill treats abortion, may prove contentious topics of debate.

JIM LEHRER: The fight over health care reform shifted to the U.S. Senate today. The House approved its bill over the weekend, but prospects for passage in the Senate remained unclear.

“NewsHour” health correspondent Betty Ann Bowser has our lead story report.

BETTY ANN BOWSER: The battle lines had already been drawn by the time that the Senate came into session today.

Illinois Democrat Dick Durbin:

SEN. RICHARD DURBIN, D-Ill.: This still is the only industrialized country in the world where a person can literally die for lack of health insurance. And that’s what we face in this debate about health care reform. There are lots of opinions. I salute the House for passing the measure, sending it over here. And we will hear those opinions expressed in the Senate in the weeks and months to come.

BETTY ANN BOWSER: Nebraska Republican Mike Johanns.

SEN. MIKE JOHANNS, R-Neb.: The government mandates and taxes and all of the other things that are going to be burdened upon health insurance policies are going to cause the premium to rise. We’re saddling policies with huge new fees and taxes and mandates.

BETTY ANN BOWSER: The debate took on new import late Saturday night, after House Democrats pushed through their version of the bill.

REP. NANCY PELOSI, D-Calif.: The yeas are 220. The nays are 215. The bill is passed.

BETTY ANN BOWSER: The House measure would extend coverage to 36 million Americans who are now uninsured. Nearly every American would have to obtain health insurance by 2013. And companies would have to cover employees, though small businesses would be exempt.

The bill would also fund insurance exchanges to let those without coverage shop for a plan. A government-run insurance option would be included. And there would be subsidies to help lower-income people buy coverage.

But, today, Republican Senator Charles Grassley said the House bill was a nonstarter.

SEN. CHARLES GRASSLEY, R-Iowa: The House bill gives me very, very much concern of health care going in the wrong direction, more towards government control of health care completely. The House is dead on arrival in the Senate, not because we’re going to have a vote on it or because anybody has got to come to that conclusion.

There’s been two separate Senate bills, and I think the work of the Senate, we want to proceed with ours and settle any differences with the House in conference.

BETTY ANN BOWSER: And Senator Majority Leader Harry Reid has been meeting behind closed doors with fellow Democrats for weeks. The fact that Speaker Pelosi, who has such a large majority in the House, passed the bill with just two votes more than she needed could serve as a warning sign to Democratic leaders in the Senate. Over the weekend, it became clear that Majority Leader Reid could have a real struggle on his hands getting the 60 votes he needs to start debate on health care reform.

One of the major stumbling blocks for Republicans and some moderate Democrats is Reid’s decision to include a public option in the Senate bill. He hopes to win over the moderates by letting states opt out of the government-run program.

But, on Sunday, Connecticut independent Democrat Joe Lieberman renewed his promise to oppose any bill that includes such an option.

SEN. JOSEPH LIEBERMAN, I-Conn.: If the public option plan is in there, as a matter of conscience, I will not allow this bill to come to a final vote.

BETTY ANN BOWSER: On the other hand, Rhode Island Democrat Jack Reed expressed confidence an overhaul in the Senate would pass.

SEN. JACK REED, D-R.I.: Senator Reid, Harry Reid, has introduced a public option. There’s strong support there. But we are far from the end of the debate in the Senate. It will take time. It will be careful, thorough and deliberate. I hope that a public option is part of the final bill.

BETTY ANN BOWSER: Beyond the public option there are other issues that could roil the Senate debate, including abortion. At the last minute, the House blocked the use of federal subsidies to buy insurance that covers elective abortions. And it could effectively bar policies on the insurance exchange that cover the procedure.

The restrictions were aimed at winning over abortion opponents. But it touched off protests today at the Capitol. Publicly, at least, White House officials took the back-and-forth in stride today. Spokesman Robert Gibbs said, they’re focused on the end game.

ROBERT GIBBS, White House press secretary: The president wants to sign health care before the end of the year.

BETTY ANN BOWSER: There’s still no word on when the Senate will try to take up its version of the bill. Majority Leader Reid has not released full details yet. His office says he’s still waiting for a cost estimate from the Congressional Budget Office.

Challenges in the Senate

Sen. Charles Grassley
The House bill gives me very, very much concern of health care going in the wrong direction, more towards government control of health care completely.

JIM LEHRER: Judy Woodruff has more about the road ahead for any health care legislation.

JUDY WOODRUFF: And, for that, we are joined by Norm Ornstein, a longtime observer of Congress and politics. He's a resident scholar at the American Enterprise Institute.

Norm, thanks for being with us.

NORMAN ORNSTEIN, resident scholar, American Enterprise Institute: My pleasure, Judy.

JUDY WOODRUFF: So, now that they have gotten it through the House, they move on to the Senate. What are the challenges there that lie ahead for the Democrats and the president?

NORMAN ORNSTEIN: This is another big battle ahead. It's not the final battle. It may not even be the penultimate battle, but what has to happen now is, they have got to find a way to get a bill, whatever it contains, through the Senate, so that they can then go to a House-Senate conference committee and figure out how to resolve many of these knotty issues, like the abortion one.

And, for Harry Reid right now, it's coming up with a package -- and he hopes as soon as he can, but it takes a while in the Senate -- where he can get 60 votes.

Nancy Pelosi in the House had some slack. She could lose up to 40 Democrats and still prevail with only Democrats. She lost 39. Harry Reid needs either all 60 Democrats, or, if he loses one or two -- and, right now, he's got one at least who's gone -- he's got to find a Republican or two. That's his big challenge.

JUDY WOODRUFF: Is he in essence in the Senate, Norm, starting from scratch?

NORMAN ORNSTEIN: You know, they have been working on two bills, Judy, that passed the two committees, the Health, Education, Labor and Pensions Committee and the Finance Committee, and trying to meld them together.

Now he has also to be at least a little bit mindful of what happened in the House. But more important than anything else, with Joe Lieberman, the independent Democrat, who said even as recently as yesterday, in a hardened position, that, if a public option is in the Senate plan, he won't vote to cut off debate on the final issue. They may not even get to a final vote.

That means Harry Reid has to find a 60th vote somewhere. And that means Olympia Snowe, who has been reluctant because Reid insisted...

JUDY WOODRUFF: A Republican.

NORMAN ORNSTEIN: A Republican from Maine, who voted to report the bill out of the Finance Committee, the only Republican so far to indicate support for any health plan that would join with Democrats, but who is very reluctant to join, and if there's the kind of public option that the Senate said they would include that Harry Reid would.

So, he may have to make an adjustment here before he brings the bill to the floor.

Abortion fight looming

Norman Ornstein
American Enterprise Institute
A question whether the Catholic Bishops, feeling their power now, step in and begin to pressure at this point pro-life Democratic senators.

JUDY WOODRUFF: So, what are the hardest things to work out? Clearly, public option is one of them, but it's not the only one.


And they have got serious issues over the financing of this package -- there are real differences with the Democrats in the House and the package that they produced -- and some real controversies that continue, heavy fees, heavier than had been anticipated for medical device manufacturers, pharmaceuticals companies and others.

They have got a provision in here which most economists believe is a very good one, but which is very controversial with labor, which is to put penalties on or taxes on the Cadillac plans, so-called, the more expensive health care plans.

They have got a provision to have an independent commission that might be able to regulate more or rein in, ultimately, the costs for the Medicare program.

So, there are a lot of knotty issues. But, right now, it's finding a way to get a public health -- public plan option in that will satisfy the liberals, but may also bring in an Olympia Snowe, if you're going to lose a Joe Lieberman, and making sure that some of the other recalcitrant Democrats, like a Blanche Lincoln of Arkansas, who is up for reelection, a Ben Nelson of Nebraska, with a heavy insurance presence in his own state, are also on board, Democrats.

JUDY WOODRUFF: You were saying a minute ago that abortion, this abortion fight not is not the first concern for Senator Reid, but it is going to be a concern in the Senate.

How did all that unfold as it did? How do you read that? And how hard is that going to be to -- to get resolved?

NORMAN ORNSTEIN: That ended up being, of course, the knottiest question for Pelosi in getting a bill through the House.

She could have lost potentially 40 votes alone from pro-life Democrats in the House, and made a choice in the end to come up with a tough provision to keep abortion basically out of any of these exchanges, even if people were willing to pay separately into a segregated account for coverage of abortions.

That meant she faced the fury of pro-choice Democrats, but promised them that there would be a resolution of it in a different way in a final bill. That's the conference committee.

And what made the difference here in getting a compromise that might satisfy both sides was the Catholic Bishops stepping in and saying that a compromise was not acceptable to them.

A question now -- the abortion issue has not been a hot topic in the Senate deliberations in the Finance Committee or in the Health Committee -- is whether the Catholic Bishops, feeling their power now, step in and begin to pressure at this point pro-life Democratic senators who have been very supportive of a health reform package, like Bob Casey of Pennsylvania, and raise it in the Senate.

More than likely, they can finesse it now, but then they're going to have to come to a resolution at the next big battle down the road, which is the conference committee, if they can get 60 votes for a bill in the Senate.

A sign of momentum

Norman Ornstein
American Enterprise Institute
This was huge.

JUDY WOODRUFF: Of all of which just makes it even more complicated.

Finally, let's put this in perspective, Norm. For all the problems that lie ahead, how significant -- how significant was the fact that it did pass the House of Representatives?

NORMAN ORNSTEIN: This was huge.

It's the first time we have gotten a major health bill this far. And the fact that it happened less than a week after an election setback for Democrats that really weighed heavily on freshmen Democrats from districts that John McCain carried, that George Bush had carried, for people who feel vulnerable in 2010, knowing that their party was a little bit back on its heels in 2009, was a big positive sign.

It's a sign of some momentum at just the point that they needed it and a sign that there's a real prospect that we will still get a health care bill through and enacted into law. The timing may not fit what President Obama wanted, but this was a big step.

JUDY WOODRUFF: Norm Ornstein, thanks very much.

NORMAN ORNSTEIN: Thank you, Judy.