Health-care showdown looms; outcome uncertain

McClatchy Newspapers

WASHINGTON — The epic Senate battle over overhauling the nation’s health-care system is hurtling toward some crucial showdowns over the next week and a half, and the fate of President Barack Obama’s top 2009 domestic priority remains highly uncertain.

As the Senate prepares to resume debate Monday on its $848 billion, 10-year plan, the measure’s immediate future rests largely with the nonpartisan Congressional Budget Office, which is reviewing the potential costs and impact of a tentative Democratic deal.

That deal, whose details remain sketchy and which appears to be subject to ongoing negotiations, could allow 55- to 64-year-olds to get Medicare coverage and set up a national, federally regulated series of privately run insurance plans.

Many senators remained confused and frustrated over a lack of specifics, and analysts were split over what the cautious mood means.

“I think we’re moving forward,” said former Connecticut Democratic Rep. Barbara Kennelly, the president of the National Committee to Preserve Social Security and Medicare, a Washington advocacy group.

Kennelly said she told former colleagues, “You’re not going to get everything you want, but over the next 10 years, if you’re still here, you’ll have the chance to improve this thing.”

Michael Tanner, a health-care expert at the libertarian Cato Institute, had a somewhat different view, however.

“They want to create the appearance of momentum,” he said of Democratic leaders. “This is throwing things at the wall and seeing what can get 60 votes.”

If the CBO finds that the proposals don’t boost anticipated federal deficits over the next 10 years, the Senate is expected to proceed to four key votes, three to cut off debate and another on final passage of its bill, all before Christmas.

Democrats control 60 of the Senate’s 100 seats, and 60 votes are crucial, because that’s what’s needed to limit debate. If the CBO’s report is well-received, notably by the handful of moderate Democrats who have serious qualms, the measure is a decent bet to win passage before Christmas.

If, however, the CBO raises serious questions about cost, affordability or access to care, there could be political trouble.

One flash point, abortion, appears to have cooled after last week’s vote to kill a bid by anti-abortion senators to put tough limits on elective abortions.

The issue is hardly dead; the House of Representatives last month approved allowing federally funded abortions only when the woman was a victim of rape or incest or the pregnancy endangered her life. If the Senate passes its version with fewer restrictions, the two sides will have to reconcile their differences.

Seven Senate Democrats voted for the tougher abortion measure, and all indicated that they expect some compromise that will allow them to vote for the final package.

“We want a bill passed,” said Sen. Bob Casey, D-Pa., one of the seven.

The bigger obstacles in the bill’s path are its potential costs and reach. Moderates are nervous about a government-run insurance program, or public option, which the White House and Democratic leaders have long sought as an alternative to private coverage.

That option is in the House bill, while the Senate version allows states to opt out of a federal plan.

Senate centrists fear that could still lead to the growth of a bloated bureaucracy and further jolt the nation’s already-exploding debt. The issue is particularly sensitive in more-conservative states such as Arkansas, where Democratic Sen. Blanche Lincoln faces a difficult re-election campaign next fall.

“Until we hear back from CBO,” she said, “it’s going to be hard to see whatever I can support, for sure.”