Making Sense of What’s Next for Health Reform

by Clive Riddle, January 21, 2010

What a difference a week makes! Amidst the political chaos and confusion during the past few days on status and prospects of health care reform, some prominent pundits and lawmakers are either proclaiming health reform is absolutely dead, or that there is still a viable pathway for reform, and it will pass. Both sides of the spectrum voicing such certainty right now would seem to be ‘spinning.’ Chaos and confusion should reign as we speak, because at this point either outcome is quite possible. Thus for now, one would be wise to position for a range of possibilities.

Here are some key points to consider in this “anything’s possible” phase that will undoubtedly clear up with a little time:

• The public nationally is clearly not happy with reform as proposed. The latest Wall Street Journal / NBC poll released this week tracking this issue pegged approval ratings of Obama's handling of health care at 38% approval and 55% disapproval.

• But doing nothing, and opposing everything isn’t necessarily popular either. The same WSJ/NMC poll gave Republicans an even lower approval rating for their handling of health care: 26% approval and 64% disapproval.

• Lawmakers up for reelection this year are looking to the Massachusetts Senate election as the referendum on health reform, so some Democrats may reverse course next time around with any health reform votes. But the Washington Post today makes an interesting point: “the Republican candidate rode to victory on a message more nuanced than flat-out resistance to universal health coverage: Massachusetts residents, he said, already had insurance and should not have to pay for it elsewhere.”

• President Obama has just signaled in an ABC interview that he would like Congress to revise the reform package to include core elements that would be more publicly acceptable and potentially gain support of a few Republicans: "We know that we need insurance reform, that the health insurance companies are taking advantage of people. We know that we have to have some form of cost containment because if we don't, then our budgets are going to blow up…And we know that small businesses are going to need help so that they can provide health insurance for their families. Those are the core, some of the core elements of this bill."

• The available options for the Senate and House to proceed leave no clear path, and plenty of disagreement. The President stated he doesn’t want to Senate to “jam” something through before new Massachusetts Senator Brown arrives, and Senate Majority Leader Harry Reid agreed this approach would not be taken. The option of the House adopting the Senate version of the reform bill as-is, has been floated, but House Speaker Pelosi is signaling the votes aren’t there at this time. Instead, she is looking at getting the House to pass the Senate Bill in combination with a companion clean-up bill.  The House has a year until the Senate Bill expires. The other options include a new watered down bill as the President now advocates, or an attempt to jam various components of the bill through budget reconciliation, which just requires a simple majority to pass, but also could trigger delays,  messy procedural fights with Republicans and make Democrats up for re –election skittish about potential public wrath.