In it, but not of it. TPM DC

Earlier Benefits Could Be On The Table In House/Senate Health Care Conference

Newscom / Scott J. Ferrell

The Senate bill is set to implement most of its largest reforms (the mandates, subsidies, and exchanges) in 2014. The House bill kicks into high gear a year earlier, in 2013.

"[Q]uite frankly it ought to even be sooner than that," Harkin said.

That meshes with the focus of Democratic aides in both the House and Senate--and with one of the House's leading progressives.

Earlier today, Rep. Raul Grijalva (D-AZ)--co-chair of the Congressional Progressive Caucus--told Greg Sargent that the idea of moving the implementation date forward is of interest to him and other Democrats.

"It would sweeten it somewhat," Grijalva said, "if they speed up the coverage mechanism."

Obviously, for political reasons, all Democrats would like to speed up the implementation of this reform package. It's hard to run for office on the platform of having passed an unpopular bill that hasn't really done anything yet. But moving day-one forward a year isn't free. Crucially, it would require the government to cover an extra year's worth of premium subsidies in the CBO's 10 year budget window. And that would cause the price tag of the bill to jump noticeably.

Conservative Democrats have blanched at the idea of voting for a bill with a significantly higher pricetag than the bills that are on the table right now, so it would be a complicated trade-off. And there are other outstanding issues as well, including whether to organize insurance exchanges at the state or national level. But implementation is worth keeping an eye on.

About The Author


Brian Beutler is TPM's senior congressional reporter. Since 2009, he's led coverage of health care reform, Wall Street reform, taxes, the GOP budget, the government shutdown fight and the debt limit fight. He can be reached at