House Gets Its Act Together on Health Reform While Senate Dawdles


As I mentioned earlier today, the past week or so has given health reformers a severe case of whiplash. First, an early version of the Senate HELP committee bill was unveiled in an uncompleted form, after divisions between the committee’s Republicans and Democrats on key issues like the public option, and the employer mandate couldn’t be resolved in time for hearings. Unfortunately, that’s the only legislation the Congressional Budget Office had to work with, and, perhaps unsurprisingly, they found it would cost about $1 trillion over 10 years while leaving, dozens of millions of people uninsured.

And this, remember, is the committee that’s putting together a liberal bill, without worrying too much about rapprochement or bipartisan compromise. All of that bellyaching was going on in the Senate Finance Committee. The CBO determined that that bill would cost about $1.6 trillion over 10 years–significantly more than the conservative committee wanted to pay. And they’ve gone about making up the difference not by upping the ante on cost-cutting reform efforts, but by slashing the very benefits and subsidies reformers are fighting for–including the public option which has been scrapped, in the Finance bill, and replaced with a plan to create regional, non-profit co-operatives (more on that in a bit).

Hearings on that bill won’t begin until next month, leaving Congress only days of session to complete the entire legislative process before their ambitious pre-August recess deadline.

But the story in the House is much different.At her weekly press conference on Thursday, Speaker Nancy Pelosi held up her end of the bargain. “I’m saying we will have a public option in the House that will be real,” she said. “If it’s not real, it’s no use doing. And if we don’t do a public option, I’m not sure that we have as effective a public health care reform as we wish.”

And compared to the disarray in the Senate, the House is pretty well poised to deliver. The three committees of jurisdiction there have agreed on a single piece of legislation, including a fairly robust public option, and, of course, the House GOP can’t resort to a filibuster. Assuming it passes, the opponents of the provision will have to choke it off at several points along a lengthy political chain. They’ll have to win out over the HELP committee to keep it out of the finalized Senate bill; then they’ll have to get it stripped out of the final bill during conference; if they fail, they’d have to filibuster the conference report (something which rarely happens); and if they were to succeed in that regard, they’d have to fight the fight all over again, with less leverage, during the budget reconciliation process in October.

All of which is to say that despite all the sturm und drang last week, we’re basically right back where we started–and the public is on the reformers’ side.


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