After the late night vote, with Democrats expecting the bill to receive at least the 60 votes required to pass that chamber, House and Senate staff are preparing for a two-week conference process that is slated to begin on Dec. 26.
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Hill staffers expect to work out a compromise on five or six major issues in conference, including the public option, abortion language that would restrict the use of federal dollars to fund the procedures, and Medicaid expansions among others.
A final vote on the House/Senate conference bill is forecast for mid-to-late January in time for the State of the Union speech by the President, according to the rumor.
Although the legislative process could turn at any time with the number of concessions being made behind closed doors, the remarkable specifics and presumptions of the pending schedule are in stark contrast with the seemingly plodding and on-the-fly dealmaking picture being presented to the public during the Senate floor debate, which is set to enter its third week.
For example, Senate Majority leader Harry Reid, D-Nev., announced Dec. 7 that a compromise had been reached as an alternative to the public plan that would include a Medicare buy-in for Americans 55 years of age to 64 but that the details of the deal would be withheld until the Congressional Budget Office scored it.
Approximately 32 million Americans fall into that age range, according to census figures, with about 4.3 million uninsured, according to research by the Kaiser Family Foundation (“The Pink Sheet” DAILY, Dec. 11, 2009).
As part of the public plan compromise, a separate proposal would establish a program where one or more insurance options would be offered under the auspices of the federal Office of Personnel Management but would be operated by private non-profit insurance companies; OPM operates the federal employee's health benefits program.
However, just one week after the compromise was announced without details, it appears that it has been jettisoned for lack of securing the required 60 votes in the Senate.
When asked if the Medicare buy-in would be stripped from the final legislation, Senate Finance Committee Chairman Max Baucus, D-Mont., responded: “It’s looking that way.”
If the rumor of a late-night Senate vote holds true, it would mirror the strategy used by Republicans on the Medicare Modernization Act, which included the Medicare Part D prescription drug benefit.
Democrats, with one of the rare exceptions being Senate Finance Committee Chairman Max Baucus, D-Mont., were locked out of the final stages of negotiations over the MMA.
The vote in the House took place in the early hours of the morning, a fact Democrats won’t soon forget.
“When the vote was called at almost 3 a.m., voting Democrats stood unanimously with 22 Republicans in opposing the legislation,” current House Rules Committee Chair Louise Slaughter, D-NY, wrote in a 2006 New England Journal of Medicine piece. “Had the vote been gaveled down in the customary 15 minutes, the bill would not have passed. So the Republican leadership held the vote open for a record three hours while attempting to change the outcome.... Finding itself with a narrow lead at 5:53 a.m., the Republican leadership immediately brought the vote to a close.”
Democrats appear ready to implement the same strategy for their health reform bill.
One area that must be addressed in order to win approval in the House is the closing of the Medicare Part D coverage gap (between roughly $2,700 and $6,100 in drug spending), also known as the donut hole, staffers say.
The House legislation completely phases out the donut hole, paid for by Medicaid-level rebates for dual-eligible beneficiaries in the Part D program. The Senate bill only cuts it in half, but that will have to change, staffers adamantly maintain.
“To get 218 votes in the House, the donut hole needs to be closed and PhRMA knows that and they want to close the donut hole,” according to one staffer, who notes that a final bill may not include Part D dual-eligible rebates but will have to find a way to pay for closing the coverage gap.
“I am committed to fully closing it, once and for all,” Reid said. “Once we pass this bill, we will do so in our conference committee with the House, whose bill already closes the gap.”
It’s unclear exactly how the Senate will structure the scorable mechanism for phasing out the coverage gap over 10 years, but many on Capitol Hill are of the opinion that the industry’s $80 bil. pledge to the White House to help pay for reform was secured knowing that drug manufacturers would have to give a fraction more as legislation neared final votes.
“They held a little back,” says one staffer.
- Ramsey Baghdadi
