Senate passes reconciliation bill 56-43

Senate Republicans failed to derail passage of the budget reconciliation bill containing changes to the health insurance reform bill and to the student loan program. The vote was 56-43, with all but three Democrats (Blanche Lincoln and Mark Pryor of Arkansas, Ben Nelson of Nebraska) voting yes and all Republicans present voting no. The Democratic strategy was to defeat all proposed amendments, so no Democrat offered an amendment to put a public health insurance option in the bill. However, some changes to the part of the bill dealing with Pell grants were made, which means the amended version of the reconciliation bill will have to go back to the House for another vote.

I assume the House will have the votes to pass the amended reconciliation bill. In theory, House Democrats could try to add a public health insurance option, but that would require another vote in the Senate. I think leadership wants to declare victory on this issue and move on.

Speaking of health insurance reform, it turns out the bill Obama just signed had a loophole that will allow insurers to keep denying coverage to children with pre-existing conditions until 2014. Health and Human Services Secretary Kathleen Sebelius claims this can be fixed through rule-making, but we'll see. I suspect insurance companies will be able to work around most of the supposedly tough regulations in the new law.

Senate passes reconciliation bill 56-43

Senate Republicans failed to derail passage of the budget reconciliation bill containing changes to the health insurance reform bill and to the student loan program. The vote was 56-43, with all but three Democrats (Blanche Lincoln and Mark Pryor of Arkansas, Ben Nelson of Nebraska) voting yes and all Republicans present voting no. The Democratic strategy was to defeat all proposed amendments, so no Democrat offered an amendment to put a public health insurance option in the bill. However, some changes to the part of the bill dealing with Pell grants were made, which means the amended version of the reconciliation bill will have to go back to the House for another vote.

I assume the House will have the votes to pass the amended reconciliation bill. In theory, House Democrats could try to add a public health insurance option, but that would require another vote in the Senate. I think leadership wants to declare victory on this issue and move on.

Speaking of health insurance reform, it turns out the bill Obama just signed had a loophole that will allow insurers to keep denying coverage to children with pre-existing conditions until 2014. Health and Human Services Secretary Kathleen Sebelius claims this can be fixed through rule-making, but we'll see. I suspect insurance companies will be able to work around most of the supposedly tough regulations in the new law.

Another health insurance reform news thread

President Barack Obama gave House Democrats a pep-talk today, and his speech (which wasn't pre-written) got rave reviews from many Democrats. If only the Senate bill were as good as Obama made it sound.

As Nathan mentioned earlier today, House Democratic leaders have decided to ditch the "deem and pass" method for passing health insurance reform with a single vote, even though the legislative procedure isn't as rare or controversial as Republicans would have you believe. Instead, the House will hold an hour of flood debate tomorrow on "the rule to allow reconcilation to get to the floor," then House members will vote on the rule, then they will debate the Senate health insurance reform bill and vote on it. I assume this means that House Speaker Nancy Pelosi is confident she has the 216 votes she needs.

Bart Stupak is now claiming only about half a dozen Democrats are willing to vote against the bill unless it contains major new restrictions on private insurance coverage of abortion. Stupak was supposed to hold a press conference this morning, but he cancelled it, so maybe that means he didn't get the deal he was hoping for from Pelosi. David Dayen speculates on who is still in the Stupak bloc. David Waldman warns about the prospect that Stupak will use a "motion to recommit" to try to get his anti-abortion language into the reconciliation fix package.

Senator Tom Harkin and the three Iowa Democrats in the House "announced a major breakthrough today on the issue of Medicare payment reform in the final health care reform bill," according to a joint press release. Excerpt:

[Representatives Dave] Loebsack, [Senator Tom] Harkin, [Leonard] Boswell and [Bruce] Braley have been outspoken advocates for changing the way Medicare pays health care providers for services, from its current fee-for-service system into a quality and value-based system.

Loebsack, Harkin, Boswell and Braley helped negotiate a compromise adding language to the health care reform bill that provides an immediate $800 million to address geographic disparities for both doctors and hospitals, as well as written guarantees from Health and Human Services Secretary Kathleen Sebelius for further action to reform Medicare reimbursement rates that do not qualify for reconciliation under the Byrd Rule. The Senate bill previously only provided a Medicare reimbursement fix for doctors.

The House reconciliation package maintained automatic implementation of a value index as part of the reimbursement structures for doctors, beginning in 2015. This language was secured in the Senate bill with the help of Harkin and is based on Braley’s Medicare Payment Improvement Act, introduced in June 2009. Under the fixes secured in the Senate bill and the House reconciliation package, Iowa doctors will see five percent increases in current Medicare reimbursement rates in both 2010 and 2011.

I posted the whole press release, containing more details, at Bleeding Heartland. This deal appears to have secured the vote of Peter DeFazio (OR-04) as well. Yesterday he threatened to vote no because of language on the Medicare payments disparity.

Outside the Capitol, tea party protesters shouted racist insults and held signs threatening gun violence if health care reform passes. Congressional Republicans should disavow this reprehensible behavior, but of course they won't.

Share any relevant thoughts in this thread.

Stupak may yet bring down health insurance reform (updated)

Several undecided House Democrats came out in support of the health insurance bill today, but it's still not clear whether leaders have the 216 votes they need. Between six and twelve Democrats are in Bart Stupak's bloc, which will vote for the bill only if it severely restricts private insurance coverage for abortions. Chris Bowers thinks some "bullshit" compromise may peel away the few votes House Speaker Nancy Pelosi needs from the Stupak bloc, but a more disturbing possibility is taking shape.

Stupak is demanding that his amendment be voted on later as an "enrollment corrections" bill. The parliamentary procedure here is complicated, so I ask you to read David Waldman or David Dayen for an explanation.

Pro-Choice Caucus co-leader Diana DeGette claims that 40 to 555 House Democrats may not vote for the final deal if it includes a promise to enact the Stupak language separately. I assume most of those would cave, but if even five or ten stood their ground, they would cancel out the Stupak bloc members.

Given how much Democrats rely on women voters to win elections, it's amazing that they would sell out abortion rights to appease a few anti-choicers. Although the Catholic Bishops have opposed the health insurance reform bill, a major Catholic newspaper as well as groups representing Catholic hospitals and nuns are supporting it. Then again, after abandoning other core Democratic positions on health care reform (like letting Medicare negotiate for lower drug prices), what's another kick in the teeth for the base?

Meanwhile, Senate Majority Leader Harry Reid offers what sounds to me like false hope of a separate vote on a public health insurance option. Such a vote would have to be attached to a budget reconciliation bill in order to have any hope of passing the Senate.

As far as I know, the dispute over Medicare reimbursement rates has not been resolved yet. Peter DeFazio has threatened to vote no if geographical disparities in Medicare payments are not corrected, and today Representative Bruce Braley's spokeswoman told me that he is undecided on the bill, in part because of that issue. Other House Democrats have also expressed concern, according to the Huffington Post. I doubt Braley will end up voting against health insurance reform, but I wouldn't be surprised to see Pelosi negotiate language on Medicare reimbursement rates that's closer to the House bill.

UPDATE: Stupak was supposed to hold a press conference Saturday morning at 11, but that was cancelled. I assume that means he and Pelosi don't have a deal yet, but who knows?

Health insurance reform whip count thread

Sunday's House vote on health insurance reform still looks like a nail-biter, though some would argue that the question isn't whether Speaker Nancy Pelosi will find 216 votes, but which Democrats in tough districts will be allowed to vote no.

Various whip counts are floating around the internet. Take your pick from David Dayen's version at FireDogLake, the Chris Bowers tally at Open Left, or the latest from The Hill staff.

Here's some recent news: Peter DeFazio (OR-04) is now threatening to vote no because yesterday leaders stripped out language on correcting geographical disparities in Medicare spending. Stupak bloc member Marcy Kaptur (OH-09) is now leaning toward "yes." John Boccieri (OH-16), who voted against health care reform in November, is switching to "yes." Dina Titus (NV-03) also confirmed today that she will vote yes.

This thread is for any comments related to Sunday's vote. I will update later if more Democrats on the fence announce their positions.

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