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Democrats Have Determined To Move Forward On Health Care, But Can They Pull It Off?

Democrats have made a clear indication to pass a comprehensive health care bill within the next two months, rejecting calls from Republicans to start over or move in an incremental fashion.

Rob Andrews, who attended yesterday’s bipartisan health care summit, laid out the path forward by saying he expected minor changes to the President’s proposal, based in part by some ideas from Republicans at yesterday’s summit, within the next week. Democrats would then seek to move that proposal through the legislative process. The President described a wait of up to 4-6 weeks to see if Republicans would come together on a proposal, but if it takes that long, it’s because Democrats are lining up votes and determining process, not in the hopes that Republicans change their minds at the last minute and jump aboard.

Before the summit even ended, Dick Durbin acknowledged that Democrats would press forward, regardless of the GOP’s stance. Harry Reid, the Majority Leader of the Senate, agreed in a statement after the meeting. “Health reform is not about process or sound bites; it’s about real people like Jesús Gutierrez in Reno who struggle with a health system that too often stands between them and the care they need and deserve. Ideological differences will always exist, but unless we act health care costs will continue to skyrocket and thousands of Americans will continue to lose their coverage or be denied treatment every day.”

House Speaker Nancy Pelosi concurred. She described herself as “not overly optimistic” that they would get Republican support for the bill, but promised to incorporate some of their ideas if they seemed worthy of support. Nevertheless, she clearly stated that the Democrats would move forward:

“The fact is, is that we are going to move forward. The ball is in everybody’s court to try to find some common ground on how we move forward. Mr. Durbin pointed out a defining difference that emerged in this meeting, though, and that is in order to make the changes, in order to end discrimination of pre-existing condition and all the reform that we want to make, in order to hold in the insurance companies accountable, there had to be some regulation of the insurance industry. That seemed to be the big separation between the Democrats and the Republicans. Whether that can be bridged remains to be seen.”

Asked at her weekly press conference today if the Senate can use the reconciliation process to fix the bill to the House’s liking, she said, “What you call a complicated process is called a simple majority.” She firmly rejected the GOP call to “start over, itsy-bitsy spider, little teeny tiny… you can’t do it. Doing this incrementally just doesn’t work.”

The President gave his clear blessing to proceeding on the reconciliation sidecar track, and a blog post at the White House’s website by Dan Pfeiffer buffeted that.

The President believes that a problem this big cannot be addressed incrementally. And while insuring 30 million people is going to cost money, it’s important to remember that most of this money is going to tax credits that will reduce premiums and help people get better coverage.

And while the President appreciated the participation and input of everyone today, he doesn’t think we can just scrap a year’s worth of work and start over. The millions of Americans that are suffering can’t afford another year-long debate. There’s too much at stake.

TPMDC reports that the timeline puts final passage at around April.

In a statement, the Progressive Caucus lamented the lack of diversity at yesterday’s summit, noting the absence of leaders from the Progressive Caucus or the Tri-Caucus (African-American, Hispanic or Asian Pacific Islander Caucuses). And they highlighted the importance of the public option as the best proposal to help reform the system. But in the end, they are expected to fall in line, with few exceptions, like Rep. Dennis Kucinich, who reaffirmed his no vote yesterday.

Really there are two issues at this point – working out the reconciliation process itself, included the order of which chamber would vote first; and then determining whether the House and Senate actually have the votes. Both have unresolved questions, but the question of the votes in the House seems like the major obstacle. Bart Stupak has identified 15-20 Democrats who voted for the bill previously who would not do so again, citing the abortion language. And it’s entirely unclear whether that gap can be made up with those who voted no initially, even if Stupak is exaggerating. Recent House retirements and deaths have thinned the margin for passage even more. And one of the few House Democrats who was amenable to flipping his vote, Jason Altmire (D-PA), didn’t think the votes were there this time around.

“It’s going to be tough because the mood is different than it was in November,” Altmire said. “The vote in Massachusetts is the result of a change in public opinion.” […]

Altmire does not know if Pelosi has a reserve of lawmakers willing to change their “no” vote to a “yes” to make up for this new deficit.

“And what about the marginal members in the middle who got hammered over this bill and would love a second chance to perhaps go against it this time?” Altmire asked.

Altmire said he is hoping Obama’s proposal is “a starting point for future discussion,” not the final bill.

Otherwise, he said, “I don’t see how you are going to change those numbers given the mood swing that has taken place over the last four months.”

At some point, the determination by the leadership to move forward must be met with the determination to solve the jigsaw puzzle that leads to 50 votes in the Senate and 217 in the House to ensure final passage of a single bill.

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David Dayen

David Dayen