D-Day for Harry Reid: Can he wrangle 60 votes for Senate health reform bill?

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Perhaps Ringo Starr should attend Saturday night's start to the debate over the health care reform bill in the Senate. After all, it was Starr who first uttered the malapropism that later became a hit song (and movie) by The Beatles -- A Hard Day's Night. Saturday evening may shape up to be just that in the upper house of Congress.

For clues regarding the bill's destiny, look for key, early maneuvering. Bill author Senate Majority Leader Harry Reid, a Democrat from Nevada, has to retain all 60 members of the Democratic Conference (58 Democrats, two Independents) to pass a procedural vote. If even one conference member strays -- and can't be persuaded to change the vote -- the health care reform bill won't even make it to the Senate floor for debate.
Assuming that hurdle is met, Reid can then concentrate on keeping the "Sweet 60" coalition together to pass the $848 billion bill, which would cut the deficit by $130 billion in its first 10 years, while insuring 94% of Americans, according to an analysis by the Congressional Budget Office. Sixty votes are needed because that's the number required to end a filibuster -- or the Senate's unlimited debate power.

Three Senators in the Spotlight

Of the "Sweet 60," Reid will likely have to concentrate his efforts on three Senate Democrats, who may stray in either the procedural vote, or after bill debate begins on the Senate floor. Each senator faces a likely competitive re-election race, either next year or in the future, thehill.com reported Friday. Sen. Ben Nelson, D-Nebraska, is a perennial Republican target. Sen. Blanche Lincoln, D-Arkansas, faces a potentially difficult campaign next year. And Sen. Mary Landrieu, D-Louisiana, although not up for re-election until 2014, does not want to alienate portions of her very diverse constituency.

If the three back the bill, Reid will likely be able to shepherd the legislation through the Senate, as he's crafted a health care reform package that meets the needs of the diverse, complex United States. The bill's key provision, from a political support standpoint? The provision to let states opt-out of the public option -- it lets states test the public option waters at their own pace, based on each state's needs and resources.

In adding it, Reid has crafted a bill that is culturally flexible, and at the same time creates 50 laboratories that policy makers can evaluate: the latter is designed to help state and federal policy makers identify best practices to further weed-out inefficiencies and program mistakes. And as UConn Political Science Professor emeritus Sarah Morehouse would say, "The states are great laboratories."

Reid Bill Sidesteps Abortion Issue

On the divisive, difficult issue of abortion, the likely outcome from the Senate bill will be no change from the the Hyde Amendment that bans federal funds for abortions, npr.org reported Friday. The abortion language of the passed House bill led Democratic abortion rights supporters to say it would increase the regulatory burden on private insurers that cover abortion to the point that they would stop covering them.

But it has not been retained in the Senate bill. Instead, Reid has modified it, and added a clause that mandates that the U.S. Secretary of Health and Human Services ensure that no federal funds are used for abortion.

And where are the Senate Republicans? Outnumbered, they'll sit and wait to see if the Democrats make a mistake or if support for the bill drops below the "Sweet 60." It's highly unlikely that any Senate Republican will vote for the bill, despite the CBO's deficit-cutting forecast.

Further, it is a guarantee that the Republicans will use every parliamentary and political tactic possible to prevent its passage, which is par for the course on major issues in partisan Washington these days. It should be noted that to date, neither House nor Senate Republicans have offered a credible, universal health care bill. Basically, all Republican bills thus far largely preserve the status quo, which is untenable, from a fiscal standpoint.

Finally, if approved, the Senate health care reform bill would then have be reconciled with the House's version, passed 220-215 on Nov. 7, in a House-Senate Conference Committee.

A Step Toward a Balanced Budget

Reid has crafted a flexible bill that's right for the nation. Concerning investors, the opt-out public option is likely to survive the conference committee, but if it does not, that would favor health insurance stocks, assuming there's no replacement public option.

Over time, the health care reform bill will cut per person health care costs, eliminate waste, improve outcomes and save lives. It's highly unlikely that any "rationing" of health care will occur, despite a Medicare restructuring that will reduce per person Medicare costs. And those citizens with strong health insurance plans will not see any substantive changes in their benefits.

Further, by finally getting control of Medicaid and Medicare costs, it cuts the U.S. budget deficit and creates momentum for further deficit reduction actions. Health care reform legislation is the first step toward a balanced budget.

Finally, a modest tax increase on upper-income Americans will likely survive the House-Senate conference committee -- a small price to pay for a health care policy whose goal is universal health insurance and a more perfect union.

Financial Editor Joseph Lazzaro is writing a book on the U.S. presidency and the U.S. economy.
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