Health care reform delayed but still on track for passage by year's end

While most Americans support the idea of change in our health care system, the House and Senate have yet to agree on how exactly the change will occur and who will pay for it. Five committees, three in the House and two in the Senate, have had their say in drafting the legislation, and we're now down to two committees -- the House Energy and Commerce Committee and the Senate Finance Committee -- to work out the final details before the bill will be brought to the floor for a vote.

The House may vote before the August recess, but Senate Leader Harry Reid says there will be no Senate health care vote until the fall. He does, however, expect the Senate Finance Committee to finish its work before the recess.

The House vote is being delayed by the Blue Dog Democrats, a group of 51 conservative Democrats, who want to see the costs of the bill and the proposed tax hikes reduced. On the Senate side, Senator Max Baucus, chairman of the Senate Finance Committee, is trying to find a way to pass the bill on a bipartisan basis. That may mean only a few Republicans will support the bill, but at least it won't be passed solely by votes from Democrats.

In addition to the sparring members of the two remaining committees, lobbyists fill the halls of Congress seeking to limit damage. Health care businesses -- including insurance companies, pharmaceutical companies and health care providers -- are spending millions to minimize the impact the bill may have on their bottom line.

The Pharmaceutical Research and Manufacturers of America spent $6.2 million on lobbying in the second quarter. The American Medical Association is the second biggest spender -- $4 million. Others spending big bucks on lobbying include: Blue Cross and Blue Shield Association ($2.8 million), GlaxoSmithKline ($2.3 million), Novartis ($1.8 million), MetLife Group ($1.7 million), Allstate ($1.5 million), Johnson & Johnson ($1.6 million), America's Health Insurance (almost $2 billion) and Bayer Corp. (almost $2 million). From January through March, the health care industry spent at the rate of $1.4 million a day.

You can be certain the health care industry will continue this spending level until some legislation is passed by Congress or the legislation is stopped completely. There are billions of dollars at stake for these companies in potential profits.

You'll probably see a vote on the bill in the House before the August recess. Some members of the House have asked that the August recess be delayed until there is a vote, but House Leader Nancy Pelosi expects that the August recess will need to be delayed only a few days.

Why are House leaders intent on getting the bill passed before the recess? Recesses tend to change representatives' minds as they return home and meet with constituents in their districts. The House leadership knows it will have a harder time passing the bill after the recess. This delay also gives lobbyists more time to work their magic as well.

If Senator Baucus can build a bipartisan coalition by taking a few extra weeks, that will make Senate passage a lot easier. Senators can stall a vote on the bill using filibuster rules. In order to break a filibuster, Baucus must have 60 votes. While Democrats do have 60 votes now, not all Democrats are on board. Conservative Democrats want to see cost savings. Baucus and his committee members met with Congressional Budget Office Director Douglas Elmendorf on Thursday night. He said their emerging plan would begin to reduce health care costs. A formal report is due out in several days. With that report in hand, the Senate will find it much easier to pass the bill.

Once the Senate Finance Committee passes the bill, Senator Reid will work with the chairman of the Senate Finance Committee and the Senate Health, Education, Labor and Pensions Committee during August to meld the two bills before a full Senate vote in the fall.

When the bill is ready for a vote, House and Senate leadership will have to determine the rules for how the bill will be voted on by the membership. The leadership can limit the number of amendments to be voted on the floor. I haven't seen any discussion about what limits, if any, will be imposed. Without limits, there could be hundreds of amendments and it could take a week or more to vote on the bill.

Lita Epstein, who has been a Congressional staff member in the past, has written more than 25 books, including The Complete Idiot's Guide to the Politics of Oil.

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