Look for Democrats to Give Health Care Reform "the Old College Try"

In Washington, it's called a "heavy lift" -- an effort by the party in power to try to pass major legislation knowing that public opinion remains clouded at best.

Even so, President Barack Obama and congressional Democrats will push ahead and give health care reform the old college try' White House Spokesman Robert Gibbs said the president wants a bill passed by the House and Senate before his scheduled trip to Asia on March 18, ABC Newsreported Monday.

Between now and then, look for congressional Republicans to use every political and parliamentary tactic possible to try to delay or defeat the bill, including the GOP's latest tactic of arguing that it's not acceptable to use the legislative procedure known as reconciliation, even though Republicans have used it numerous times to pass key legislation, including the 2001 and 2003 Bush administration-backed tax cuts.

Reconciliation: A Required Route

Democrats will likely use reconciliation, which would require only a simple Senate majority of 51 votes to approve any House-agreed-to changes in the previously-passed Senate health care reform bill, because not one Senate Republican is expected to vote for the legislation. Conversely, starting over with a new health care bill would likely require a filibuster-squelching 60 votes in the Senate, where there are only 59 Democrats and affiliated independents. Hence, "starting over" would be tantamount to giving up on an attempt to pass health care reform legislation this year.

The first step in the reconciliation process involves getting the House to pass the Senate-passed health care bill, and at this stage, it's uncertain whether House Speaker Nancy Pelosi (D-Calif.) will be able to hold together the diverse House Democratic coalition. Conservative and moderate Democrats may vote against the bill, arguing that its language makes abortions more accessible. At the other end of the spectrum, some liberal Democrats may vote against the bill, arguing it doesn't do enough to lower health insurance costs for the working poor and others who currently can not afford health insurance. One thing is certain: Speaker Pelosi is unlikely to bring the bill to the House floor if she does not have the votes for passage.

However, if a reconciled health care reform bill passes both chambers, it would eventually help tens of millions of poor and lower-income citizens obtain health insurance through subsidies, insurance exchanges, and through expansion of Medicaid coverage, among other changes. The Obama administration puts the number of currently uninsured Americans who would eventually be able to purchase health insurance under the reform plan at 31 million. Further, in addition to banning discrimination for pre-existing conditions, the bill would also likely reduce the federal budget deficit over the next two decades by containing public health care costs through lower original point-of-service costs, competition, and improved system efficiency.

Bill's Failure Would Likely End Federal-Level Effort

But if a reconciled bill does not pass, that would end any chance of universal health care insurance in the United States for this year, and most likely, for many years to come. That's because the political capital involved makes it highly unlikely that the Democrats would want to try again anytime soon. And there's not likely to be a counter-proposal to address universal coverage from congressional Republicans. To date, the most inclusive Republican proposal would cover roughly 3 million more Americans -- nowhere near the 40 million to 45 million Americans who do not have health care insurance. The GOP program would rely on the private sector to deal with the remaining problem of the uninsured.

Finally, either of the latter two scenarios -- no federal reform legislation or the Republicans' "health care reform lite" -- would guarantee that the number of uninsured Americans would continue to surge higher, as no modern, industrialized nation has had a private sector-based health insurance system that insured all citizens at an affordable price.