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Just When You Thought It Was Safe: 3 Potential Obstacles to Health-Care Reform

Harry Reid may have gotten the Senate to move his health-care bill forward, but a handful of conservative Democrats could still keep the bill from getting a final vote.
 
 
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It was high drama for a Saturday in the U.S. Capitol Building -- at least what counts for high drama in the Senate. Would Majority Leader Harry Reid be able to deliver every single senator in his caucus for a vote that would allow his historic health-care bill to move to the floor for debate? In the end, Reid won that victory, with caveats from a handful of reluctant senators. Hundreds of millions in Medicaid funds were handed to Sen. Mary Landrieu, D-La., for the very poorest of her state’s poor in exchange for her vote (a move Capitol Hill staffers dubbed the “Louisiana Purchase”).

The fate of national health-care reform rests on Reid’s ability to repeat his 60-vote feat in order to close debate and bring the bill to a final vote, and there’s no guarantee that he can. In fact, it’s looking a little dicey. But even among veteran Congress-watchers, there’s no consensus on whether or not Reid will succeed in the end. To do so, the majority leader will need to negotiate three points of contention. 

The Public Option

The suspense leading up to the vote ended when Sen. Blanche Lincoln, D-Ark., the lone Democratic hold-out, took to the Senate floor to announce that she would not join a Republican filibuster that would keep the bill from moving forward. But, Lincoln promised, she would not vote for a final bill that contains a public health-insurance plan. That may simply mean that she allows the bill to come to the floor but votes against it, knowing that Reid needs only 51 to win the bill after he clears the final procedural hurdle.

But Sen. Joe Lieberman, I-Conn., has promised to keep the bill from coming to the floor if it contains a public option of any kind, so that means Reid may have to find a way to lure Sen. Olympia Snow, the Republican from Maine, into keeping a filibuster away from his bill, and that would likely require a dramatic change to the public option as currently configured -- perhaps requiring states to “opt in” or setting some sort of trigger mechanism that would activate a public insurance plan only if insurance companies fail to meet benchmarks for cost containment. Sen. Ben Nelson, D-Neb., has made a similar threat.

Anti-abortion Language

Nelson of Nebraska has also threatened to filibuster any bill that does not include the unprecedented anti-abortion measures called for by the Stupak language attached to the bill passed by the House a week ago. Nelson is associated with the right-wing religious group known as The Family, to which Rep. Bart Stupak, D-Mich., the congressman who sponsored the anti-abortion amendment to the House bill, also belongs.

Stupak spent the last week setting himself up to be some sort of a broker of an abortion-language deal, appearing on both Fox News, where he promised to take a hard line during any future negotiations between members of the House and Senate in a conference committee, and on MSNBC's Hardball, where he seemed to be playing good cop. (The Stupak language goes far beyond current law, which simply forbids the use of federal dollars for abortion procedures -- a measure known as the Hyde amendment. Stupak's amendment essentially bars insurance companies from offering abortion coverage in polices offered to women receiving a subsidy for the purchase of insurance through a federally administered health-care exchange, even if the purchaser is buying that part of the coverage with her own dollars.) Stupak told Hardball host Chris Matthews that he might accept a compromise that would forbid private insurers who currently include abortion coverage in their policies from dropping such coverage.

Pro-choice House members have also laid down a marker, with as many as 40 saying that if the bill produced by a conference committee -- the last step in the legislative process before a final bill, where House and Senate bills will be combined -- contains the Stupak language, they won't vote for it. Rep. Diana DeGette, D-Colo., who co-chairs the House Pro-Choice Caucus with Rep. Louis Slaughter, D-N.Y., told AlterNet that she was engaged in discussions with pro-choice Senators Barbara Boxer, D-Calif., and Barbara Mikulski, D-Md., and was hopeful that the Senate would avoid the fate of the House bill with regard to abortion coverage.

The Rationing Ruse

If that wasn’t enough for Reid to deal with, this week the U.S. Preventive Services Task Force gave Republicans a big present with its controversial recommendations that women under the age of 50 forgo annual mammograms. The task force based its recommendations on the number of lives saved from the screenings, as opposed to the numbers of “false positives” and the amount of overly aggressive treatment often given women with slow-growing cancers. An uproar ensued, with advocates for cancer patients, such as Nancy Brinker of the Susan B. Komen Foundation, crying foul.

Although the task force was convened by the Department of Health and Human Services, the outcry prompted HHS Secretary Kathleen Sebelius to distance her agency from the guidelines, which were issued last Monday. On Thursday, Sebelius called a press conference to announce that women over 40 should continue with their annual mammograms. Amid the controversy, the Republicans saw an opportunity. With the myth of government-mandated "death panels" now fully discredited, they needed a new bogeyman for their scare-mongering on health-care rationing, and the task force unwittingly obliged.

Arguing against bringing Reid's bill forward, Sen. Tom Coburn, R-Okla., a medical doctor and member of The Family, suggested on the Senate floor that the task force’s suggested changes in mammography guidelines exemplified the kind of “rationing” one could expect to see if Reid’s health-care bill became law.

"Do these recommendations make sense from a cost standpoint?" he asked. "Absolutely, from a cost standpoint, they're right. From a patient standpoint, they're atrocious. And that's the problem with a bureaucracy stepping between a physician and their patient."

Coburn's gambit was set up earlier in the week by Rep. Marsha Blackburn, R-Tenn., who called a press conference to say that under the House bill, the recommendations by the task force would carry the force of law -- which is not true. What the task force will be empowered to do is to mandate certain preventive measures, not take them away. (Blackburn also, in a press release, called the task force "an agency of the Department of Heath and Human Services," which it is not. It is an independent commission convened by HHS.) But at a press conference, flanked by Jean Schmidt, R-Ohio, who once accused combat veteran Rep. John Murtha, D-Penn., of being a traitor, and Michele Bachmann, who, two days before the House health-care vote, used her congressional office to organize a right-wing rally against the president, Blackburn nonetheless said, "This is how rationing begins. This is the little toe in the edge of the water. This is when you start getting a bureaucrat between you and your physician. This is what we have warned about."

On ABC's This Week, Blackburn squared off with Democrat Debbie Wasserman-Schultz of Florida, a breast-cancer survivor who also opposes the new guidelines but supports health-care refrom, while Ben Nelson and Tom Coburn looked on. Blackburn painted a grave specter of "a government bureaucrat in the exam room" getting between the patient and her doctor. "There's an insurance company bureaucrat between the patient and her doctor right now," Wasserman Schultz replied.

Socialism, Abortion and Boobs

Senate leaders are aiming for a final vote on their bill before Christmas, with debate commencing on the Senate floor when Congress returns from Thanksgiving break. What does this mean for you? Well, in addition to the usual charms of the holiday season -- crass commercialism, financial anxiety and over-packed schedules -- you can look forward to endless discussion of the Senate health-care bill framed in terms designed to terrify. For senior citizens who remember the Cold War, there will be lots of talk of socialism, as in how the public option amounts to such. For everybody else, fear will be draped on the bodies of women. As the men of the right seek to scuttle health-care reform, they will try to squelch women's autonomy through abortion language, even as they try to convince women that Democrats seek to get between them and their doctors.

Happy holidays!

 

Adele M. Stan AlterNet's Washington bureau chief.