Health-Care Deal Almost Sealed, But Will A Special Election Nix It?

Here is where things currently stand on the health care endgame:


  1. Breakthrough on excise tax.  Labor and the White house appear to have reached a deal on the excise tax.  Some details:
    Under the outline currently being discussed, which the sources stressed is still fluid, the threshold for the tax on insurance plans would be raised above what passed the Senate - which was a tax on insurance plans costing $23,000 and up for families.

    In addition, health care policies for state and local workers and health care policies negotiated by labor unions would not be subject to the excise tax until 2017.

    The sources also say a working idea is to remove dental and vision plans from the calculation.

    One of the sources familiar with negotiations said that in addition to protecting health plans negotiated under collective bargain agreements, labor leaders are pushing to expand the deal to exempt health plans for all Americans making under $200,000 a year.

  2. Regulatory reform.  Reportedly, the White House is backing the House of Representatives on including a national exchange instead of a state by state exchange, and on repealing the anti-trust exemption for the health care industry.  However, those discussions remain in flux, and deal has been reached yet.  No guarantee either way, right now.
  3. Reproductive rights?  No word on whether the final bill will contain the Stupak amendment (which would create a national ban on abortion procedures in insurance), or Ben Nelson's state opt-out language.  Pro-choice House members have been pushing for Nelson's language.
  4. Subsidies. The level of subsidies will be somewhere between the House and Senate bills.  Higher than the Senate ($871 billion in subsidies), but lower than the House ($1,052 billion in subsidies). Estimated at around $930 to $950 billion.
  5. Overall deal now imminent--Friday or Saturday. The excise tax was one of the largest remaining obstacles to a final deal between the House and the Senate.  The timeline for such a deal appears to be either tomorrow or Saturday, at which time the bill would be sent to the CBO for review.
  6. Timeline. The House will likely send a bill to the CBO on Friday or Saturday.  The CBO will reportedly take between 10 to 13 days to return a score on the bill.  From that point, it will take the House between one day and three days to pass the bill, and the Senate another three days.  All told, this means the final bill will be passed by the Senate as late as early as January 29th, and as late as February 4th.  The State of the Union address is on February 2nd.
  7. Coakley loss blows whole thing up--or does it?. With the Massachusetts Senate election on January 19th, and the Senate voting on the bill on January 29th at the earliest, it seems entirely possible that a victory by Republican Scott Brown would sink the whole deal...

...or would it?  As David Waldman writes, the Massachusetts special election would not be certified until February 20th, and Senate rules require certification to swear in a new member.  Republicans delayed Al Franken from taking his Senate seat for six months because of this, and Democrats could simply do the same to Republicans in order to pass the bill.

Also, as noted by multiple people in the comments, the House could theoretically just pass the bill that the Senate already passed, verbatim, and send that to the President.  That is one possibility, but I doubt the House has the votes for the Senate bill.  Some Progressives could be lost, and some conservative Dems would be scared off by a by a Brown win.  Republican Joseph Cao would probably be lost, too.  Stupak, and some of his acolytes, might also vote against it.  All in all, with only a three-vote margin, the Senate bill might not be able to pass the House.

Anyway, as I wrote earlier today, Coakley still has a 91% chance of winning.

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