Why has Congress set a Christmas deadline for healthcare reform?

Until 8:30 a.m. on a snowy Saturday, few outside Senate majority leader Harry Reid's conference rooms knew exactly how he amended the $849 billion Senate healthcare bill in order to satisfy the nonpartisan Congressional Budget Office and the 60 senators needed to stop a potential Republican filibuster

Yet by 3:48 p.m. Saturday, Senator Reid had filed a key procedural amendment to end debate on the bill, with a formal voted scheduled for 1 a.m. Monday.

In those seven hours and 18 minutes, Senator Reid had finally won the 60th vote, with Sen. Ben Nelson (D) of Nebraska announcing his support, and Senate clerks had finished reading Reid's 383-page amendment aloud – a delaying tactic by minority Republicans.

Now, a bill that only days ago looked as likely to fail as succeed is on a fast track to pass by a self-imposed Christmas deadline.

But what is the rush to pass a bill that will impact one-sixth of the American economy?

House Speaker Nancy Pelosi told reporters Wednesday that not completing House and Senate bills before a break would be “very bad for the American people and very, very bad for us."

The prospect of losing momentum is what's driving Democrats to complete the bill even in the face of blizzards, late nights, and ruined holiday plans, says Ross Baker, a political scientist at Rutgers University in New Brunswick, N.J.

“At this point, momentum has a virtue, almost like a law of physics that has kicked in and is propelling this to a climax, and they don’t want to do anything to arrest that momentum, including a break,” he says.

August's town halls: lessons learned

For weeks, Democrats have been pounded by new polls reporting that public support for healthcare reform is below a majority and falling. Democratic leaders did not want their members to go home to face angry town hall meetings, as many did in August, without legislation in hand that will allow them to counter angry allegations with hard facts.

“It’s very hard to merchandise healthcare until we have a bill,” Speaker Pelosi added Wednesday.

Now, it seems, they might be able to.

Nelson's support makes passage of the bill through the Senate virtually assured. And the nonpartisan Congressional Budget Office released a score of the revised bill Saturday. With Reid’s changes, CBO analysts project that the bill would cut the federal deficit by $139 billion over 10 years.

Democrats responded by promptly beginning their offensive. “This is the greatest deficit reduction bill in the history of the United States,” said Sen. Richard Durbin, the majority whip, Saturday on the floor of the Senate.

From 2020 to 2029, "it will reduce the deficit of the United States by $1.3 trillion," he added. "At the end of the day, 94 percent of the people in the United States will have health insurance – the highest percentage in our history.”

The fine print

Meanwhile, lawmakers on both sides the aisle – and their snowbound staff – are digging into the details of the Democratic revisions for grist for the floor debates expected to run into Christmas eve.

Key changes include:

• Dropping a public option run by the Department of Health and Human Services in favor of multistate plans.

• Expanding the small business tax credit

• Increasing payroll taxes on higher-income workers

• Increasing penalties on individuals who don’t purchase mandated health insurance

• Dropping provisions to increase payment rates to physicians treating Medicare patients.

Senate Republicans aim to highlight the deals in the revised bill that favor some states over others.

“Democrats say they have 60 votes, but we’ll see after people read this bill,” says Don Stewart, a spokesman for Senate Republican leader Mitch
McConnell. In the revisions introduced today, “Virginia has to take second seat to Nebraska and Vermont, which both got extra Medicaid money,” he adds.

Just like the days of Wilbur Mills

Republicans hope to peel off Democrats like Sen. Jim Webb (D) of Virginia, who voted with Republicans on an amendment to drop proposed cuts in Medicare.
GOP moderates, such as Sen. Olympia Snowe (R) of Maine, pushed for more time to understand changes in the bill, build support across party lines, and propose amendments to improve the bill. But Democratic leaders say they have seen little evidence that Republicans, even with more time, would support this bill.

“What we saw in the floor in the last two hours is very reminiscent of how they passed Medicare in 1965,” says Julian Zelizer, a congressional historian at Princeton University in Princeton, N.J. “When [House Ways and Means Chairman] Wilbur Mills released the text of the bill, most committee members didn’t even know what he was about to do. It was a big surprise to everyone and that was standard practice in the 1950s and '60s.”

“It’s not democratic, but it facilitates doing things,” he adds.

Despite the closed door negotiations that produced the final version of this bill, leaks and the power of the Internet made the process this year more open than in the heyday of Wilbur Mills.

“To the chagrin of the White House, many of the deals that produced this legislation were up on the Internet within hours,” Professor Zelizer says.

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