Healthcare reform: Now, the hard part

The Senate health committee approved a healthcare bill and the House introduced a more ambitious one. How will they be reconciled?

Healthcare reform legislation, President Obama’s top domestic priority, has now made it over some difficult obstacles. But it still faces a long road before it becomes the law of the land.

On Wednesday, the Senate health committee approved its version of legislation expanding insurance coverage to nearly all Americans. This came on the heels of Tuesday’s unveiling of a House health bill by Speaker Nancy Pelosi (D) of California and other Democratic leaders.

Now, the hard part begins. In the Senate, the health panel’s bill must be melded with the work of the Senate Finance Committee, which is drawing up methods to pay for the $600 billion measure. The House bill will be split up and handed for approval to three committees, before it can proceed.

There will be a lot of late nights on Capitol Hill over the next few weeks if both House and Senate are to pass their versions of healthcare reform by August, as Mr. Obama says he wants.

Wednesday’s Senate committee action “should give us hope, but it should not give us pause,” said Obama in a statement. “It should instead provide the urgency for both the House and Senate to finish their critical work on health reform before the August recess.”

Even if the August goal is met, some difficult political dealmaking will remain undone. The Senate legislation is less expensive and less ambitious than the House version. Reconciling the two will involve some contentious and longstanding healthcare issues.

Specifically, should the final legislation authorize a public insurance option, as the House bill now does? Should it be paid for by a tax on the wealthiest Americans and a levy on employers who do not provide their employees with insurance, as the House bill suggests?

“Today marks a major step in this long journey of ours,” said Rep. John Dingell (D) of Michigan Tuesday. “However, it is not the last step.”

The Senate health committee approved its version of healthcare reform on a 13 to 10 party line vote. The measure would require all Americans to get health insurance, and employers to contribute to the cost.

The federal government would subsidize coverage for individuals and families with incomes up to four times the federal poverty level, or about $88,000 for a family of four.

Sen. Mike Enzi (R) of Wyoming, the ranking Republican on the committee, denounced the speed with which the legislation had moved through the panel, and noted that it passed on straight partisan lines.

The bill “kills jobs and cuts wages,” said Senator Enzi.

Senate Majority Leader Sen. Harry Reid (D) of Nevada said he would like a full Senate floor debate on the bill to begin a week from Monday.

That may be an ambitious goal. The Senate Finance Committee is still struggling to reach consensus on how to pay for the bill.

The House bill would cost an estimated $1.5 trillion over ten years. It would be funded by higher taxes on the wealthy and businesses, and by squeezing excess costs out of the health system.

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