Health care bill 2009: what happens next

President Obama hailed a key vote in the health care bill Monday morning. Several more Senate votes remain before a potential conference committee could take up the legislation.

Healthcare reform is very close to becoming the law of the land. But if it passes the Senate, as now appears almost certain, it still will have one last summit to climb if it is to make it to the White House for President Obama's signature.

That final obstacle? It's a congressional conference committee, where the Senate bill must be harmonized with the version of health legislation approved by the House in November.

The conference could be acrimonious. There are major substantive differences between the Senate and House bills. There's natural rivalry between the chambers, plus the pride of individual lawmakers who have worked hard on the issue.

Given all this, a hard shove from the White House might be necessary if health reform is to make it over the top.

"We're going to have to call on the president to get us through to reconciliation," said Rep. Elijah Cummings (D) of Maryland in an interview on MSNBC Monday. "He's got to be on a day-to-day, hour-to-hour basis working with us."

Reveling in their apparent victory, Senate Democratic leaders said Monday that they were taking the process day by day.

"We'll worry about the next steps at a later time," said Senate majority leader Harry Reid at a Monday afternoon press conference.

It is something of a Christmas season miracle, say proponents, that health-reform legislation has even made it this far. Only days ago, it appeared that Senate Democratic leaders might not be able to round up the 60 votes necessary to secure a filibuster-proof majority in favor of the bill.

But in the early hours of Monday, at the end of a marathon session, all 58 Democrats and the Senate's two independents held together in a crucial test vote.

This week, several more procedural votes will be taken on the bill – the earliest scheduled for Tuesday morning. But barring an unforeseen development, the bill itself should pass the Senate sometime during the evening of Dec. 24.

On Monday, Mr. Obama hailed the move, saying that it showed the Senate could stand up to special interests. In the long term, the effort could reduce the federal deficit, he said.

The vote was a "big victory for the American people," said Obama.

Whatever it was, it was not pretty. A frenzy of last-minute dealmaking secured the final margin. To please Sen. Joseph Lieberman (I) of Connecticut and other moderates, majority leader Reid ditched from the bill all vestiges of a public option, or government-run insurance plan. To win over Sen. Ben Nelson (D) of Nebraska, Reid toughened antiabortion provisions and included an extra $100 million in Medicaid payments for Senator Nelson’s state.

Former presidential candidate Sen. John McCain (R) said that this process was unsavory and in the end, the American people overall oppose current healthcare reform efforts.

“American public opinion doesn’t like it, and they’re very correct in not liking it,” Senator McCain said in an interview on ABC.

For healthcare reform to be forwarded to Obama for his signature, both the House and Senate must pass identical versions of the bill.

Right now, there are big differences between the House and Senate approaches. The House bill contains a public option; the Senate bill does not. The Senate bill contains a tax on high-value insurance plans; many in the House object to this idea. The House bill has tougher antiabortion language.

The venue in which these issues will be hashed out, the conference committee, is sometimes called the third chamber of Congress.

Senior leaders from both the House and Senate take part. Meetings are supposed to be open, but lots of bargaining takes place behind closed doors.

Members aren't supposed to add anything that isn't in either version of the bill, but in past conferences, it has happened. Thus the outcome of a heath-bill conference – the biggest such meeting in years – could be unpredictable.

"Conferences are marvelous," Alan Simpson, a former Republican senator from Wyoming, once said. "They're mystical. They're alchemy. It's absolutely dazzling what you can do."

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