The health care debate resumes in earnest on Tuesday after more than a week of quiet following Senate passage of its landmark bill on Christmas Eve.
The four relevant House chairmen will meet with Speaker Nancy Pelosi and her leadership team at 1 o'clock in the speaker's Capitol office to start setting the parameters for negotiations with the Senate.
Then, Pelosi and House Majority Leader Steny Hoyer (D-Nev.) will head to the White House for an early-evening meeting with President Barack Obama to discuss the final bill, according to Democratic officials. Senate Majority Leader Harry Reid (D-Nev.) and party Whip Dick Durbin (D-Ill.) will participate in the meeting via conference call because neither has returned to Washington from the holiday break.
House negotiators have their work cut out for them because Reid – and his wavering moderates – will be reluctant to make any changes that would upset the fragile accords that paved the way for last month's historic, hard-fought, party-line vote to approve the Senate bill. This spells trouble for the public option, but there are plenty of other substantive differences between the two bills that could give House leaders a foothold to make other changes.
Democrats in the House are expected to push for increased subsidies for the lowest-income Americans who don't qualify for Medicaid. On the eve of the Senate vote, Democratic aides in the House also suggested they would push for a blend of new taxes to help pay for the subsidies and new programs created by the bill. That could include a tax on high-end insurance plans at a higher threshold organized labor could accept along with a tax on the wealthiest Americans.
But House aides acknowledge they don't have much room to maneuver. For starters, congressional negotiators need to keep the final 10-year price tag below $900 billion, forcing Democrats to pick priorities, since the House bill costs more than $1 trillion compared with a Senate measure that would cost an estimated $871 billion over the next decade.
House leaders also want the Senate to adopt a national insurance exchange, instead of the state-by-state exchanges established under the Senate bill, and add tougher mandates for employers and individuals. And, of course, Democrats get another chance to spar over the public option, coverage for abortion and whether illegal immigrants can purchase insurance through the exchanges.
Other issues are sure to pop up. For example, Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) wants to squeeze more money from drugmakers by reimbursing them at a lower rate for seniors who qualify for both Medicare and Medicaid, and a pair of senators is pushing to include more money for the state-run Children's Health Insurance Program, while the House bill would fold it into the new exchange program.
Congressional Democrats are embarking on an abbreviated negotiation to save Reid the hassle of overcoming more procedural hurdles, but that means the resulting negotiations will be held behind closed-doors as the various stakeholders push for final changes. Liberal Democrats in the House have taken exception with the revised process, but most aides argue a drawn-out conference negotiation would give Senate Republicans too many opportunities to derail the process.
The White House is expected to take a very active role in melding the two bills after keeping quiet publicly during negotiations in the House and Senate. Obama's top aides took a much more hands-on role crafting the Senate bill, so it includes administration priorities that the House bill lacks, like the tax on high-end health care plans and language giving an outside panel the authority to increase efficiency and advocate cost-containment under Medicare.
They also want to make sure congressional negotiators wrap up work as quickly as possible so the administration and its congressional allies can turn their attention to the economy and job creation. That means bartering with lawmakers on other issues. According to TalkingPointsMemo, the Congressional Hispanic Caucus might relent in their push to let undocumented immigrants buy insurance on the exchange if the president pushes a comprehensive overhaul of the country's immigration laws – one that grants immigrants who seek a path to citizenship the right to purchase this insurance.
During the Tuesday session, the speaker is expected to set loose parameters for the abbreviated conference negotiations with the four chairmen with jurisdiction over the final legislation, Waxman, Education and Labor Chairman George Miller (D-Calif.), Rules Chairwoman Louise Slaugher (D-N.Y.) and Ways and Means Chairman Charlie Rangel (D-N.Y.).
Democrats are also scheduled to hold a caucus meeting on Thursday at noon in the Capitol. But since few lawmakers are expected to be in town to attend, party leaders are setting up a conference call that will give every member a chance to participate in the dialogue and hear how the process will work. Aides suggested Pelosi might even walk her members through some of her early priorities for the final bill. The speaker also wants to hear from her members frequently as the process moves along.