Pelosi Maps Strategy for Approval of Health Care Overhaul Legislation

On Wednesday, House Speaker Nancy Pelosi (D-Calif.) said that if the Senate health care reform bill (HR 3590) is adjusted through the budget reconciliation process to address House members' concerns, she would be able to corral enough votes for the House to pass it, CongressDaily reports (Brownstein, CongressDaily, 1/28).

At the same time, House Democratic leaders are considering how to move smaller, stand-alone health care measures that would not be able to pass as part of the reconciliation process.

For instance, there could be a floor vote next week on a bill that would repeal the 1945 antitrust exemption on health insurance companies (Edney, CongressDaily, 1/28). Such a provision is currently in the House health reform bill (HR 3962) (Harris, Politico, 1/27).

Amending the Senate Bill

Pelosi identified several changes she would like to see made to the Senate bill through the budget reconciliation process, including:

• Removing the provision that would cover the full cost of a proposed Medicaid expansion in Nebraska;
• Addressing cost issues for residents who would be required to obtain health insurance under an individual mandate;
• Establishing the structure for the proposed health insurance exchanges; and
• Reducing the proposed excise tax on high-priced insurance policies.

Pelosi declined to discuss the issue of insurance coverage for abortion, saying, "Let's just say that's not the subject of our conversations at this time."

Speaking to reporters on Capitol Hill before President Obama's State of the Union speech, Pelosi said, "What I'm saying to you is the Senate bill, stand-alone, I don't see any chance of it (passing the House)," adding, "Reconciliation resolving some of the issues: then we can pass this thing."

Pelosi noted, however, that a majority of members in both chambers would have to agree to the package of amendments to the Senate bill before the House could hold a vote on the bill. "Whatever the order is, the whole thing has to be finished, reconciliation, House and Senate, before we take up the Senate bill," she added (Brownstein, CongressDaily, 1/28).

House's Amendments Draw Senate Criticism

House Democrats' package of amendments reportedly would drive up the cost of health care reform by $300 billion to just over $1 trillion and drew strong criticism from an unnamed senior Democratic Senate aide on Wednesday, Politico's "Live Pulse" reports.

The aide called the package "irrational" and an attempt by House Democrats to set "this bill up for failure."

According to "Live Pulse," eliminating the excise tax -- the Senate bill's primary financing mechanism -- would cost $150 billion.

Other changes include a $38 billion proposal to fill the Medicare prescription drug coverage gap and $23 billion for additional Medicaid subsidies, according to the aide (Frates, "Live Pulse," Politico, 1/27).