With a change here and a discussion there, a healthcare reform measure appears to have inched its way closer to a starting point on the route to a final passage. However, there are several new twists.
Under the plan emerging Thursday, the House would first need to accept the bill that the Senate approved on Christmas Eve. To pass in the House, the bill will need 216 votes—a razor-thin margin, considering the House healthcare reform bill passed 220-215 in November. If the bill passes, in a vote that could occur next week, it would be signed by President Obama.
But then a second bill would go through the reconciliation process in the Senate with a series of "fixes." These fixes would include removing payments that favor some interests in the Senate bill (such as additional Medicaid funding to Nebraska).
Under discussion this week, the fix for healthcare reform could also include a measure that overhauls the nation's student loan program. Sen. Tom Harkin (D-IA), speaking Thursday at a joint House-Senate press briefing about this combination, predicted that the addition of this provision "will help us get some votes" for the healthcare reform bill.
Initially, Senate Budget Committee Chairman Kent Conrad (D ND) had opposed combining the education proposal, which could free up billions in federal subsidies to private lenders in the process of increasing funds for Pell Grants, saying it would trigger procedural challenges from the GOP. However, as of Thursday, he appeared to be changing his mind after a discussion with the Senate parliamentarian, who suggested in a preliminary ruling, that putting the bills together could work.
In a letter to Sen. Mitch McConnell (R-KY) Thursday, Senate Majority Leader Harry Reid (D-NV) detailed the steps that he said the Senate Democrats would take to move the healthcare reform legislation through Congress—starting with an "up or down simple majority vote to revise the health reform bill already passed by a supermajority of 60 Senators last December."
Also on Thursday, the Congressional Budget Office (CBO) released a new estimate on the cost of the Senate's healthcare reform bill. The CBO's previous estimate was based on the Dec. 19 version of the bill, the new one evaluates amendments that were included in the Dec. 24 version.
The CBO concludes that by 2019, the bill would reduce the federal deficit by $118 billion—a smaller amount ($132 billion) than the earlier estimate. The gross cost is put at $875 billion, which would be used to pay for subsidies, tax credits, and expansions of Medicaid and Children's Health Insurance Program.
But some of this would be offset by increased revenues from taxes on "Cadillac insurance" plans—making the net cost of the bill $624 billion. Other sources of savings, including a reduction in Medicare spending, would save an additional $702 billion, according to CBO.