Healthcare Reform Passage Could Come Down to Three Ifs

After a year of debate, a healthcare reform decision may actually happen in the next two weeks.

To provide assurances that the bill would go through the House, President Obama has delayed his trip to Australia, Indonesia, and Guam by three days to next Sunday. But it may take responses to a number of "ifs" as to whether the reform provision will move ahead.

If support is there to achieve a majority vote in the House.
The number "216" viewed is the magic number for passage of the Senate bill (HR 3590) in the House and it will be an extremely tight vote. A vote is anticipated by the end of the week.

Presidential advisor David Axelrod, speaking Sunday on CNN's State of the Union, said he thinks the votes are there "to pass this."

The White House is "very optimistic about the outcome of this process," he said. "I think people have come to the realization that this is the moment."

If Congress fails to move forward on the bill, he said, "There will be dire consequences for people all over this country in terms of higher rates."

However, as of Sunday morning, the votes were not there, said House Majority Whip James Clyburn (D-SC), speaking on NBC's "Meet the Press." "But we've been working this thing all weekend; we'll be working it going into the week."

He added, "I think we have gotten to a place where we do have the way to do it, and I think the members are going to, to vote for this."

Nevertheless, House Minority Leader John Boehner (R-OH) said, "I don't have enough votes on my side of the aisle to stop the bill. But I, along with a majority of the American people who are opposed to this, can stop this bill. And we're going to do everything we can to make it difficult for [the Democrats], if not impossible to pass the bill."

If the Senate can assure the House it will take up the House's reconciliation bill before the House votes on the Senate bill.
In a separate move, the House will create a reconciliation measure "fixing" provisions in the Senate bill. The votes for the fixes will be cast in the House Budget Committee starting this afternoon.

Rep. Chris Van Hollen (D-MD), assistant to House Speaker Nancy Pelosi (D-CA), said on "Fox News Sunday" that, "We need some absolute guarantees from the Senate. We need to be absolutely assured that at least 51 senators there will support the package of changes."

This could take a form of a letter or a statement from the President that "he has conferred with 51 senators and they're all on board. ... It has [to] provide assurances to enough House members that they will follow through, because we want to change the Senate bill."

Among the "fixes" the House is expected to seek are:

• Changes in the provisions addressing high-price or "Cadillac plans"
• Removal of special provisions for Florida Medicare Advantage and Nebraska Medicaid populations
• Increased Medicaid funding for the states
• Increased subsidies for the uninsured individuals

In addition, an overhaul of the student loan system will also be included.

If the Senate debate will be minimal after the House passes a reconciliation measure.
Under reconciliation rules, there can be no filibusters. However, both Democrats and Republicans can add amendments, as Sen. Lamar Alexander (R-TN) underscored in an interview on CBS's "Face the Nation," and it could take some time.

"All 41 Republican senators have agreed that we're going to enforce the rules of the Senate, which means, for example, that the only things they can change have to do with taxing and budget."

"We're going to go sentence by sentence through the 3,000-page bill to make sure the rules are followed. That's what the American people would expect us to do," he said.