It has become easy – too easy – to believe that health care reform legislation will finally pass and make its way to the president’s desk within, at most, several months. The House narrowly approved its version of the reform bill in a historic vote just over two weeks ago. Senate Majority Leader Harry Reid (D-Nev.) finally unveiled the merged product of two competing Senate bills last week, and the first procedural vote to bring the bill to the floor cleared the 60 vote majority hurdle on Saturday night.
But the work is hardly complete. Disagreements on the issue remain, and strike at the heart of ideological tensions within the Democratic Party, as well as at the nature of health care reform itself.
As might be expected, one of the central areas of contention I am referring to is abortion. The other, although it is less obvious, may be just as difficult to resolve: cost vs. coverage. There are no easy answers, but I suggest some tough calls that could move the bill toward final passage.
Let me first clarify that the Senate has not yet passed a bill. The vote on Saturday simply overcame a Republican Party filibuster that was blocking the bill from coming to the Senate floor. In the House, Speaker Nancy Pelosi (D-Calif.) was able to release her draft and hold a vote roughly within a week. Reid, on the other hand, faces a complex web of procedural motions, nearly all of which will require him to hold his 60-vote caucus together. With Senators Joe Lieberman (I-Conn.), Blanche Lincoln (D-Ark.), and Nelson (D-Neb.) threatening to oppose the bill unless amended – and the requirement to find sixty votes for any amendment – the bill’s outlook is actually quite bleak.
Assuming that Reid accomplishes one of the greatest legislative feats in U.S. history and passes his proposal, the abortion fight awaits. The language of the Senate bill is far more permissive of abortions than the House bill is; the Stupak amendment of the latter bans federal funding for abortions.
Though pro-choice House Democrats held their noses and voted for the restrictions in the House bill, many claim that they will not support Rep. Bart Stupak’s (D-Mich.) controversial language in the final bill. Pelosi believes that allowing Stupak and his pro-life cohort to make their stand once may have been enough to secure their ultimate support.
But that is a highly optimistic assessment. The U.S. Conference of Catholic Bishops – representatives of which played a significant role in the negotiations of the final House bill – has said that it will not support anything less. And from the perspective of pro-life members, it makes sense to take a hard line. The House bill, without the Stupak language, would vastly expand the ability of currently uninsured women to afford abortions.
Pro-choice Democrats act as if this stance comes as a surprise. But pro-lifers regularly advocate far more restrictive abortion policies. They seek to overturn Roe v. Wade, and many would support a full ban on abortion. Furthermore, the pro-life block has a solid majority in the House.
It is for these reasons that, if the final bill must embrace Stupak to pass, Democrats should take the plunge. The pro-life lobby has made steady and significant progress over the last decade. That pro-choice supporters – who only recently seem to have awoken to their plight – are having a collective freak-out is no excuse to kill the most significant victory for progressives since Medicare.
Throughout the reform debate, two factors have motivated policymakers: the moral imperative to provide universal coverage and the economic necessity of reducing unsustainable health care inflation. Ideally, the bill should tackle both, but, thus far, that has been a daunting task.
The Senate bill is better on cost-efficiency. Much of the funding comes from a tax on “Cadillac” health plans. Over the long term, this tax will persuade businesses to stop offering excessive benefits that encourage people to gorge on unnecessary health services. The House bill simply levies a tax on millionaires.
Yet the Senate bill’s subsidies are meager. Poor Americans may still struggle to afford premiums even with new subsidies. That is one reason the Senate bill is so much cheaper than the House proposal, which costs about $250 billion more over 10 years.
In the conference committee that will seek to bridge the differences between the House and Senate bills, negotiators will have to resolve the cost-coverage tension. The House seems unlikely to embrace the Senate funding mechanism. The Democrats’ union allies have stood in the way of effective cost-control measures, like taxing health benefits, even if limited to the most expensive plans.
In the end, Democrats should remember what drove them to prioritize health care in the first place. As much a threat as spiraling costs pose, many progressives fundamentally believe that every American should have health coverage. And, realistically, the Senate’s cost measures are limited compared to what is needed for long-term cost reduction.
In the short term, the long-elusive goal of health care reform cannot wait. But the work of true reform must also continue into the future.
Sam Harbourt is a senior in the School of Foreign Service. He can be reached at harbourtthehoya.com. The Pragmatic Progressive appears every other Monday at www.thehoya.com.
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