Health reform rests on public

WASHINGTON – Democrats are calling the Senate’s health care bill a first big step toward insuring more Americans and controlling costs, while Republicans counter that it’s the first step toward bigger government and higher taxes.

The two parties are locked in a fierce battle to sway public opinion, and whoever wins it will win the health care struggle, which now looks likely to stretch into 2010.

The next legislative step is expected at about 7 a.m. today, when the Senate plans to take a second vote on cutting off a Republican-led debate on the Democrats’ $871 billion plan. The first effort passed 60-40 early Monday on a straight party-line vote.

If the Senate passes the bill later this week, as expected, negotiators from both chambers of Congress will begin trying to reconcile the Senate measure and one the House of Representatives passed last month.

One threat to eventual passage is the public’s view of the legislation, said Paul Ginsburg, the president of the Center for Studying Health System Change, a nonpartisan Washington research group.

It could take several weeks for the conference to produce a bill, and “that’s a long time for public opinion to shift,” he said, and its success, particularly in an election year, will depend on “how this plays out with the public over the next few months.”

Signs of what could happen next are mixed.

“There’s pretty broad agreement on a lot,” said Elizabeth Carpenter, a health policy analyst at the New America Foundation, a center-left Washington research group.

Under both bills, insurers would be barred from rejecting anyone because of pre-existing conditions. Gone, too, would be the practice in many states of charging women more than men, and insurers would be limited in how much they could increase rates on older people.

Consumers would be able to shop for coverage through exchanges, much as they now scan the Internet for the best airline fares. Most people would have to obtain a certain level of coverage, and they would have to pay penalties if they fail to do so.

Both houses agree on financial help for people having trouble affording coverage: They both would provide aid to families earning up to about $88,000 per year.

What could derail the entire effort are areas in which Democratic leaders have struggled for months to find common ground: abortion, taxes and the public option.

Ultimately, Democrats will write the final bill, because they control 60 Senate seats – enough to cut off extended debate – and 258 of the House’s 435 seats. However, that means appealing to the approximately 52 moderate-to-conservative Blue Dogs in the House, as well as to the eight to 12 centrist Democrats in the Senate.

That’s likely to mean important concessions on the three big sticking points.

Already, liberals’ yen for a government-run insurance alternative and giving women more access to elective abortions faded when moderate senators balked.

Sen. Ben Nelson, D-Neb., who over the weekend provided the crucial 60th vote to cut off debate, explained a big reason he went along: “The Senate health care bill is not perfect. Yet it doesn’t include a public option or taxpayer funding of abortion I worked to exclude.”

One of the public option’s biggest boosters, Sen. Russell Feingold, D-Wis., realized that without the moderates, the entire health care bill could be defeated.

“While the loss of the public option is a bitter pill to swallow, on balance the bill still delivers meaningful reform, and the cost of inaction is simply too high,” he said.

What all this means, said Barbara Kennelly, the president of the Committee to Preserve Social Security and Medicare, is that bill supporters need to be reminded, “This is truly an opportunity to begin health care reform.”