The waiting is the hardest part

Don't worry, Senate Democrats and the White House say, healthcare negotiations will be done soon enough

By Mike Madden

Published October 21, 2009 7:05AM (EDT)

Negotiations on healthcare reform legislation have reached a stage that's disconcertingly common on Capitol Hill -- one with few visible signs of actual progress, plenty of reassurances from the people involved that everything is going just fine, and a lot of waiting around for everyone else.

Days after the Senate Finance Committee finally handed its version of the healthcare bill off to the rest of the chamber, Democrats haven't yet figured out how to merge two different proposals in order to move the legislation along to the next step: debate and, the White House hopes, a vote on the Senate floor. "We're continuing to make progress on merging the two bills," Senate Majority Leader Harry Reid, D-Nev., said Tuesday. "We've had a number of meetings. We worked very hard on Thursday. Our staffs worked all weekend -- and I mean all weekend, early in the morning till late at night."

But all that work, concentrated in Reid's office on the second floor of the Capitol, hasn't yet led to consensus. After the party's weekly caucus lunch Tuesday, lawmakers said they didn't even talk much about healthcare reform specifically; instead, they focused on pending legislation to change the way doctors get reimbursed by Medicare, which involves some policy questions that intersect with the reform bill, but isn't directly related to moving President Obama's top domestic policy priority. Reid -- who had little luck trying to force the Finance Committee to speed up its work over the summer -- now seems to be in no hurry at all. "I'm going to do it just as quickly as I can, with the legislation being as quality as it can be," he said. "I hope to get something to [the Congressional Budget Office] soon, but that's a relative term. We'll see."

The message from the administration and Senate leadership was pretty upbeat, regardless. "It's going very well, and I can't overemphasize the number of elements where there is agreement between the two committees," said Nancy-Ann DeParle, the top White House health policy advisor. "So, in fact this is actually an easy process and one that's going really well." Other Democrats who aren't even part of the talks struck the same tone. "We all know what the pieces are, it's just how it's getting built," Sen. Claire McCaskill, D-Mo., told Salon. "Which building blocks are getting in and which are being changed and modified."

The chief moving part, of course, is what to do about a public insurance option. The Finance Committee bill doesn't have one; the more liberal Health, Education, Labor and Pensions Committee bill does. Progressives in the Senate are adamant that a majority of the Democratic caucus supports a public plan to compete with insurance companies, but a handful of moderates and conservatives who need to sign off on the bill to prevent a Republican filibuster aren't convinced of the idea's merits yet. The GOP, though Reid continues to bash them constantly for lining up with insurance companies instead of regular people, is more or less out of the picture -- this one is an intramural problem for Democrats now.

Asked Tuesday whether the talks were leaning "toward or against" a public option, Reid picked option 3. "We're leaning toward talking about a public option," he said. "We have -- no decision has been made. We had a -- not a long discussion last night on public option. I've had a number of meetings in my office dealing with Democrats and Republicans on the public option aspect of it. And when the decision's made to send this on to the [Congressional Budget Office], I will have made a decision as to what we're going to do with the public option. It's not done yet."

Momentum, though, did seem to be shifting toward the public option, even if it's shifting slowly. A Washington Post-ABC News poll published Tuesday showed 57 percent of respondents want the public plan. Conservative Democrats who once scoffed at the idea now sound like they're thinking about it differently; Ben Nelson, of Nebraska, used to be dead-set against a public plan, but he said Tuesday he "absolutely would" favor the plan if individual states got to decide whether to offer it or not. Nelson was also meeting in groups with other moderates who support phasing the public option in on a "trigger," only if the other changes in the reform legislation don't bring insurance premiums down. Privately, some aides say that might wind up being a more likely solution to the impasse than the opt-out plan, because Sen. Olympia Snowe, R-Maine -- who could be the only GOP vote in either the House or Senate for the healthcare plan -- supports it.

There are plenty of reasons to believe the assurances coming from the negotiators that things are going fine. The legislation out of both committees would set up an insurance exchange system for people who don't have coverage through their jobs or for small businesses that can't afford to offer it, with subsidies to help pay for the policies; ban insurers from denying coverage based on preexisting conditions or from dropping patients from the rolls once they get sick; and encourage some shifts toward tying payments to outcomes, as opposed to simply covering whatever procedures doctors order. But there are still some big outstanding issues, beyond the public option, which will need to be dealt with eventually -- how to pay for the subsidies, for instance, and whether to mandate that employers offer coverage to their workers.

So the "don't worry, all is well" mantra coming from Democrats didn't exactly keep progressive groups who support the reform proposals from worrying. The Democratic National Committee's Organizing for America besieged the Capitol with more than 200,000 phone calls to push the plan through. That was twice their original goal of 100,000, which they hit by 2:15 p.m. Eastern. "This is unreal," DNC spokesman Brad Woodhouse said. Other reform supporters rolled out new ads bashing insurance companies.

By nightfall, the major players involved -- Reid, White House aides, Sen. Chris Dodd, D-Conn., and Sen. Max Baucus, D-Mont., representing the two committees -- were back at it for another meeting. They'll be done eventually, they promise. Just don't ask them to tell you when. For now, at least, the process doesn't seem to have exhausted Washington's patience -- yet.

Mike Madden

Mike Madden is Salon's Washington correspondent. A complete listing of his articles is here. Follow him on Twitter here.

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Democratic Party Harry Reid Healthcare Reform U.s. Senate