- The Washington Times - Sunday, August 2, 2009

Five congressional panels have wrestled - some for hours, some for months - with whether to include the creation of a public health insurance program in their reform legislation. But as Congress breaks for its August recess, the real battle over the measure may not have even started, even as the rhetoric continued.

President Obama on Saturday urged lawmakers to “seize this unprecedented opportunity for the future of our economy and the health of our families,” while Republicans continued their opposition to Democrats’ various plans.

The five congressional committees that have written a portion of the bills - three in the House and two in the Senate - are working on different tracks, each crafting a plan different from the others.

Eventually, they will have to be combined, creating the potential for massive squabbles that could take place in small committees, behind closed doors, with the chance of overriding previous compromises as long as the votes are there.

The most significant differences likely will revolve around the public health insurance option. The program, which would establish government health care coverage, is supported by Democrats who say it will provide competition for private insurers, and it’s opposed by Republicans who say it will lead to rationed health care. Both call it a deal breaker. Particularly in the Senate, the different versions are also likely to contain different payment plans and mandates.

Funding was the key criticism made Saturday by Sen. John Thune, South Dakota Republican. He highlighted the cost of the overhaul, saying it could end up creating $45 million annually in new state spending. That money, he said, will “have to come from somewhere, and that means either higher taxes or cuts to other priorities.”

The various steps in the legislative process sound mundane, but with a bill as complex and broad as health care reform, each step could pose a significant barrier to passage.

“My sense always has been, just keep moving the ball forward,” said G. William Hoagland, vice president of public policy at insurance company Cigna Corp. and ex-budget aide to former Senate Majority Leader Bill Frist. “Because, if you get down to a conference between the House and the Senate, that’s really where the hard negotiations would take place. That’s where the vote-counting has to take place.”

The three House panels and one of the Senate committees would establish the public option. But the Senate Finance Committee is likely to shun it in favor of establishing insurance co-operatives, a compromise designed to get Republican support.

That support will be crucial in the Senate. While Democrats have 60 seats, two members have been ill and may not be able to vote. Also, President Obama and congressional leaders say they want to pass a bipartisan bill.

So the merger of the Senate bills will put the public option to its first test. Some Democrats on the Health, Education, Labor and Pensions Committee are prepared to fight for it, but the Finance Committee, which has been furiously negotiating a bipartisan plan for months, isn’t likely to let go of its work easily, either.

Sen. Michael B. Enzi, Wyoming Republican and one of the six negotiating a plan in the Finance Committee, said he would like an assurance from Senate Majority Leader Harry Reid that the payment methods in the Finance plan, called “pay-fors,” won’t be combined with the more liberal policies of the health committee.

“I’m not interested in solving the pay-fors so that the [health] committee’s tragic bill could be the lead line,” said Mr. Enzi. “I need those assurances to know what we’re doing isn’t just providing the pay-fors for a very liberal bill.”

Mr. Reid, who will be responsible for merging the two plans, said Thursday that he’s not going to “jam” any bills through.

“I know how to count to 60,” he said. “And the point is, we need 60 people to get a bill done - I’d like to have a few more than that. So anyone that is intimating that this is going to be all the [health] committee bill or all the Finance Committee bill does not know how to count to 60.”

The Senate also could come up with some kind of combination of the public option in the health committee with a co-op.

“If they put those two together, I think you’re going to lose bipartisan support in the Senate from Republicans,” said Mr. Hoagland. “You end up back in the soup, where you’ll have to depend 100 percent on the Democratic senators. I don’t think there’s 60 senators there.”

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