Congressional Democrats and the president have been spending the past few weeks discussing how to move forward with some version of healthcare reform. In public, both the president and congressional leaders have been adamant in their claims that they will be going forward with healthcare reform. Reports of private conversations suggest less certainty about both the strategy and the timing of next moves.
Whatever the political uncertainties, it is clear that the challenges that have been identified during the debates--15 percent of the population without health insurance, unsustainable spend growth rates, and unacceptable measures of clinical outcomes and patient safety measures remain with us.
Congress has a limited number of options that seem viable for the short term. The most obvious is not passing any new legislation or, at most, passing only minor pieces of proposed health-related legislation, such as the repeal of the McCarran-Ferguson antitrust exemption, as has been mentioned by the Speaker of the House Nancy Pelosi (D-Calif.). Another possible option for congressional Democrats is to use the reconciliation process to pass a modified version of the Senate bill. And a third is for them to attempt to construct a new bill that can gain 60 votes in Senate and that the House can agree to support.
The use of the reconciliation process seems unlikely on several fronts. First, many aspects of healthcare reform are unrelated to the budget and thus "off limits" in reconciliation, which is restricted to budget-related issues. Moreover, the public, which is already incensed by what it regards as too many "back-room deals" in health care, is likely to be further angered by the...