The House Goes on a Diet – Are We at the Crossroads or the Divide?

Speaker Nancy Pelosi (D-CA) – not to be outmaneuvered by the Senate – has been working for several weeks to negotiate internal House disputes over the shape of the final healthcare reform package.  It’s increasingly clear that meeting the President’s targets will only occur by slicing billions of dollars from each of the three $1.2 trillion bills approved by House panels in July.  To prepare for the House diet, I noted last week that Pelosi asked the CBO to analyze the House’s competing versions for a slimmed-down bill that would extend health insurance coverage to millions of Americans ~ aka the modified public option.

The CBO delivered the report privately this week to Speaker Pelosi and the House leaders. In essence, a modified public option will cost around $859-$905 billion over the course of the next decade with the lower mark representing an option put forward by the Moderate Democrats supporting a dramatic expansion of Medicaid and the latter, by those supporting a national public option program. 

Brendan Daly, a Pelosi spokesperson, noted, “… the coverage provisions of the House bill will be under $900 billion, and we will have a public option.” Daly stated that “no final policy decisions have been made on how to proceed.” Long story short, we are at the juncture.  Do the Democrats come together, or do they go down different paths? 

A key item to consider is that the new CBO score for the House proposals does not take into consideration the impact either plan will have on the federal deficit.  There is looming concern related to the magnitude of the nation’s deficit.  Most predict that despite any positive CBO scores, not a single Republican will support the House Democrat leadership for including a public insurance plan.  Despite the rhetoric, even if no Republicans or Blue Dog Coalition Democrats supported the legislation, Pelosi could get the votes to pass healthcare reform legislation due to the overwhelming majority of liberals in the House.   But, is that what Obama wants?  Is that what Obama needs?  The bipartisan mantra continues to hum in the background…

The debate is clearly headed towards a path of potential division between the liberal and moderate wings of the Democrat Party.  While we could be on the path of a clash between the wings of the party, I anticipate President Obama will weigh in and – with the gravitas of the Oval Office – set the course for discussions.  I predict his position will weigh in the direction of the Moderates.  After all, it is Snowe-ing in …

Kevin Fickenscher, MD

The views and opinions expressed herein are my own and do not necessarily represent the views and opinions of Dell Perot Systems or its affiliates.