Column: House vote on health reform is a big milestone but far from final word

Posted on November 8, 2009

The health-care bill the House planned to vote on this weekend had been hailed as a historic milestone in the decades-long effort to increase the number of Americans with insurance while slowing the growth in health-care spending. While the process toward that goal may seem byzantine and slow, the road ahead for proponents of Democrats' reform proposals likely will be even more difficult, with prominent roles played by members of the Tennessee congressional delegation. Even if a final health-care bill passes Congress in the near future, it will be awhile before voters begin to feel its impact. For those who haven't followed daily developments on health-care reform, here's a quick recap: The House Democratic reform legislation was introduced in July and was referred to three committees. The committees met nine times to amend and vote on the bills. Each panel then passed its own version of the bill. Democratic leaders melded the three versions into one bill, almost 2,000 pages long, that was released Oct. 29. In the Senate, Democrats on the Health, Education, Labor and Pensions Committee introduced a reform bill in June. It passed the committee in July. Sen. Max Baucus, D-Mont., chairman of the Finance Committee, released an outline of his proposal in September. That proposal eventually became the 1,500-page bill that the Finance Committee later approved. After the House vote, the next step is for the Senate to act. But Democratic leaders there say they may not get around to voting on a bill until next year. That's partly because the Senate has other legislation to deal with this year. But it's also because Senate Republicans have more weapons than their counterparts in the House to delay or kill legislation. In the Senate, Democrats need 60 votes, not just a simple majority, to overcome the threat of a GOP filibuster. That's why most observers say it will be the Senate that ultimately decides the fate of health-care legislation. Vote may not hurt Democrats Whatever the Senate passes will be different from the House bill. At that point, a conference committee with members from the House and Senate will negotiate a compromise bill that will be sent back to both chambers for a final vote. The compromise bill is supposed to contain only provisions already approved by both the House and Senate, but new provisions could be inserted at the last minute. Sen. Lamar Alexander, the No. 3 Republican in the Senate, will play a lead role in opposing the legislation. So will Republican Rep. Marsha Blackburn of Brentwood in the House. The four moderate Middle Tennessee Democratic House members — Reps. Jim Cooper of Nashville, Bart Gordon of Murfreesboro, Lincoln Davis of Pall Mall and John Tanner of Union City — will be targeted by proponents and opponents of health-care reform. Some analysts contend that delaying Senate action until 2010 would harm House Democrats facing re-election later in the year in conservative districts. But Bruce Oppenheimer, a professor at Vanderbilt University, doesn't think the Middle Tennessee House members, all members of the fiscally conservative Blue Dog Coalition, would be affected. Any legislation emerging from negotiations with the Senate would be more moderate than the original House version, he said. So House members who voted for the original bill would feel safe voting for the final legislation, and other members wouldn't be crucial to passing it. "In a nice way, I am saying that once the House passes its version of the bill, the Blue Dogs become largely irrelevant," Oppenheimer said. The House health-care bill would create a temporary insurance program that would offer coverage to some people almost immediately. But most major provisions — such as expanded Medicaid coverage and an insurance exchange in which low-income people could use government subsidies to buy coverage — wouldn't kick in until 2013.