Decision Time on Health Care

President Barack Obama signs H.R. 4691, Temporary Extension Act of 2010, in his private office in the residence of the White House, March 2, 2010.

Image: Official White House Photo by Pete Souza

President Barack Obama today asked Congress to vote on health care reform legislation “in the next few weeks.”

“Everything there is to say about health care has been said and just about everyone has said it,” Obama said. “So now is the time to make a decision about how to finally reform health care so that it works, not just for the insurance companies, but for America’s families and businesses.”

This decision, he said, should be made through an “up-or-down vote,” meaning the bill should not be subject to procedural rules that require 60 votes to move most major legislation in the Senate. Lowering that threshold to a simple majority would make it far easier to pass the bill in the Senate, since Democrats now only have 59 votes in that chamber.

To avoid the 60-vote requirement, Senate leaders would have to use a procedure known as reconciliation, through which measures related to the federal budget can’t be filibustered. Using this tactic, however, could be problematic since many of the most popular pieces of health care reform -- such as forbidding insurance companies from denying coverage to Americans because of pre-existing conditions -- aren’t budget-related and therefore wouldn’t appear to be eligible for reconciliation.

Senate Minority Leader Mitch McConnell, R-Kentucky, said Republicans would “scrub the bill thoroughly” and object to any provisions that aren’t eligible for consideration through reconciliation. By using this tactic, Democrats are asking their members of Congress to “ignore the wishes of the American people,” McConnell said. He contends most Americans oppose the legislation.

As the president spoke, Democratic leaders in Congress were working with White House officials on a final version of the legislation.

“We are moving ahead with a version of the health care reform bill which we believe has a good chance of passing both the House and the Senate,” Majority Whip Richard J. Durbin, D-Illinois, told Congressional Quarterly.

The president today talked about the legislation only in broad terms: It would “end the worst practices of insurance companies,” he said, “and give uninsured individuals and small business owners the same kind of choice of private health insurance that members of Congress get for themselves” by creating new insurance exchanges.

Tax credits would help lower-income Americans and small businesses afford health insurance, he said.

The president said his proposal also incorporates some Republican ideas, such as increasing grants for state demonstration projects on alternatives to medical malpractice lawsuits.

Obama said, however, that he and Republicans have “a fundamental disagreement” over how much the government should regulate insurance companies. Many Republicans, he said, “believe the answer is to loosen regulations on the insurance companies -- whether it’s state consumer protections or minimum standards for the kind of insurance they can sell,” he said.

“I’m concerned that this would only give the insurance industry even freer rein to raise premiums and deny care,” Obama said.

The president also rejected Republican calls to start over on health care reform.

“I do not see how another year of negotiations would help,” he said.

House Minority Leader John Boehner, R-Ohio, said the president “made clear he is willing to say and do anything to defy the will of the people and force his job-killing health care plan through Congress.”

Boehner said “the final battle” over health care reform will be in the House, “and if the American people stay engaged, we can win this fight.”

If the president does succeed in getting his health care reform passed, “every election in America this fall will be a referendum on this issue,” McConnell said.