For Obama, No Place Like Home

Health care reform is headed for a vote Sunday in the House, and President Obama has decided not to leave home without it. The president was scheduled to leave Sunday for a trip to Asia, but today he postponed that journey to June.

"Passage of health care reform is of paramount importance, and the president is determined to see this battle through," White House press secretary Robert Gibbs said.

The chances for passage may be helped the Congressional Budget Office’s preliminary cost estimates for the revised bill. Although CBO projects the bill would cost $940 billion over the next 10 years, it estimates the legislation would reduce federal deficits in that time frame by $138 billion. That’s $20 billion more than the deficit reductions achieved by the Senate’s bill. After 2020, the bill would lead to additional reductions in the deficit—at least $1.2 trillion over a decade, according to House Democrats.

“That makes this legislation the most significant effort to reduce deficits since the Balanced Budget Act in the 1990s,” Obama said.

The deficit reduction comes from a combination of spending cuts and new taxes.

House Speaker Nancy Pelosi said more than $500 billion would be saved by eliminating “waste, fraud, and abuse” in federal health care programs, primarily Medicare. Payments to insurance companies who participate in the Medicare Advantage program—which offers extra benefits and lower co-payment than traditional Medicare—would be slashed. Medicare benefits would not be cut, Pelosi said.

Individuals who make more than $200,000 would have to pay the Medicare payroll tax on unearned income, such as dividends and capital gains. This type of income currently is exempt from payroll taxes.

The revised bill includes more generous subsidies to help middle-income Americans buy insurance, makes Medicaid reimbursement to states more equitable by striking the Senate’s “Cornhusker Kickback” for Nebraska, and closes the so-called “doughnut hole” for Medicare prescription drug coverage. It also would delay the Senate-passed tax on high-end insurance policies until 2018.

CBO estimates that 32 million additional Americans would be covered by health insurance over the next decade as a result of the bill.

Republican budget analysts questioned whether the bill’s reduction in Medicare spending actually would occur. They also noted that Democrats also relied on changes in student loan programs—which were added to the bill even though they are unrelated to health care—to hit their deficit-reduction targets.

It’s still not clear whether Democrats have enough votes to pass the bill.

“We feel very strongly about where we are,” Pelosi said.

Obama’s decision to remain in Washington, however, seems to indicate that more arm-twisting will be required in order to secure the 216 votes needed to pass the president's top legislative priority.

The tactics Democratic leaders plan to use to to pass the bill remain under attack. The House will vote on a set of changes to the Senate bill that will be made under a budget-related procedure known as reconciliation. This means the revisions will need only 51 votes to clear the Senate, not the 60 needed to break a filibuster. Instead of voting directly on the Senate bill, which many House members dislike, the rule for the reconciliation bill will state that the Senate bill will be “deemed” passed if the reconciliation bill is approved.

Senate Republicans today warned the House that they plan to try to mount parliamentary challenges to many of the provisions of the reconciliation bill, contending they don’t qualify for this procedure.

In other words, they’re telling House members they shouldn’t count on the Senate going along with their fixes. If the House passes the reconciliation bill, it could—in the end—be stuck with just the Senate bill.

That’s not something most House members would deem to be wise.