Three ways healthcare reform could pass even if Coakley loses

It’s an extraordinary political situation: The fate of healthcare reform now may be determined by the outcome of Tuesday’s Senate election in Massachusetts.

If Republican Scott Brown beats Democrat Martha Coakley in the special ballot to fill the late Sen. Edward Kennedy’s seat, as now seems possible, the GOP would have 41 Senate votes. That would be enough to block final passage of the House-Senate compromise on healthcare legislation that Democratic lawmakers are now negotiating under President Obama’s oversight.

If this happens, Democrats basically have three options:

1. TALK FASTER. House and Senate Democratic leaders could cobble together a final package at a more rapid pace and push it through both legislative chambers before the new Senator Brown is seated.

Pros: This would enable Democrats to settle their differences in the manner they had originally planned. Liberal House members would get their chance to move the final legislation leftward from the Senate’s more conservative version.

Cons: This method could also make Mr. Obama and other Democratic party leaders look as if they are thwarting the will of the people – specifically, the will of the people of Massachusetts – by acting before the new senator is sworn in. And Republicans might sue. Conservative commentator Fred Barnes, editor of the magazine the Weekly Standard, opined over the weekend that the current placeholder in the Massachusetts Senate seat, Democrat Paul Kirk, will legally lose his ability to vote the moment election returns are final.

2. BYPASS THE SENATE. House-Senate conferees could also simply agree to adopt the Senate’s version of healthcare legislation. The House would have to vote to approve this move, but the Senate would not, since the House would be considering the exact version of a bill Senators have already passed.

Pros: By bypassing another Senate vote, Democrats would avoid a scenario in which a new Senator Brown helps filibuster healthcare reform into oblivion. Plus, the White House prefers the Senate version of the legislation, anyway.

Cons: This could be described as another thwarting-the-people move – and one that looks a bit trickier than the “Talk Faster” option. Also, House members would be very unhappy about having to swallow the Senate bill, and could even vote the whole thing down.

3. RECONCILIATION. Obama and Democratic leaders could also junk months of work and start over with a stripped-down version of healthcare reform. Using "reconciliation" – a Senate maneuver designed for passing crucial budget items without a filibuster – a narrow, more budget-focused approach might need only 50 votes to get through the Senate.

Pros: Democratic leaders might look like they were heeding the will of the people. Lots of nervous moderate Democrats would prefer a less-ambitious healthcare bill, anyway.

Cons: The “reconciliation” approach is extremely controversial and complicated. It involves breaking the healthcare bill into many pieces and proving that each would trim the deficit. Using reconciliation on non-budget bills has been called the "nuclear option" because of the ill-will and partisanship it generates in the Senate. It would be subject to GOP attack at every turn. Moreover, President Obama would find it difficult to sell the result as the sort of healthcare reform worthy of being the defining domestic achievement of his first years in office.

None of these options are particularly good ones, notes one veteran Washington political expert.

“They’re too artificial,” says Stephen Hess, a political analyst at the Brookings Institution in Washington.

Democratic leaders should not manipulate the legislative process to get healthcare reform through, according to Mr. Hess. He suggests another option: if the Massachusetts seat does go to the Republicans, the Obama administration should redouble efforts to try and get Sen. Olympia Snowe (R) of Maine to vote for the finished healthcare effort.

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