Healthcare reform 'fixes': What does the House want to change?

With Republicans on the sidelines, the endgame for healthcare reform is playing out within divided House Democratic ranks, where a decisive vote is expected as early as this week.

Since Senate Democrats lost their filibuster-proof majority with the election of Sen. Scott Brown (R) of Massachusetts, Democratic leaders have decided to try to pass the Senate's version in the House – in part to avoid the Senate's procedural hurdles as much as possible. The problem is, many in the House don't like the Senate bill and won't pass it.

The proposed solution has been a package of "fixes" to the Senate bill. It's not a perfect answer, because the Senate will also need to pass the fixes – and will need to resort to the controversial process of reconciliation to avoid a filibuster. But Democrats see it as the least worst option.

The drama now unfolding is how to rally 216 House Democrats to the fixes. In short, what does the House want to fix?

How much will it cost?

One essential element is cost. Undecided Democrats, especially fiscal conservatives, want to be sure that the legislation, with fixes, will cut federal budget deficits significantly over the next 20 years, as scored by the independent Congressional Budget Office.

“It is very important to us that this legislation be fiscally sound – that is, save $100 billion in the first 10 years and $1 trillion in the second 10 years,” said House Speaker Nancy Pelosi at a briefing on Tuesday.

“The numbers have to add up to drastic deficit reduction as we go forward. And that is why for this, more than many bills that we deal with, it’s essential for the members to see the numbers,” she added.

Other fixes target affordability for the middle class, where the money to pay for the bill comes from, and controversial provisions to benefit particular states – such as the so-called Cornhusker Kickback. These are the issues most dear to the 30 Democrats from conservative districts who broke with leadership to oppose the House bill in November.

“The American people were rightfully angry that there was a special deal,” said House majority leader Steny Hoyer at a briefing on Tuesday. With the fixes, “on our side of the aisle, the bill is overwhelmingly supported,” he added.

Still counting votes

But on Monday, Democratic whip James Clyburn of South Carolina said that Democrats did not yet have the 216 votes. “I will defer to Mr. Clyburn’s judgment on that issue. We are working on the votes,” Mr. Hoyer added.

One vote could be announced as early as Wednesday. Rep. Dennis Kucinich (D) of Ohio said he would make his decision then.

On Monday, President Obama visited the district of Mr. Kucinich to promote healthcare reform, traveling with him on Air Force One. The 10-term lawmaker is one of 39 Democrats who voted against the House version of healthcare reform.

Kucinich wants healthcare reform to include a robust government-run system. He has threatened to vote down the Senate bill, because it includes even less of a public option than the House bill.