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Can Health Care Reform Be Revived?

Democrats scramble to regroup and reshape their efforts

Tamara Lytle

Democrats grappled with a stark new political reality today—how to push for national health care reform as the deep blue state of Massachusetts prepares to send a Republican to the U.S. Senate, after an election many political experts see as a dramatic repudiation of the bill.

The health care reform measure that occupied much of the first year of the Obama administration and of Congress’s time is now in a precarious position. But polls showed the Democratic measure was deeply unpopular with Massachusetts voters, who reacted Tuesday by electing Scott Brown as their first GOP senator in nearly 40 years.

The House and Senate have passed health care bills that would bar insurance companies from turning away consumers with preexisting conditions, require Americans to carry insurance, offer help to older Americans with prescription drugs and bring a series of other reforms to the health care system. Lawmakers and the White House were working out the differences between the two measures when the Brown election dramatically changed the political landscape.

Reforms in jeopardy

“The American people have made it abundantly clear … they don’t want the government taking over health care.” said Senate Republican Leader Mitch McConnell of Kentucky, who had called the Massachusetts election a national referendum on health care reform. “The voters have spoken. They want a course correction.”

White House press secretary Robert Gibbs said conversations about what to do next are “ongoing” but that Obama is still committed to reforming health care.

“There are a number of different ways to do this,” Gibbs said, during a briefing, adding that no decision has been made.

What’s at stake for older Americans

John Rother, executive vice president of policy and strategy, said it’s still possible to pass health care reform, which AARP has backed. “The bill did make health care affordable. It made it accessible to everyone and it did the things we wanted to do,” he said.

The legislation included free preventive care for Medicare beneficiaries and long-term care assistance to help people remain in their homes rather than go to a nursing facilities. The bills would have closed the “doughnut hole” of Medicare prescription drug coverage where medicines are not currently covered. All those reforms, including a ban on denying people coverage because of preexisting medical conditions and limits on how much more they could charge older people for coverage, are up in the air now.

Democrats still hold majorities in both chambers, but when Brown is sworn in to the seat once held by the late health reform champion Sen. Edward Kennedy, they will lose the crucial 60th vote that prevents Republicans from stopping legislation through filibusters.

Democrats huddle

On Wednesday they worked behind closed doors to weigh their options. Among them:

    *  Rush through a House-Senate compromise before Brown is sworn in. President Barack Obama threw cold water on that idea Wednesday.

    *  Have the House pass the Senate bill exactly as is so that no further Senate vote is needed to send the measure to President Obama. A House Democratic leadership aide said Wednesday they probably don’t have the votes for that.

    *  Pass a narrower bill of less controversial elements, or a series of smaller reform bills. “I would advise that we try to move quickly to coalesce around those elements of the package that people agree on,” Obama said in an interview with ABC, citing cost containment, insurance reform and help for small businesses in providing coverage for their workers.

    *  Toss the whole 2,700 pages out and start over, as Republicans called for on Wednesday.

Republicans revel

Sen. John McCain, R-Ariz., took to the Senate floor to call for a do-over that involved more transparent negotiations. “Last night, a shot was fired across the nation,” McCain said. “Stop this unsavory sausage-making process called health care reform.”

The changed landscape was driven less by the loss of one vote than by the impact it had on the political will of Democrats to push a plan that deeply divides the public. All House members and a third of the Senate are up for reelection in November.

Rep. Anthony Weiner of New York came out of a Democratic caucus Tuesday night saying it was time for fellow Democrats to realize many people didn’t agree with the direction they were taking on health care. “There’s a limit to which we can say they just don’t get it.”

One message that came from Democrats on the Hill and the White House Wednesday was that they weren’t ready to give up on health care reform. “We’ve come too far to stop now,” says a Democratic leadership aide who spoke on condition of anonymity.

Preexisting conditions, drug coverage may survive

As Democrats picked through the ruins Wednesday, the Democratic aide says that if a smaller bill is the new strategy, it likely will include two measures important to older Americans. Prohibiting insurance companies from refusing coverage to people with preexisting conditions and helping with prescription drug coverage for older Americans are such high priorities they will have to be included, he says.

But Rother says insurance companies initially agreed to cover people with preexisting health problems only on condition of a mandate that Americans carry health insurance, which could now be eliminated from the measure. The prospect of that large pool of new consumers—many of them young and healthy—had persuaded insurance companies to agree to accept potentially sicker clients as well.

Rother says the prescription drug aid to seniors was now “very much at risk.” But, he said, AARP plans to continue to push for health care reform. “It’s not a setback yet. It’s an additional obstacle in the road.”

Tamara Lytle was a correspondent and Washington bureau chief for the Orlando Sentinel from 1997 to 2008.

If you would like to discuss health care reform in AARP’s Online Community, please join the group Health Action Now Mythbusters.

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