RENEE MONTAGNE, host:
On Capitol Hill, Democrats are regrouping after Tuesdays election of Massachusetts Republican Scott Brown to the Senate. If his victory is a sign that voters want them to scale back the health care bill, that won't be easy. NPRs Julie Rovner reports.
JULIE ROVNER: First things first, the House is not about to pass the Senate's version of the health overhaul bill. That pretty much puts a fork in the massive bill thats been nearly a year in the making. Yesterday, following what was reportedly a fairly rowdy meeting of House Democrats, House Speaker Nancy Pelosi said the votes for the Senate bill simply aren't there.
Representative NANCY PELOSI (Democrat, California; Speaker of the House): Unease would be a gentle word in terms of the attitude of my colleagues toward certain provisions of the Senate bill.
ROVNER: And so far, at least, the idea of scaling back and reaching out to Republicans doesn't seem likely to pay off, at least not while Republicans like House Minority Leader John Boehner smell electoral blood in the water.
Representative JOHN BOEHNER (Republican, Ohio; House Minority Leader): But listen, our goal is to stop this monstrosity. And we're working with our members so that we don't find ourselves in a position where they're able to pick off a few of our members and - to get this bill passed.
ROVNER: One option that seems to be gaining some traction is the idea of pulling out the most popular pieces of the health bill and passing them separately. President Obama even hinted at such a strategy in an interview with ABC News on Wednesday.
President BARACK OBAMA: I would advise that we try to move quickly to coalesce around those elements of the package that people agree on.
ROVNER: That may sound good. But in practice, says health policy analyst Jeff Goldsmith, it comes with its own set of political perils.
Mr. JEFF GOLDSMITH (Health Policy Analyst): Each one of those pieces has barbs attached to it. I mean, you can say, well, you know, health insurance reforms are really very popular across a broad spectrum, but then when you put them in - you know, like eliminating preexisting conditions or lifetime caps - you know, not only don't you have the health plans at the table, I mean, theyre going to come at you hammer and tongs.
ROVNER: In other words, powerful interest groups that have so far stayed mostly on the sidelines could declare full-out war.
At the same time, he says, many of the pieces of the bills only work in conjunction with other pieces, making picking and choosing problematic. In particular, hospitals, drug companies and other health-provider groups agreed to take pay cuts in Medicare because they knew they would recoup that money through other provisions of the bill that ensured that millions more people would be getting private insurance.
Mr. GOLDSMITH: If they don't have the healing balm of millions of new paying customers to salve their wounds, they're not going to sit still for the cost containment provisions in this bill. So the idea that you just have the freedom to pick little pieces of this, I think the real art form here is deciding who you can afford to piss off.
ROVNER: For example, requiring insurance companies to take people with preexisting health conditions without also requiring that everyone have coverage wouldn't cost very much and would be politically popular. After all, with no mandate, the government wouldn't have to provide subsidies for those with lower incomes. But it would make insurance companies furious. And, says Goldsmith, it would probably cause all premiums to rise, since people would likely wait until they got sick to buy insurance.
Mr. GOLDSMITH: Well, you can do it and then blame the insurers when the rates go up.
ROVNER: But while Congress ponders its options, lawmakers should keep in mind that waiting too long is also risky. Lawmakers are eager to get on to other agenda items, like jobs bills and financial regulation. They were hoping to have health care wrapped up by next month. About all they know now is that's not going to happen.
Julie Rovner, NPR News, Washington.
MONTAGNE: And coverage of the fate of the health care overhaul continues on our health blog called Shots at npr.org.
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