Passing a health care overhaul bill might be one of the hardest things Congress has ever attempted. But waiting until next year might jeopardize a top priority for President Barack Obama and Democrats in Congress.
The political peril of waiting until 2010 — a midterm election year — could mean the death of comprehensive health care legislation, according to some analysts. "If they're going to do it, they have to do it this year," said University of Virginia political analyst Larry Sabato. "Everyone knows that. They know it."
If there isn't a bill on Obama's desk by Christmas, Obama supporters fear lawmakers could face a repeat of the brutal August town hall meetings where angry constituents railed against a government-run "public plan" and other elements of proposed bills. And under that scenario, lawmakers could return to Washington in January considerably less enthusiastic about health care legislation.
In addition, Tuesday's election results — in which Republicans won the Virginia and New Jersey governors' races — might make some moderate Democrats facing reelection next year hesitant to back a health care measure that will cost $900 billion or more over the next decade. Exit polling showed substantial numbers of voters in both states expressing concern that government "is doing too many things better left to business and individuals," according to ABC News.
As for delaying health care until next year, Sabato said, "If you're talking about having everything done except for tying it in a ribbon, that's one thing. Once everything is lined up you could have the final votes once Congress comes back but it has to be done." But because of the risks of waiting, he doubts that Obama and congressional Democrats would let the health care debate drag into next year.
Steve Elmendorf, a former top aide to Rep. Richard Gephardt when he was House Majority Leader, agreed. Elmendorf said that Senate Majority Leader Harry Reid of Nevada needs to keep his troops in town and get the health bill passed.
"I think they can't ever stop," said Elmendorf, now a lobbyist. "If it carries over to next year, you can't leave for two weeks at Christmas and then come back. You always have to look like you're trying to push the ball down the field." Waiting until January won't make it easier with moderate Democrats who have concerns about the bill or Republicans who have promised a lengthy floor fight, he said.
Others don't think the situation is nearly so dire. They say that Democrats could deliver a bill to Obama by the State of the Union speech early next year or even in the spring. Between Christmas and the New Year, they say, people are focused on their families — rather than politics — and would be unlikely to participate in town hall meetings aimed at health care or any other legislative issue.
House Democrats are expected to begin debate on their health care overhaul measure on Friday and may vote on the bill as soon as Saturday. In the Senate, Reid is awaiting a Congressional Budget Office analysis of proposals he sent to the agency as part of his efforts to combine bills passed by the Finance Committee and the Health, Education, Labor and Pensions Committee into one measure that the chamber could begin considering later this month.
Obama took office vowing to make a health care overhaul his premier domestic policy goal, and for much of the year it appeared that the legislation had great momentum. Then a series of angry town hall meetings in August set back the legislation and raised questions about whether Congress could pass a bill this year. When the Finance Committee finally passed a measure last month with one Republican vote, it appeared that the health care bill was back on track, with both chambers moving full speed ahead.
But with some moderate Democrats hanging back, Reid has been unable to put together a 60-vote majority to take up and pass the bill. Reid and House Speaker Nancy Pelosi, D-Calif., both have struggled to win support from moderates who have expressed concern about the cost of the bill. Other House Democrats have threatened to block the measure over contentious abortion and immigration issues.
Reid shocked the Senate on Tuesday when he said that the chamber might not act on health care legislation this year. "We're not going to be bound by any timelines," he said. "We need to do the best job for the American people."
Reid spokesman Jim Manley later clarified Reid's remarks. "Our goals remain unchanged," he said. "We want to get health insurance reform done this year, and we have unprecedented momentum to achieve that. There is no reason why we can't have a transparent and thorough debate in the Senate and still send a bill to the President by Christmas."
Even if House Democrats move their measure quickly, debate in the Senate could take considerably longer.
"I think this is as big and complicated an issue as has Congress has faced in a long, long time. I think it's very difficult to truncate the time," said Sen. Byron Dorgan, D-N.D. "The House of Representatives can do that by packaging up the rule and bringing it to the floor. This is going to be difficult and long, and I think it's going to take awhile in the Senate."
Noting the size and complexity of the health care bill, as well as its historic significance, Senate Minority Leader Mitch McConnell, R-Ky., has signaled that Republicans intend to have a long debate over the measure.
"We don't think we ought to be passing a 2,000-page, trillion dollar bill. I think we ought to be going step by step to fix the problems the American people see in our health care system," he told reporters.
This story was produced through collaboration between NPR and Kaiser Health News (KHN), an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente.