Who blinks first? Dems can’t agree

Democrats’ final push on healthcare reform has become a game of chicken between the House and Senate.

Lawmakers are at an impasse over who should go first, and a lack of trust between Democrats in both chambers threatens to derail the effort in the final stretch. This is complicating an effort to use special rules to move the legislation with a simple majority vote in the Senate.

{mosads}Each side is demanding that certain preconditions be met before acting.

“In coming days there will be an endgame strategy that will get a healthcare bill,” said a senior Democratic aide.

The shift in negotiations, from policy details to timing, signals lawmakers are largely in agreement on the substance of the final bill. The problem is that members of both chambers doubt their colleagues on the other side of the Capitol can be trusted to hold up any bargain.

In what may be a sign that Democrats are close to sending President Barack Obama his top legislative priority, Republicans have issued strong warnings that the majority will pay dearly at the polls for using reconciliation to pass healthcare reform. Democratic aides say the dire threats show Republicans are nervous.

But before Democrats can focus on the opposing party, they must resolve the process of who goes first. The House must vote on both the broader Senate bill and on changes to the legislation contained in a “sidecar” measure. The Senate would only need to act on the changes.

The emerging strategy would have the House go first, clearing the Senate bill and passing the accompanying changes. Then Senate Democrats would consider the changes under a special budget process called reconciliation that enables them to pass the measure with a simple majority of votes. Those changes would have to be made under reconciliation because Democrats lack the votes needed to quash a GOP filibuster.

But the House does not want to take up the broader Senate bill without assurances that the Senate will act on the changes.

“Can the Senate bill be enacted prior to those changes being effected? I think it’s difficult to do so,” said House Majority Leader Steny Hoyer (D-Md.). “I think [colleagues] want some assurance that those items they have problems with are in fact modified before they vote for the Senate bill.

“I don’t know that it’s impossible, but it’s difficult,” said Hoyer, who attributed the wariness of House members to “experience” in dealing with their Senate colleagues.

The Senate, however, is not ready to make any promises to the House.

{mosads}“Nobody is going to sign off on something they don’t know about,” said Senate Budget Committee Chairman Kent Conrad (D-N.D.), who has jurisdiction over the reconciliation process.

“They need to know what is in the package,” Conrad said of his fellow Senate Democrats. “Is it paid for? Does it meet the rules of reconciliation? Would it reduce the deficit over five years? Would it be deficit-neutral every year thereafter? That’s a lot of things that have to be asked and answered first.”

Senate Democrats also say it would be difficult to promise to pass a reconciliation measure when it is not yet clear whether the Senate parliamentarian would approve all the changes requested by the House.

Republicans are betting that the voting public will punish Democrats in November for using the special rules to advance a substantive healthcare measure with a partisan vote.

Senate Minority Leader Mitch McConnell (R-Ky.) on Tuesday declared that voters are “overwhelmingly opposed” to using reconciliation to pass healthcare reform.

“Once reconciliation is explained to them — it will be the issue in every single race in America this fall,” McConnell said.

House Minority Whip Eric Cantor (R-Va.) said during an appearance on Fox News: “It is my belief that the Democrats will lose their majority in November if they ram this through without any bipartisan support.”

But Democrats are skeptical of this threat.

“Politically, the bigger win for Republicans is for the healthcare bill to fail, and that’s clear to everybody,” said a senior Democratic aide.

The real issue is whether voters care more about the substance than the process. Steven Smith, a professor who specializes in congressional politics at Washington University in St. Louis, said Senate process won’t be nearly as big a political issue as the substance of healthcare reform and whether the Democratic proposal works.

“Next fall, campaigns won’t be about reconciliation or Rule XXII as much as about healthcare policy or the economy,” said Smith, who added that if Democrats fail to pass a bill, “it will hurt them.”

{mosads}There’s growing evidence that centrist Democrats who were initially leery of supporting healthcare reform have come around to the political necessity of passing it soon.

Sen. Ben Nelson (D-Neb.) signaled Monday that he is ready to support the home-stretch effort to get a bill to President Obama.

“Doing nothing on healthcare reform might seem like a reasonable option to some, but in my opinion it’s not,” Nelson said at a conference hosted by the Federation of American Hospitals.

Centrist Sen. Mark Pryor (D-Ark.) also indicated he could be open to using reconciliation to get healthcare reform over the finish line, if that’s the only option.

“I haven’t seen all the details of what the president’s trying to do with reconciliation, and it’s not my first choice,” Pryor said. “But under the circumstances, it may be the only way to pass legislation around here.”

Senate leaders say the House would have to first pass the changes because the measure containing them would include revenue-raising provisions that must originate in the lower chamber.

All proposals in a reconciliation measure must have significant budgetary impact or would be subject to a procedural objection.

The Senate and House disagree over language restricting the availability of insurance policies covering abortion to women who accept federal subsidies. Conrad said that measure could not be covered by reconciliation protection, noting there is clear Senate precedent on the matter.

This has raised the possibility that Senate Democratic leaders might advance a third bill addressing abortion and other issues that fell outside the reconciliation process. But Senate Majority Whip Dick Durbin (D-Ill.) told reporters there has been no discussion of that scenario.

J. Taylor Rushing and Jeffrey Young contributed to this article.