"Health Care Faces Uncertain Future"

MADELEINE BRAND, host:

In Washington, health care legislation is basically frozen. That's because of last night's surprise victory for a Republican in the Massachusetts Senate race. Scott Brown campaigned to become the 41st vote Senate Republicans needed to block a final health care bill. And that's left Democrats in both the House and Senate scrambling to figure out how to get a bill to the president's desk.

For some details of that scrambling, we're joined now by NPR health policy correspondent Julie Rovner. She spent the afternoon on Capitol Hill. Hi, Julie.

JULIE ROVNER: Hey, Madeleine.

BRAND: Well, if you would, describe the mood today among lawmakers.

ROVNER: Well, I think the best word to describe it is shell-shocked. Really, it's not like they didn't see this coming, at least since late last week. But I think the enormity of losing that 60th vote in the Senate didn't really sink in until today. One reporter who was - talked to some lawmakers described it as like being hit by a bus on the way to your wedding. They were, you know, perhaps only hours away from this final compromise House-Senate bill and now it seems there's virtually no way to get that bill passed.

BRAND: So, what are their options?

ROVNER: Well, the leading option that now seems off the table was to try to hurry up and finish those negotiations and jam the bill through both the House and the Senate before Senator-elect Brown got certified and seated because, of course, at least for the next two weeks or so Democrats still do have those 60 votes in the Senate. But both President Obama and Senate Majority Leader Harry Reid said today that wasn't going to happen. Here's Senator Reid.

Senator HARRY REID (Democrat, Nevada; Senate Majority Leader): We're not going to rush in to anything as you've heard. We're going to wait until the new Senator arrives before we do anything more on health care.

BRAND: Julie, couldn't the House just pass the Senate bill as it is and send it to the president?

ROVNER: Yes, indeed they could. That's clearly, I think, what the Senate hopes will happen. But there's still a lot of resistance from House Democratic members. There are many, many things that the House Democrats really don't like about the Senate bill. They particularly dislike that so-called Cadillac Tax, the tax on high-cost health plans, the subsidies in the Senate bill for lower-middle income people are much less in the Senate bill than the House bill. Of course, there's no public option, a government-run health plan in the Senate bill.

BRAND: So, a lot of objections for House Democrats. What are the other options?

ROVNER: Well, there is a procedure called budget reconciliation and they did allow for this, you know, as sort of a fall back in last year's budget. It does not allow Senators to filibuster and it only requires 51 votes to get through the Senate. But it has drawbacks too. Everything in it has to be closely related to the budget, so things like creating those insurance marketplaces like exchanges might not be allowed under the reconciliation process. And they would have to use a separate bill, which might or might not be able to get through the Senate.

BRAND: And Julie today, any talk about just giving up saying, you know what, this is impossible? We're just not going to try.

ROVNER: You know, there were some members who said that, you know, the voters have spoken, maybe we shouldn't do health care. But mostly what I heard were people who seem to think they wanted to do something they just aren't sure how to get it done. And one thing that does seem clear is that for the people who were around in 1994, the last time a health care bill tanked after which Democrats lost both the House and Senate for 12 years, they are pretty certain this time that can't be allowed to happen. They better find a way to pass something. Here's how House Energy and Commerce Committee Chairman Henry Waxman put it.

Mr. HENRY WAXMAN (Democrat, California; Chairman, House Energy and Commerce Committee): People do want it and if the Democrats don't accomplish it, as we did not in 1994, I think there will be hell to pay.

ROVNER: So, I think this is something like the stages of grief for the Democrats. They're going to have to get through the anger and the bargaining and the denial, all the way to acceptance. And eventually, they'll figure out what they're going to do about how to precede on a health care bill.

BRAND: And you will be watching it. Thanks, Julie.

ROVNER: You're very welcome, Madeleine.

BRAND: That's NPR health policy correspondent, Julie Rovner.