Vote is the endgame for the health care reform debate, says health policy expert

“If the House passes the latest version of legislation this weekend and sends it to the Senate, that will be the key legislative event in the long health care debate, because both chambers have already passed the legislation,” says Timothy McBride, Ph.D., health economist and associate dean of public health at the Brown School at Washington University in St. Louis.

“I believe the House will pass the legislation, but the vote will be very close, probably within one vote or two. The House probably has not had a vote this close since the vote on Medicare prescription drugs.”

According to McBride, the key provisions in the House reconciliation bill added to make it acceptable to House members are: changing the financing (taxes), making the subsidies more generous, and removing some of the “sweetheart deals” added in by the Senate.

“The core piece of legislation that is under consideration should have profound effects on the health sector, leading to over 30 million people gaining health coverage, the end of insurance practices such as denials of coverage and pre-existing condition exclusions, expansions of coverage to all the poor and near poor, subsidies for small businesses, the creation of health insurance exchanges, and incentives to improve health prevention,” he says.

“It is hard to underestimate the importance of this vote, because we have been debating the issue of universal coverage for almost one hundred years, and had eight significant debates over it nationally, with only one of these debates leading to any legislation — in 1965, when Medicare and Medicaid were passed.”

Reconciliation and ‘deem and pass’

There is considerable controversy right now about how the House is pushing this legislation through, using reconciliation and the even more arcane and less known “deem and pass” provision allowing the House to deem the Senate bill passed without voting on it, while passing amendments to it at the same time in the reconciliation bill.

“Average voters do not like all these shenanigans, and support for health care reform drops as attention focuses on these tactics, but if the legislation passes, after a few months, people will begin to focus their attention on what is in the legislation as well as the benefits and costs of the legislation,” McBride believes.