Health Care: Lock and Load

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After all the missed deadlines, I’m hesitant to say this, but here goes:

Next week is the week.

The House Democratic leadership now expects to schedule a vote on the Senate health care bill and send it to President Obama’s desk next Friday, March 19, or Saturday, March 20.

After that, assuming the bill passes, the House will turn to making adjustments to that legislation through a reconciliation bill, which it would then send to the Senate. There are still some procedural details to work out; for instance, rather than passing the Senate bill as a stand-alone measure, it may “deem” the bill to be passed as part of the procedural vote that brings the reconciliation bill to the floor. (JNS wrote about this “self-executing rule” here.) The political argument for doing it in this contorted manner is to avoid forcing House Democrats to go on the record as supporting some of the more egregious provisions in the Senate bill, such as the “Cornhusker Kickback.” But the result would be the same: The Senate bill would be on its way to becoming law.

Here’s what Nancy Pelosi had to say in her news conference today:

Speaker Pelosi. Good morning. Here we are on Friday morning, one day closer to passing historic legislation to make health care more affordable, more acceptable to the American people and holding insurance companies accountable. Each day we move closer in terms of narrowing the decisions that need to be made.

We are still awaiting the report of the Congressional Budget Office for us to finally put something in print and on the Internet. But the CBO did come out with a report yesterday on the Senate bill. Mind you, the Senate bill passed Christmas Eve, but there was a CBO score going into the vote, but this addressed as amended. And what was positive about it is it showed over $100 billion in savings for the first 10 years of the bill and $1 trillion over the second 10 years. That is exactly what we — or better — what we hope to do with the reconciliation bill, to sustain those numbers. So the fact that it started at a good place for us is very positive.

Of course, we’re eagerly awaiting the final word from them. And when they do, then we will be able to send a bill to the Budget Committee, the Budget Committee will pass that out, we’ll go to the Internet with that and discuss the specifics of the legislation with our Members, and we’ll take whatever time is required for us to pass the legislation.

Again, I feel very exhilarated by a Caucus meeting that we had this morning in terms of the questions that Members have. We spent a good deal of time on the substance, but then some on the process as well. We stand ready to stay as long as it takes to pass the bill. I think Members are eager to pass the bill. And again, it won’t be long before we’ll be making a real difference in the lives of the American people.

So in terms of the House, again, as I said, the CBO, the substance in terms of what the agreement is between the House and the Senate and what the Senate tells us they are prepared to act upon, and then the action of the House.

I’m delighted that the President will be here for the passage of the bill. It’s going to be historic. And it would not be possible without his tremendous, tremendous leadership, his persistence, his concern for the American people, always, always guided by his statement that we will measure our success by the progress being made by America’s working families. This legislation not only makes history, but it will make progress for America’s working families.

Any questions?

Q: Madam Speaker, are you saying by March 21st you will pass health care reform?

Speaker Pelosi. I have said we will take the time that we need to pass the legislation.

Q: But you just said…

Speaker Pelosi. Well, I’m hoping that it will be in that time frame. Our clock can’t start ticking until we get the CBO score. But that increases the prospect that he will be here since he will be here three more days.

Q: Madam Speaker, do you think it will be easier to get votes for health care by attaching this student loan provision also to a reconciliation?

Speaker Pelosi. Thank you for that question. Right from the start, our budget instruction was about two bills that would be reconciled. One was health care, and one was education.

If I may just step back for a moment, this goes back to our budget bill that we passed in the House 100 days after the President’s inauguration, so calculate that, in the spring of last year. In that bill, the President had a blueprint in the budget for lowering taxes, reducing the deficit, creating jobs, stabilizing our economy well into the future, around three pillars. Those three pillars were investments in education and innovation, which go together; investments in energy and climate change; and investments first among equals in health care.

We have passed all three of those bills. Two of them, the education bill and the health bill, were to be part of the reconciliation. So the budget bill we passed in the spring, the budget instruction we received in the fall was about the reconciliation would deal with those. Reconciliation of education would bring us more savings and, of course, cost the taxpayers less and the students less for their student loans. So that has always been part of the plan.

There was some question as to whether this would prevail in the Senate until the Senate Parliamentarian, was it yesterday morning, I’m losing track of time, announced that it must be part of the reconciliation. And so that’s why it has emerged again as a subject of more public view, but it is really important. It’s not there to — no, I don’t think it would make any difference in our House about passing the bill.

What it will make a difference is in community colleges and support for community colleges, Pell grants, minority serving institutions, K through 12 school construction. Those are the kinds of things that will receive funding. The amounts will depend on the amount that we hear from the CBO and from the Senate.

Q: Madam Speaker, Senator Durbin said this morning that if you include the public option in your version, he will aggressively whip it with more than 40 Senators now on board. Is that something you are considering?

Speaker Pelosi. Let me say this, and I know I can say this with certain assurance in this room. I have supported — when I say support, signs in the street, advocacy in legislatures — I have supported single payer for longer than many of you have been — since you’ve been born, than you’ve lived on the face of the earth. So I think, I have always thought, that was the way to go, A.

B, the public option, it isn’t without a little sadness that I view that it is not in the bill. But in fighting for the public option, which is, I think, a fight that was led in the House, and we had it in our bill, we improved what is going to be in the final product, because while we may not have a public option, we have the purpose of the public option served by the exchanges and what they allow by the rate reviews, which we insisted upon, insurance rate reviews, and by saying that insurance companies, should they be raising rates between now and the onset of the exchanges, may be prohibited from participating in the exchanges.

So I believe we have a very strong bill that will increase competition, will lower cost for the American people and accomplish some of the same goals. It doesn’t produce the same savings, and that’s why, you know, we were fighting for it. The goal had to be served; we wanted more savings than a public option would provide, but it did not prevail.

What we will have in reconciliation will be something that is agreed upon, House and Senate, that we can pass and they can pass. So I’m not having the Senate, which didn’t have a public option in its bill, put any of that on our doorstep. We had it, we wanted it; they didn’t have it, it’s not in the reconciliation. But it has nothing to do with whether we initiated it here. We did initiate it. They didn’t.

Q: You’re saying if you initiate it, then they will whip it.

Speaker Pelosi. We’re talking about something that is not going to be part of the legislation, so why don’t we talk about what is going to happen? Because I’m quite sad that a public option isn’t in there. But it isn’t a case of it’s not in there because the Senate is whipping against it. It isn’t in there because they don’t have the votes to have it in there or they would have had it in there to begin with.

Q: How troubling is the ruling that the Senate Parliamentarian did yesterday on the President must sign the bill before they can do the reconciliation?

Speaker Pelosi. Not very troubling. I mean, it’s more of a visibility issue. But the fact is that once we pass the Senate bill, it is enacted. And that remains for the President to sign it.

Maybe more on the subject than you want to know, so I know you’ll stop me if that’s the case. It’s important to note that what we are doing is reconciliation. We’re dealing with a very few points: affordability for the middle class, equity for the States to correct the Nebraska fix, closing the donut hole for seniors — and I’m finding out that a lot of people don’t know about the donut hole — making prescription drugs more affordable for seniors, and expanding the accountability, the insurance reforms. In addition, on the pay for side, changing the pay for from the excise tax to another pay for.

That’s largely what is in the bill and some things that go with that. It all must be central to the budget, nothing incidental or peripheral to the budget, central to the budget. That’s what it is. The bills that have passed, ours with 220 in the House, theirs with 60 in the Senate — we’ll be acting upon the Senate bill with changes that were in the House bill reflected in the reconciliation. So in order to have the Senate bill be the basis and build upon it with the reconciliation, you have to pass the Senate bill, or else you’re talking about starting from scratch.

So we will pass the Senate bill. Once we pass it, whether the President signs it or doesn’t, people would rather he wait until the Senate acted, but the Senate Parliamentarian, as you have said, said in order for them to do a reconciliation based on the Senate bill, it must be signed by the President. So it isn’t going to make any difference except maybe the mood that people are in, but the fact is that once we pass it in the House, it’s going to be the law of the land.

Q: Won’t it make a big difference? We’re hearing from so many of your rank and file that they just so don’t trust the Senate.

Speaker Pelosi. Well, that’s another thing. But the fact is that they’re committed enough to extending insurance to 31 million more Americans, to making insurance more affordable to the middle class, for having reforms that say that we end the prohibition on denying insurance to those because they have a preexisting medical condition. They’re committed to the goals of the legislation, and they’re strong enough to do it regardless if the bill is signed on Monday or if it’s signed on Friday, because we’ll have already passed the bill.

Q: Speaker Pelosi, speaking of the CBO, they came out with their newest budget number that $9.7 trillion will be added to the debt over 10 years. The smallest deficit in that window will be $724 billion in 2014. Do you intend as Speaker ever to preside over a balanced budget like Hastert or Gingrich did, and if so, what kind of time frame would that be?

Speaker Pelosi. Well, first of all, let us reflect upon where that budget deficit came from. We have two wars that were always done on a supplemental, not paid for. We had the tax cuts for the wealthiest people in our country, which was a very major contributor to the deficit in the Bush years, and now thereafter.

But having said that, it is our responsibility to reduce the deficit. And for that reason I’m very pleased that the Senate has now agreed to have pay as you go. It became the rule of the House the day I became Speaker; it became the law of the land only recently when the Senate agreed that they would abide by pay as you go.

Q: Did you ever intend to balance the budget at any point in time?

Speaker Pelosi. Excuse me, I’m answering the gentleman’s question.

The second point is that we have the commission that the President has, by executive order, put forth to take under consideration everything: revenues, expenditures, entitlements, the rest. But to talk about — and that has a short fuse. You know, that will be a “this year” phenomenon. And then the President has asked for a freeze or a cut in the appropriations bills as we go forward.

So what I say to Members when they have an idea or a suggestion for legislation or an amendment to a bill, does it create jobs, does it reduce the deficit? That is the course we have to take.

But let me remind you that when the President — under pay-as-you-go under President Clinton, we came out of the Clinton Administration, the last four Clinton budgets were either in budget or in surplus. We were on a trajectory of $5.6 trillion going in a positive direction. After President Bush’s reckless economic policies, and tax cuts to the wealthiest, and engaging in wars that he did not pay for but just added to the deficit, but even before we got all of that, just in a couple of years the trajectory changed to about $6 trillion in deficit, a swing of about $11 trillion, bigger than has ever happened in history.

We know how to turn that around. President Clinton did it following the Reagan Bush deficits. We have to turn it around now, and that is our commitment.

Q: Speaking of the Senate, on the assurances from the Senate, I realize Leader Reid can’t give you ironclad assurances because of the…

Speaker Pelosi. Why not?

Q: Because of the rules of the Senate. But what assurances have you gotten from the Senate that they will promptly take up this reconciliation bill to ease your Members’ fears?

Speaker Pelosi. Well, our Members have sent a number of bills over to the Senate which have not been acted upon yet. But let me say that that is largely because of the obstructionism of the Republicans there requiring 60 votes on every bill. As I’ve said to you before, Senator Reid has had the votes, he just hasn’t had the time to address each one of these issues. So the concern that they had was about what has happened in the past based on the 60-vote rule.

Under the reconciliation, the simple majority, the constitutional majority, I think Members are much more comfortable about the fact that this reconciliation will happen. Nonetheless, there are certain assurances that they want and that we will get for them before I ask them to take the vote. But I think we’re at a very good place because our numbers are coming; you know, what we are seeing from CBO is positive. We want it to be certified so that we can go forward with the scored bill as soon as possible. And again, any hesitation anybody might have about do you trust the Senate is offset by the great vision that they have for health care for all Americans and that we will be able to do it in a reasonable length of time. It will take a little faith, but what we do always does.

Q: Madam Speaker, just on timing. You said yesterday that you would give your Members a week to look at the legislation.

Speaker Pelosi. When I said that, I meant we would have at least a week from yesterday before we would have a vote. I hope that we would have the CBO scores as soon as possible so we can go to budget on the beginning of the week, and then go on the Internet, and then take a vote.

Q: Do you expect the scores today?

Speaker Pelosi. You know, it’s an independent agency. I wanted them last Friday, and I would hope that we have them today.