I don’t think it’s a surprise to anyone that, on first blush, the Senate health care reform bill isn’t as good as the House health care reform bill. That said, I think the bill — again, on first blush — is far better than what I had expected from Senator Reid. There is an opt-out public option, which is better than most of the last year’s discussion of what conservative Democrats in the Senate would have suggested. There’s also better provisions, though not great, on providing coverage for abortion. It won’t exist in the Senate public option, but there isn’t the punitive, Stupak-like measure of limiting it from being in private plans in the exchange.
I want to see where the wonks shake out on this before I really know what this bill does and does not do.
The best thing about the Senate bill, though is that it comes with a huge process advantage for progressives.
If the consensus is that this is a generally good bill and something that moves the ball forward for health care reform, the way the Senate works makes further changes unlikely. Essentially anything that is controversial and subject to amendments on the floor will require 60 votes to pass. That is, if there is an effort to make the bill either substantially more progressive or more conservative, a super majority will be required. Contrast this to most non-controversial amendments, which will likely require a simple majority.
This means it is unlikely that the Senate will do worse than an opt-out. It is unlikely that anti-choice senators will be able to do the same damage as Rep. Stupak. It is also unlikely that the public option will be improved or affordability dramatically increased or employer responsibility increased.
In essence, what we see now with the Senate bill is the opportunity to move the ball forward to conference with the House bill. The two bills are going to end up being closer together than a lot of us had thought. Proximity likely makes movement more possible, but less impactful. This will hopefully mean that the final product is better than the Senate bill and not significantly worse than the House bill.
There’s still a long way to go, but at least for now, this is a victory in the path towards health care reform.