Firestorm erupts as Dems weigh a shortcut

WASHINGTON — As lawmakers clashed fiercely over health-care legislation on the House floor, Democrats struggled Tuesday to defend procedural shortcuts they might use to win approval for their proposals.

The ferocious floor fight Tuesday was the opening clash in what is shaping up to be the decisive week in the yearlong health-care battle.

House Democrats are so skittish about the current vehicle for a health-care overhaul — the bill passed by the Senate in December — that they are considering a maneuver that would allow them to pass it without explicitly voting for it.

The idea is to package changes and the underlying bill in a way that amounts to an amended bill in a single vote. Many House Democrats dislike some Senate provisions, such as extra Medicaid money for Nebraska, and therefore want to avoid a direct vote on the Senate measure.

Thomas Mann of the Brookings Institution said leaders of both parties are using the procedure more frequently, with 36 instances under the last Republican-led House, in 2005-06, and 29 during the immediate past session, when Democrats were in control.

Still, Republicans paraded to the House floor Tuesday to denounce the maneuver as a parliamentary trick.

House Minority Leader John Boehner, R-Ohio, called it "the ultimate in Washington power grabs." House Speaker Nancy Pelosi fired back: "I didn't hear any of that ferocity when the Republicans used this, perhaps, hundreds of times."

Legal scholars disagreed about whether the procedure would be a constitutional way to pass the legislation. Yet, even critics said they doubt the measure would be struck down by the courts.

"I feel pretty confident it is unconstitutional," said Michael McConnell, director of Stanford Law School's Constitutional Law Center and a former appellate judge appointed by President George W. Bush. "What a court would do about it is a murkier problem."

Charles Tiefer, a University of Baltimore law professor who is a former Democratic House counsel and has written about House procedure, disagreed. "This is so familiar a House procedure. ... I don't know anything in the Constitution that prevents the House from holding one vote for two bills. ... Why would it make a difference?"

Close watchers of the debate were divided about whether the parliamentary strategy would influence public sentiment.

Robert Laszewski, a consultant who follows the politics of health care, predicted the effect would be negligible. "Either people really want this to happen or they think it's incredible arrogance," he said. "I don't think there's anybody in the middle on this."

Rep. Chris Van Hollen, D-Md., the assistant to the speaker, said Republicans were trying to deceive the public.

"They want to send a signal to the American people that the product that is going to come out of the House is the Senate bill, but the fact of the matter is we are amending the Senate bill," he said. "We are going to get rid of the Nebraska deal. We are going to get rid of other provisions in the Senate bill that shouldn't have been there."

Still, some Democrats who support the bill have expressed reservations about the maneuver and said House leaders might rethink their plans if the chorus of criticism continues to grow.

House Democratic leaders said they still expected the full House to vote by the weekend, even though they are tinkering with the legislation and do not have a final cost estimate from the Congressional Budget Office. Democrats hoped to receive that report late Tuesday.

Democrats are trying to hold the cost of the bill to roughly $950 billion over 10 years, in keeping with a limit suggested by the president. Under budget reconciliation rules that would protect House changes from a Republican filibuster in the Senate, the measure must reduce the deficit by at least $2 billion over five years and avoid increasing the deficit in any year thereafter.

To make the numbers work, Democrats said, they are considering bigger cuts in payments to private Medicare Advantage plans, which cover about one-fourth of the 45 million Medicare beneficiaries. And they may ask pharmaceutical companies for more money to help close a gap in Medicare coverage of prescription drugs.

In a fusillade of one-minute speeches on the House floor Tuesday, the two sides argued over both substance and procedural issues.

While Republicans accused Democrats of resorting to legislative sleight of hand, Democrats said Republicans were arguing about arcane rules and procedures because they could not make a cogent, substantive case against the bill.

Democrats said the procedures they wanted to focus on were insurance-industry practices that the legislation would outlaw, including denying coverage based on pre-existing conditions, imposing annual and lifetime limits on benefits, and revoking coverage on technical grounds even when premiums have been paid in full.

If necessary, Democratic leaders said they were confident they could muster the 216 votes needed to pass the legislation and give President Obama a victory on his top domestic priority.

House Republicans said they were intent on never letting that happen.

"The American people are appalled by what they have seen in this health-care debate, but the worst is still ahead," Boehner thundered in his speech. "... There is no way to hide from this vote. It will be the biggest vote most members ever cast."