Health Care Reform: Where It's At

After almost a year of discussions, speeches, grandstanding, and dissembling about health care from those who roam Pennsylvania Ave., you'd be forgiven for feeling like the debate would never end. But it's definitely in the final stretch right now. The bill has clear momentum. There's been many developments this week, but if, like most people, you stopped combing the papers for the latest tidbit on reform, here's what you need to know.

1. Abortion. The Associated Press reports that House leaders have given up trying to negotiate with the Stupak faction over abortion language. What's always been dubious about those negotiations is whether the desired changes could even be made via reconciliation. House leaders figured out this week that it probably wouldn't work. Regardless, Pelosi is charging ahead, with or without Stupak and his handful of potentially critical votes. (Related: David Gibson over at Politics Daily makes a really interesting argument that the House language is actually more pro-life than that in the Senate bill.)

2. Reid's letter. Yesterday, Harry Reid wrote a letter to Minority Leader Mitch McConnell informing him, unequivocally, of his intention to make fixes to the Senate bill using reconciliation. Translation: it's on. Former boxer Reid didn't pull a single punch in the letter. It's harsh. He writes: "Though we have tried to engage in a serious discussion, our efforts have been met by repeatedly debunked myths and outright lies. At the same time, Republicans have resorted to extraordinary legislative maneuvers in an effort not to improve the bill, but to delay and kill it. After watching these tactics for nearly a year, there is only one conclusion an objective observer could make: these Republican maneuvers are rooted less in substantive policy concerns and more in a partisan desire to discredit Democrats, bolster Republicans, and protect the status quo on behalf of the insurance industry." Yikes! You can read the whole thing here. (Nevada election watchers should take note of this letter. Despite his often demure affect, when he wants to be, Reid can be a fighter, and a scrappy one at that.)

3. House must vote first. After weeks of speculation, the Senate parliamentarian, Alan Frumin, has ruled that the House must vote on the Senate bill and the president must sign that bill into law before senators can attempt to amend aspects of it through the reconciliation process.

(**UPDATE: News of that ruling came from Republican Hill staffers. Today Democrats argue that Republicans have misinterpreted Frumin's statement. Frumin hasn't commented publicly.**) This makes Pelosi's life even more difficult than it already is. Over the past year, distrust between House and Senate Democrats has amplified to near historic levels. House members feel that they've made numerous tough votes—on health care, climate change, jobs, the stimulus—only to see legislation wallow while nervous senators fidget and fuss. The Senate has given them few good reasons to trust that they'll keep their word and pass the desired fixes through budget reconciliation. First Read reports that House Dems might go so far as to seek a written agreement on the fixes, signed by at least 51 Senate Dems who are thereby committed to vote for the changes.

4. Obama delays overseas trip. After days of brushing aside questions about whether the president would delay his trip to Indonesia, Guam, and Australia in order to oversee the final days of the health-care debate, the White House announced this morning that the president would indeed delay his departure by three days. That's probably a result of the parliamentarian's ruling. If the House passes the Senate bill, Obama will want the Senate to move as quickly as possible, and Frumin's decision places that ball squarely in the president's court. The delay also indicates that the White House doesn't think Pelosi will take the vote before the March 18 deadline. But that's no surprise. If there's one common thread throughout this entire debate it's that deadlines bite the dust.