Last weekend a huge snow storm brought Washington D.C. to a standstill. The federal government is closed, supermarket shelves stand empty waiting for new deliveries and most people are stuck inside, some without electricity. Suddenly the city and its politics seem to be equally frozen.
Since the election of the Republican candidate Scott Brown in Massachusetts on 19 January, health reform has been stuck. It is hard to overstate how much of a shock Brown’s election caused among Democrats. What is now Brown’s seat was Ted Kennedy’s seat until less than a year ago and Kennedy held the seat for over forty years. In his campaign, Brown recognised the general need to reform healthcare but spoke out against the current reform bill, calling for it to be scrapped and for the whole process to begin again from scratch. Unsurprisingly, Brown’s election has been taken as a warning by many Democrats to stop pushing so hard for health reform and to wrest back political momentum by focusing instead on the economy. President Obama’s State of the Union speech a week after the Massachusetts election was heavy on jobs and the economy and comparatively light on healthcare.
There are two major political problems that now face President Obama in getting any kind of health reform bill passed. The first is that the election of Scott Brown brought to an end the Democrat’s sixty seat majority in the Senate. That means that the Democrats will need Republican support to pass a new bill that represents a compromise between the bill passed in the Senate before Christmas and the bill passed by the House of Representatives last summer. But no Republicans are stepping up to support healthcare reform. The second problem is that there is a Congressional election in November which is making conservative-leaning Democrats nervous. Many were elected in 2006 in traditionally Republican areas due to the unpopularity of the Bush administration. If the election of Scott Brown is anything to go by, backing health reform legislation that is unpopular among their constituents can only harm their electoral prospects this autumn. That leaves the President unable to even count on all the votes from his own party.
There is a complicated legislative procedure known as reconciliation that could allow a health reform bill to be passed without sixty votes in the Senate. Under reconciliation, only a simple majority is required to pass legislation and, although it is generally used for budget provisions, it is being floated as an option for health reform. If the House of Representatives passed the current version of the Senate Bill, a reconciliation bill could be used to amend the current Senate bill in order to reach a compromise between the House and the Senate. But the complexity of just describing this process, let alone getting it done, tells you how precarious the future of health reform currently is. It seems almost incredible that America might fail again to fix healthcare. If it cannot be done with a President who remains relatively popular and an enormous Democratic majority in Congress, when will it ever be possible? At the heart of this struggle to fix healthcare is a fundamental problem: most Americans have health insurance and they like what they have. Politicians have tried to convince the insured majority that they have nothing to lose and, in fact, a lot to gain from health reform. They do not appear to be listening.
Vidhya Alakeson is a former Harkness Fellow in Healthcare Policy based in Washington DC.