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Health Reform Is Messy Business
Bringing Together Factions Is Only Part of a Complicated Process

By Joel Achenbach
Washington Post Staff Writer
Saturday, August 1, 2009

The bill, a work in progress called H.R. 3200, is already phone-book thick. The latest amendments this week swamped Room 2123 of the Rayburn House Office Building, home turf of the Energy and Commerce Committee. Some 250 amendments had appeared by Wednesday night, and the number jumped to 350 by Thursday afternoon. The amendments filled 39 file boxes on chairs, under desks and in the aisles.

"The minority has one more amendment on Title B, after the Murphy amendment," Rep. Joe L. Barton of Texas, the committee's ranking Republican, said on Thursday afternoon. "Two? Three? We're growing like weeds over here."

The committee finally approved its version of health-care reform late Friday, and it wasn't easy, coming only after liberal Democrats cut a deal with more conservative colleagues on how to trim the cost of the America's Affordable Health Choices Act of 2009.

The popular metaphor for the process is, needless to say, sausage-making. As Rep. John B. Larson (Conn.), head of the House Democratic Caucus, said Wednesday as he raced to his eighth meeting of the day, "Two things that shouldn't be observed: the sausage being made and a bill becoming law."

This was a particularly epic week in the legislative sausage industry. Both chambers have, between them, three health-care reform bills -- one in the House and two in the Senate. Only one of the Senate bills has won committee approval.

Three House committees have labored on various parts of their chamber's bill, H.R. 3200. The huge cut-and-paste job now goes to the House Rules Committee, to be smoothed out into a final product to send to the House floor.

Almost every major provision of health reform remains very much in play. No one knows whether Congress will produce one of the most colossal sausages in American history or just a bunch of scraps for the compost bin. Only one decision has been made in the past week that has sounded firm, definitive and immutable: the decision to postpone a final vote until after everyone comes back from a five-week vacation.

All week, there were closed-door meetings among disparate ideological factions. The negotiations are invisible not only to the media and the public, but also to most other members of Congress. Reporters stake out hallways and shove tape recorders at speed-walking congressmen who generally say nothing more compelling than, "We're making progress." White House Chief of Staff Rahm Emanuel spent so much time in the office of House Speaker Nancy Pelosi (D-Calif.) this week that she could have charged him rent.

Any deals appear to be provisional, subject to backtracking, renegotiation or outright annulment. Party leaders can tell unhappy members of Congress that any particular version of the bill now being considered is not actually the bill that will come to the floor. Democrats have large majorities in both chambers, but they have discovered the perils of being a party that yokes together Northern California liberals and Deep South good ol' boys.

"I think this is getting very hard. The clock is ticking," Rep. Jane Harman (D.-Calif.) said during a particularly tense period Wednesday. "Hours and hours and hours and hours have been spent [in meetings] by all the big players. I haven't heard any good news."

Then came "good news" of a compromise reached by House leaders and a handful of moderate-to-conservative Blue Dog Democrats -- but it infuriated the liberals.

"We've already compromised. We're not going to compromise anymore," said Rep. Lynn Woolsey (D.-Calif.), co-chairman of the Progressive Caucus, which said in a letter to Pelosi that the Blue Dog deal was "fundamentally unacceptable."

The liberals caucused. The Congressional Black Caucus voiced objections. President Obama made calls to keep people on board. What is unclear at week's end, with members about to go home, is whether the middle ground is spacious enough to hold a majority of the House.

"There's nothing orderly about this process. It's chaos that sometimes is managed, sometimes is not. But it's the way the legislative process works," said Rep. Peter Welch (D-Vt.), who sits on the Energy and Commerce Committee.

It's the perfect environment for turf battles.

"We did not spend 60 hours, 300 amendments, 23 sessions, to roll over," Sen. Christopher J. Dodd (D-Conn.) said Wednesday. He was not talking about some Republican political gambit, but rather about a compromise being negotiated by a fellow Democrat, Senate Finance Committee Chairman Max Baucus (Mont.).

Baucus, two other Democrats and three Republicans spent much of the week huddled in Baucus's office, trying to figure out what it would take to bring a few Republican votes into the fold. But a health-care bill had already been approved by Dodd and his fellow Democrats on the Senate Health, Education, Labor and Pension Committee, led by the ailing Sen. Edward M. Kennedy (D-Mass.). Dodd, in effect, was telling Baucus not to assume that Finance was calling the shots.

Much of the drama the past few days has centered on the House side, and particularly on the Energy and Commerce Committee led by Rep. Henry A. Waxman (D-Calif.). At one point, Rep. Charles B. Rangel (D-N.Y.), chairman of the Ways and Means Committee, which passed its version of the bill, popped into Waxman's "mark-up" of H.R. 3200, taking a prominent seat in the audience, as if to remind everyone of the high stakes.

"If they don't function, then the two legs of the three-legged stool can't stand on their own," Rangel said outside the room, referring to the three House committees.

In recent months, there has been much GOP criticism of Democrats for passing legislation that some lawmakers have not read. But the bills are not exactly beach reading. They are legal documents crammed with legislative coding, sentence fragments and assorted gibberish that modifies laws already on the books somewhere. To really understand what a bill says, you'd need to have the existing laws memorized.

Here's a fairly typical passage from H.R. 3200:

Section 1834(a)(7)(A)(iii) of the Social Security Act (42 U.S.C. 1395m(a)(7)(A)(iii)) is amended

(1) in the heading, by inserting 'CERTAIN COMPLEX REHABILITATIVE' after 'OPTION FOR'; and

(2) by striking 'power-driven wheelchair' and inserting 'complex rehabilitative power-driven wheelchair recognized by the Secretary as classified within group 3 or higher.'

And that goes on for a thousand pages.

The frenetic nature of the Capitol this week was the result of a strategic decision by the Obama administration to let lawmakers do most of the heavy lifting on health-care reform. Obama did not want a repeat of "Hillarycare," the ill-fated proposal during the first term of President Clinton. Then-first lady Hillary Rodham Clinton put together that plan and presented it to Congress for essentially an up-or-down vote.

"I've never seen anything like this. Hillarycare, we got one very long and impressive lecture by Hillary," said Rep. Peter A. Defazio (D-Ore.).

Before either chamber can vote on a bill, the committee chairmen, along with congressional leaders, will have to merge the disparate versions into a single bill to bring to the floor. Whatever is passed by the two chambers must then be reconciled again in "conference."

The conference committee would then produce a final bill that would have to be voted on by each chamber. If passed, the bill would go to the president. If he found it acceptable, he would sign it.

And, simple as that, it would be the law of the land.

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