Next phase in health-care debate: The art of the deal

By Ceci Connolly
Washington Post Staff Writer
Monday, October 26, 2009

In Washington, there are two ways to wage legislative war: fight to kill and fight to tweak.

With a growing sense that Democrats may have the votes to pass health-care reform, many participants are now attempting to shape the components of landmark legislation rather than to defeat it.

"We're very close to getting the 60 votes we need to move forward," Sen. Charles E. Schumer (D-N.Y.) said Sunday on NBC's "Meet the Press."

On Monday, Senate Majority Leader Harry M. Reid (D-Nev.) is expected to request a cost estimate on the bill he has worked out behind closed doors, moving one step closer to debate in the full Senate, his spokesman said.

Lawmakers, industry executives and lobbyists said over the weekend that this is the moment to exert maximum influence on legislation aimed at refashioning the $2.4 trillion health-care sector. From company-specific minutiae to far-reaching changes in the tax code, it is bargaining season.

"We're entering the final stage, and everyone is maneuvering to get the best possible deal," said Drew E. Altman, president of the nonpartisan Kaiser Family Foundation. "The odds of passing legislation are steadily moving up."

The shift into dealmaking mode is both good news for President Obama and an indication that the most arduous work is yet to come. Although Democrats are nearing a compromise on a government insurance option, large hurdles remain.

The party in power is divided over how to pay for health-care legislation, and it could easily become sidetracked by emotional issues such as abortion. Most important, Democrats are still searching for the right recipe for making insurance affordable for average Americans.

Chris Jennings, who worked on the Clinton administration's attempt to overhaul the health-care system, compared this phase of the debate to the final third of a marathon.

"It is the most challenging and the most rewarding part of the race," he said. "The problem is, it is the most painful part as well."

To cross the finish line, Obama will almost certainly have to offend some allies, make more concessions and risk additional political capital -- even as his popularity has fallen. In recent weeks, he has stepped back from the process, leaving his aides and Congress to work out the details.

"I'm becoming increasingly optimistic that we will have a health-care bill," Sen. Russell Feingold (D-Wis.) said on CBS's "Face the Nation." "I'm frankly getting excited that we may have some momentum for something very positive."

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