This week the White House and Democrats in Congress settled on a strategy for passing health reform by which the House would first approve the Senate-passed bill, followed by both chambers passing a reconciliation bill, changing aspects of the Senate bill before sending both measures to the President.

• Moderates Continue To Express Concerns About Costs, Abortion.  President Obama and Congressional leaders want the House to vote by March 18, with approval by both chambers of the reconciliation bill before March 26, when Congress is scheduled to recess for Easter. This is an ambitious timetable considering key lawmakers have yet to reach consensus on the substance of the reconciliation measure or get a cost estimate from the Congressional Budget Office.  One sign as to whether lawmakers are able to stick to their timeline will be if they are able to release the reconciliation bill by next week.  The final bill would largely resemble the Senate bill with some modifications, but nothing that would significantly contain health care costs.  Moderate Democrats in the House remain skittish about the health care expansion bill amid slipping public support for the proposal.  Also, disagreements over federal funding of abortion, which most agree cannot be addressed in a reconciliation bill, could prove to be the biggest hurdle for Democrats.  Several House members who supported the House bill’s more restrictive provisions on abortion have indicated they cannot support legislation that would weaken the language authored by Rep. Bart Stupak (D-MI), which the House initially accepted.
• Reform's Fate Rests in House.  Most policy experts agree that House Speaker Nancy Pelosi (D-CA) has a heavier burden to lift than Majority Leader Reid (D-NV) in her quest to secure a majority of votes.  Several moderate Democratic Senators who had previously expressed reservations, including Sens. Bayh (IN), Byrd (WV), and Nelson (NE), have publicly stated they could vote for a reconciliation bill that amends the Senate bill to get health reform done.  As a result, getting a majority of Senate votes doesn’t appear to be in doubt.  The situation is very different in the House.  Complicating matters is the fact that the House has to take two votes – one on the Senate bill and another on the reconciliation package – creating more opportunity for things to go wrong.  Democrats now need 216 votes to pass the bill.  The House passed the bill with 220 yes votes in November; with 39 members of their caucus voting against the bill.  Since then, several of the aye votes have been lost.  The sole Republican voting for the measure Rep. Joseph Cao (R-LA) has said he is opposed, Rep. John Murtha (D-PA) passed away, Rep. Robert Wexler (D-FL) resigned, and Rep. Neil Abercrombie (D-HI) left to run for Governor.  Speaker Pelosi will have to work to hold all of her caucus who voted yes and convert some of those who voted no.  The concerns of moderates are not the only issues that could derail a Democratic victory.  At least one liberal who voted against the House bill – Rep. Dennis Kucinich (D-OH) – has indicated as recently as this week that he will not change his vote, because it doesn't go far enough toward a single payer system.
• Concerns About Mandates for Part-Timers in Reconciliation Package.  Employers should be concerned that the reconciliation package could contain provisions that would make the legislation even more costly to large employers in an effort to make concessions to liberal House members.  One important issue to watch is the applicability of employer penalties to part-time workers.  Under the Senate bill, employers would be subject to a penalty for failing to provide coverage or when an employee opts out of the employer’s plan because the coverage is deemed unaffordable and the employee obtains coverage through a health insurance exchange.  These penalties would only apply to full-time workers under the Senate bill, and that appeared to be the intention of the President’s proposal.  However, there are reports that some House members are pushing to apply the penalties for part-time workers as well.