Image: Sen. Harry Reid
Charles Dharapak  /  AP
Senate Majority Leader Harry Reid, of Nev., center, followed by House Speaker Nancy Pelosi, of Calif., walks out of the West Wing of the White House in Washington on Sept. 8, 2009.
updated 10/5/2009 2:24:57 PM ET 2009-10-05T18:24:57

Forget mission accomplished. Try mission seemingly impossible.

With the Senate Finance Committee on the verge of approving a sweeping health overhaul bill as early as Tuesday, the path might appear open for action by the full Senate.

Not so fast.

First the Finance Committee bill must be combined with a more liberal version that the Health, Education, Labor and Pensions Committee wrapped up this summer. Such a merger is so rare that Senate Majority Leader Harry Reid, D-Nev., has never attempted it on any piece of legislation — much less one as complex as President Barack Obama's top legislative priority.

Sen. Maria Cantwell, D-Wash., had a one-word description of Reid's task: "Tough."

Said Democratic Sen. Jeff Bingaman of New Mexico: "He's on the hot seat."

"I don't even want to think about it," said Sen. Kent Conrad, D-N.D. "What a daunting challenge."

Everything about health overhaul legislation seems to be unusually complicated, but this process is particularly so because of the disparities between the bills and Obama's goal of keeping the cost at $900 billion over 10 years. Reid won't go it alone; he will get some help from the White House and the committee chairmen.

"It's not going to be one silver bullet," Reid said. "There isn't any one thing, there are lots of things we're going to have to work on."

These two bills diverge on some of the thorniest issues, perhaps most notably on the question of whether the government should sell insurance to compete with private industry. The health committee bill has the government-run plan; the finance bill does not.

The health committee bill offers more generous subsidies to low-income people to help them buy coverage than the finance committee bill.

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The finance committee bill proposes a new tax on high-value health insurance plans that the health committee bill doesn't include.

The health committee bill would require employers to offer coverage to their workers or pay a tax penalty. The finance bill has no such requirement, although it would levy a charge on businesses whose workers end up getting government subsidies.

Reid must resolve all those issues and more over the next week or so to come up with a single bill to bring to the Senate floor. In its broad contours, the legislation would expand coverage to about 95 percent of Americans with a new requirement for individuals to purchase insurance. The costs would be borne partly by hundreds of billions of dollars in cuts in projected Medicare and Medicaid spending. Policies would be available — for those who have coverage and those who don't — through so-called insurance exchanges.

But many of the details are unresolved and it's Reid's job to decide. Every step of the way he must ensure that the choices he's making keep 60 senators happy, or at least on board. That's how many votes it takes to avoid a bill-killing filibuster by Republicans in the 100-member Senate.

Any one change could lose a senator, and losing even one could be fatal.

Move too far to the left and a moderate Democrat like Ben Nelson of Nebraska could rebel. Too far to the right, and a liberal like Ron Wyden of Oregon could be alienated.

And then there's perhaps the most important senator of all, Olympia Snowe of Maine, virtually the only Republican seen as a possible "yes" vote on the health care bill. Reid will need to bring her along every step of the way.

The process has already started in the congressional and White House staffs. Beginning this week it will shift into high gear with Reid personally involved with a handful of key senators including Finance Chairman Max Baucus, D-Mont., health committee chairman Tom Harkin, D-Iowa, and Sen. Chris Dodd, D-Conn., who led the health committee consideration of the overhaul bill.

Snowe is expected to be closely consulted, and White House Chief of Staff Rahm Emanuel likely will participate in the meetings. They'll meet in Reid's stately office on the second floor of the Capitol and elsewhere. Obama will likely call wavering Democrats and shore up support, as he did all last week with members of the Finance Committee.

It's still not clear what the product will look like finally, including whether it embraces any version of a government-run plan. Reid has been somewhat equivocal, saying last week: "Before this bill goes to the president's desk, we are going to have some form of a public option in this bill."

Whatever the legislation looks like, it will face a barrage of amendments once it gets to the Senate floor, and it could easily go down in flames like former President Bill Clinton's attempt at a health care overhaul in 1994.

Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Video: Health care debate, far from over

  1. Closed captioning of: Health care debate, far from over

    >> his plan, look at that. helping to identify corporate communism in our country has is a cancer on our nation the folks at the sunlight foundation , jake brewer, a little sunlight is a very powerful thing for those who like to use money to steal from us. sheila crumhotel and its website open secrets .org which is where we are able to find out who is getting bought off by here. then you can see, jonathan and karen. walk us through how it is as the lobbyists are controlling this process.

    >> the thing with the lobbyists they are not able -- we're not able to track the real influence that they are having or at least we weren't until last week. we were finding that they are coming together to form these clusters of influence. along with see sheila and her team they are getting together in large numbers and giving large sums of money having a much more influence than we were able to track. again, we're running up into a case we have a 19th century government process or practically so coming up to a 20th centuriry that demands this type of accountability and transparency and able to track that now through new investigation that we've been able to uncover.

    >> sheila , how does this work? in other words, if i understand correctly, lobbyists are actually giving their own money and then lobbying firm has a lot of lobbyists, i go to karen and all of the other lobbyists i work with and say everybody give as a syndicate to max baucus to make sure the corporate communists don't have to compete while everybody else in this country does have to to prevent competition so our health care companies can continue to take money without having any real competition.

    >> it's interesting. this research, i think, puts the fine points on the connections how the lobbyist contributions echo and compliment those of their clients. it is a smoking gun , however. i should say there is no proof of coordination by the fact that there are all of these contributions coming from and really representing the same sources. we don't know if it was raised through a fund-raiser or by the lint or the lobbyist. we don't know the direction and motivation necessarily, but we can say these lobbyists who are marching up to capitol hill to lobby on behalf of their clients have a big dollar sign on their back. they represent so much money from themselves, their leagues, their family members and their clients.

    >> well, politically speaking, though, too, you have to ask yourself. you look at the committees and dollar donations they are getting. this is how business is done in washington. maybe we'll get a little bit of change but not so much change. and that is sort of what we are seeing i think with wyden.

    >> jake, the more i learn and see this the more i suspect we don't have a two- party system but one-party where those who have the money to control democrats and republicans so insure they don't have to compete and they get tax loopholes and the rest of the country gets screwed.

    >> the problem we're not able to track who is having the real influence on this bill, at least we haven't been. so there is a real onus now on congress to release more information about who is having that influence on them and so that when it comes time for us as a citizenry who sent them to washington to really represent us around these truly vital and important issues to this country, that we're able to track who is, in fact, influencing them. that's what it's really about. money and influence and now for the first time we're starting to see who is actually having that with numbers and dollar signs through this new work.

    >> senator baucus actually told us who was influencing him when he refused to bring competition and choice to health care . take a listen to his comments at 1:00 in the morning last thursday.

    >> i cannot think of a major member, either so opposed by both business and labor. both. there must be some wisdom there if they are both opposed and i just think that it's -- you've done a lot, senator, but i don't think this amendment really is the right thing to do.

    >> the wisdom, of course, is that again, business and labor accumulates more power and more money by perpetuating a version of corporate communism as opposed to having to compete like everybody else in this country. and again, if you look, sheila , i've been using open secrets to do this, at the multiples. forget the dollars. if you look look at which senator and which congressman gets nor money than the average senator or congress person it tends to be very telling as to their voting record. do you have the technology you can calculate people's voting records with the multiple? in other words, those who get the most from health care and this is how they voted and those who get the least from union, banks, whoever it may be, can you do that?

    >> we do that on specific bills where we think there is an interesting pattern of contributions going to the no vote versus the yes vote. there is an organization that utilizes our data. this is an interesting way to look at the money and the votes to see whether or not it's a party line split or, in fact, if the money is telling about potential motivation behind the vote.

    >> how often is the money telling?

    >> you know, it's interesting. it's not always the causal effect here. if it's a party line is split, i think that is more interesting, more kind of the factor than the money. but, on occasion, particularly where it's an industry fight, where the consumer and the constituents aren't really at the table but maybe it's the banks fighting against the credit card companies or very arcane issue, that is where the money really has the potential to speak and speak loudly.

    >> understood.

    >> that is where corporate communism makes its money so god bless them. contessa, what else

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