The hubbub has subsided after President Obama’s health care speech, but reform’s treacherous route through Congress remains the same.

Obama called for reining in the insurance industry, creating a public option to help make insurance available to everyone, and requiring everyone to have coverage. But he must still reconcile his views with proposals in the House and the Senate, which differ from one another and from what the president outlined.

For people out there who don’t like to read 1,000-page bills, ProPublic has posted the health care reform bills being considered by Congress. So far, there is one bill in the Senate (see http://tiny.cc/SyJ20), with one more to come, and one in the House (see http://tiny.cc/VqpOt). You can search each document for specific terms, and ProPublic will keep the bills up-to-date as they change. 

 

Until last week, President Obama took a hands-off approach health care reform. Instead, in February he included eight general principles in the presidential budget. The principles laid out requirements of a plan — it must make insurance available to everyone and address rising costs, for example — but did not specify policies.

That left Congress to debate many of the contentious issues, including whether to have a public option, and whether everyone should be required to have health insurance.

The three House committees that have jurisdiction over health care matters, Energy and Commerce, Education and Labor, and Ways and Means, all passed a bill in June. Now that it has made it out of committee it must be passed by a majority of House members.

But the House will probably not act until the two Senate committees with jurisdiction over health care settle on a bill. The Senate Health, Education, Labor and Pensions Committee passed its version of a health care reform bill in July, but the Senate Finance Committee, which has jurisdiction over Medicare and Medicaid, has yet to pass a bill.

 

Though Democrats have a majority on the committee, its chairman, Max Baucus, a Democrat from Montana, initially decided not to move a bill forward without the support of three key moderate Republicans on the committee: Olympia Snowe of Maine, Mike Enzi of Wyoming and Charles Grassley of Iowa. But those three senators and three Democratic negotiators from the committee, a group known as the Gang of Six, failed to reach consensus in time for Obama’s speech, as Baucus asked, and he said they will produce a bill by the end of this week or, if necessary, he will move ahead on his own.

Having the support of the Gang of Six — including the three Republicans — will both move health care proponents in Congress closer to a filibuster-proof majority of 58 senators and please moderate Democrats who have threatened to vote against the bill. It will also allow proponents of the bill to portray it as bipartisan, and make it an easier sell for Democrats from moderate or conservative districts.

In part because of Baucus’ approach, intended to produce a bill that the whole Senate is more likely to pass, there are likely to be significant differences between the two Senate bills. In particular, Baucus has said any bill must cost less than $900 billion, and should not include a public option because that would keep the Senate from passing it.

 

The Senate could separately consider two different bills from two different committees, but most likely members of the two committees will negotiate a compromise version which will then move to the full Senate for a vote.

If bills pass in both the House and Senate, representatives of the two houses will meet to negotiate a compromise version. Key sticking points here are likely to be the amount and what kind of help — including a public option — that individuals will be given to buy insurance, the size an employer should be before it is required to provide insurance to workers or pay a fee, and cost.

Once the two houses of Congress agree on a compromise bill, both must pass it. If they manage to do that — regardless of how close it comes to the president’s goals — Obama is almost guaranteed to sign it. It is unlikely he will veto legislation passed by his own party, even if it does not do everything he asked.