Senate’s Counting and Recounting Add Up to Delay

By DAVID HERSZENHORN

WASHINGTON — The Senate majority leader, Harry Reid of Nevada, hopes to finalize the Senate version of major health care legislation this week.

But don’t count the days. Mr. Reid and his aides have been saying the same thing for a month, ever since the Senate Finance Committee approved its bill on Oct. 13.

Mr. Reid is tied up in the numbers: the 10-year cost to taxpayers and the impact on future health spending; the number of people who will gain health coverage versus the number who will be left uninsured; the price of premiums for a new public insurance plan; and the effect on premiums for the 160 million Americans who already have insurance.
Senator Harry Reid, the majority leader, hopes to complete his version of health care legislation this week.Luke Sharrett/The New York Times Senator Harry Reid, the majority leader, hopes to complete his version of health care legislation this week.

Finally, there is the most crucial number of all: the count of members of the Democratic caucus who will vote in favor of a motion to bring the bill up for debate. (Mr. Reid needs the unanimous support of those 60 members.)

That last number will depend heavily on all the other numbers. And all the other numbers depend entirely on the nonpartisan Congressional Budget Office, the official bean counters who have worked night and day for months on the many incarnations of the health care legislation in the Senate and in the House.

The Congressional Budget Office is so essential to the process and its time and attention are so precious that after the House approved its health care bill on Nov. 7, Mr. Reid’s elation was only partly about Democrats having advanced landmark legislation.

“Now that they are done with the House bill,” he told a reporter, “C.B.O. can focus on us.”

The process is complicated. About 11 p.m. last Tuesday, the budget office sent Mr. Reid 11 pages of questions about his legislation. On Wednesday afternoon Mr. Reid’s staff met with budget office officials. And the back-and-forth continues.

But Mr. Reid has already received some substantial analysis of his measure, and if the numbers had been what he wanted, he would have released a bill by now.

Instead, he has repeatedly gone back to the budget office with variations of the legislation, trying to figure out how to limit the overall cost of the bill while increasing the number of people who would gain health coverage.

Mr. Reid has put forward a proposal to increase the Medicare payroll tax on wealthy taxpayers, in part to help reduce a proposed tax on high-price health insurance plans, which is opposed by organized labor interests.

But the tax on high-price insurance plans is one of the few proposals still included in the legislation that the Congressional Budget Office has said would help slow the growth of the nation’s health care costs. So Mr. Reid must choose between following the recommendation of experts on health economics and angering a crucial Democratic constituency.

Should there be any doubt about the importance of the cost calculations, consider the recent comments of some Democratic senators who are considered crucial centrist votes.

“The message at times has gotten garbled, where it has been more about extending coverage to individuals than it has been about bending the cost curve,” said Senator Ben Nelson, Democrat of Nebraska. “I think we need to control costs.”
Senator Ben Nelson, Democrat of Nebraska, is pushing for a greater focus on controlling costs.Associated Press Senator Ben Nelson, Democrat of Nebraska, is pushing for a greater focus on controlling costs.

The budget office is also working on a request by Senator Evan Bayh of Indiana for an analysis of the legislation’s potential effect on premium costs for people who already have coverage — a deeply complex calculation.

In the meantime, frustration has been growing among some lawmakers over the delay, especially as they are asked repeated questions about a bill they have not yet seen.

“I don’t think the bill text is being shown to anybody,” Mr. Nelson said last week.

At the same time, the Senate Republican leader, Mitch McConnell, is mounting his own numbers-driven attack.

Mr. McConnell criticized the bill’s size — 2,000 pages — and said it should be debated on the Senate floor for as long as Mr. Reid has been working to finish it.

“This is a bill that cuts Medicare, raises taxes and raises insurance premiums,” Mr. McConnell said on “Fox News Sunday.” “We know it has been in Harry Reid’s office for six weeks and the other 99 senators have not seen it.”

Of course, it has been only four weeks since the Finance Committee approved its bill. But who’s counting?