SCENARIOS: Passing healthcare reform in Congress

Wed Sep 2, 2009 5:30pm EDT

(Reuters) - Democrats in the U.S. Congress hope to pass President Barack Obama's overhaul of the country's $2.5 trillion healthcare system amid mounting public skepticism and unified opposition from Republicans.

Administration officials said on Wednesday that Obama, who has staked significant political capital on the healthcare drive, would address a joint session of Congress on September 9 to discuss the next steps.

Here are some scenarios of what could happen next:

WAIT FOR REPUBLICANS

Obama and Democratic leaders have said repeatedly that they hope to win Republican support to build legitimacy in the eyes of the public, but so far it has not been forthcoming.

No Republicans voted for the four versions of healthcare legislation that have cleared committees so far in the House of Representatives and the Senate.

Democrats do not need Republican cooperation to pass legislation out of the House.

After the death of Senator Edward Kennedy, Democrats control 59 of the Senate's 100 seats, just short of the 60 needed to pass legislation without Republican support. Democratic Senator Robert Byrd is also in poor health and might not be able to vote, so Democrats need at least two Republicans on their side.

Democratic Senator Max Baucus hopes to craft a compromise with three Republicans on his Finance Committee -- Charles Grassley, Olympia Snowe and Mike Enzi. But months of discussion have so far not resulted in a bill.

Other Democrats are growing impatient and have suggested moving ahead on their own if the group doesn't reach a deal by September 15. The six negotiators have scheduled a round of talks on Friday by teleconference.

PASS IT IN PIECES

Democrats could also split healthcare reform into pieces.

Controversial aspects that would require new government spending might be brought up for a vote under special Senate rules that prevent opponents from forcing a 60-vote majority.

Instead, it would allow budget-related bills to pass with the support of a simple majority of 51 of the chamber's 100 senators.

The most controversial element of the package, which would create a public health plan to compete with private insurers, could be brought up for a vote under this method.

This would infuriate Republicans, putting other elements of Obama's agenda at risk, and could result in a piecemeal effort that does nothing to control costs.

Less-controversial aspects that would reform unpopular insurance practices, such as denying coverage to applicants who already have health problems, would be brought up under the Senate's normal rules since supporters think they can get at least 60 votes to overcome any procedural hurdles.

SCALE IT BACK

Democrats could also scale back the plan to focus on reforming the existing insurance industry, hoping that would lay the groundwork for more far-reaching reforms later on.

This could attract the votes of centrist Democrats and some Republicans but would anger Obama's liberal supporters, who believe a public option is essential to reining in costs.

"There's a point at which realism shades over into weakness, and progressives increasingly feel that the administration is on the wrong side of that line," liberal columnist Paul Krugman wrote on August 21 in the New York Times.

CALL THEIR BLUFF

The full House is expected to vote in September, and House Speaker Nancy Pelosi said there is "no way" that bill will not contain a public option.

Senate Majority Leader Harry Reid could bring up a similar bill for a vote in his chamber. If Massachusetts changes its laws to allow the governor to quickly fill Kennedy's seat, and if Byrd is healthy enough to vote, and if wavering moderates fall into line, he could have just enough votes for passage.

(Editing by Vicki Allen)