Big hurdles for Senate on health bill

Obama’s remarks came just 14 hours after the House narrowly approved a landmark plan that would cost $1.1 trillion over 10 years and extend insurance coverage to 36 million uninsured Americans; the president called it “a courageous vote.’’ But the votes had barely been counted when the White House began turning its attention to an even bigger hurdle: getting legislation passed in the Senate.

In the Senate, where proposals differ substantially from the House-passed measure on issues like a government-run plan and how to pay for coverage, the bill is stalled while budget analysts assess its overall costs.

The slim margin in the House - the bill passed with two votes to spare, and 39 Democrats opposed it - suggests even greater challenges in the Senate, where the majority leader, Harry Reid of Nevada, is struggling to hold on to all 58 Democrats and two independents in his caucus.

Obama has staked his domestic agenda on passing comprehensive health legislation, a goal that has eluded presidents for decades. While Democrats were forced to make major concessions on insurance coverage for abortions to win House passage of the bill, they were nonetheless ebullient yesterday, with many saying the vote gave them momentum to push the bill forward.

“For years we’ve been told that this couldn’t be done,’’ Obama said in the Rose Garden. Of the American people, he said, “Moments like this are why they sent us here.’’

But for all the exultation, there was a sense inside the White House and on Capitol Hill that the hardest work is yet to come. The House debate highlighted the pressures that will come to bear on senators as they weigh contentious issues like federal financing for abortion, coverage for illegal immigrants, and the public option, a government-backed insurance plan to compete with the private sector.

In the Senate, Reid has merged two bills into one. The fine print is not public, but the broad outlines are known. Unlike the House bill, which pays to extend coverage by taxing individuals who earn more than $500,000 a year and couples who earn more than $1 million, the Senate bill imposes a 40 percent excise tax on so-called Cadillac plans that cost more than $8,000 a year for an individual or $21,000 for a family.

Apart from substantive hurdles, the Senate bill faces procedural ones; Reid cannot bring it to the floor for debate until he gets an analysis, or “score,’’ from the nonpartisan Congressional Budget Office, expected this week. The delay could push Senate consideration of the bill until after Thanksgiving, which could in turn make it very difficult for Congress to meet Obama’s goal of signing a health bill into law by the end of this year.

Timing is crucial. Administration officials say Obama wants to wrap up health care so that he can turn his attention to other legislative priorities, including passing an energy bill and revamping financial regulations. But White House officials also know that the closer the final vote comes to the November 2010 midterm congressional elections, the more difficult it will be to pass legislation.

Sending members of Congress home over an extended Christmas break without a health care bill in hand could prove disastrous politically. Democrats remember well the setbacks they suffered over the August recess when the Senate Finance Committee failed to meet Obama’s deadline for finishing its measure, and lawmakers were pummeled in town-hall-style meetings around the country.

“The holiday break is viewed the same way as the August break,’’ said one Democrat close to the White House, speaking anonymously to discuss strategy. “We don’t want a repeat. We could probably survive it, but why take the chance?’’

The White House began prodding Reid to move quickly even before Saturday’s House vote. In a private meeting with Obama this year, Reid pledged to work to finish the measure by the end of December. But last Tuesday, Reid said the Senate was “not going to be bound by any timelines.’’

On Wednesday, Rahm Emanuel, the White House chief of staff, visited Reid. The two met on Capitol Hill to “continue the discussion on ways to get a bill done by the end of the year,’’ said Reid’s press secretary, Jim Manley, adding that Reid intends to bring the bill to the floor “as quickly as possible.’’

In case Reid did not get the message, Obama reinforced it Saturday night. In a statement after the House vote, he said he looked forward to signing comprehensive health legislation “by the end of the year.’’

A big question is whether Reid has the 60 votes that will almost certainly be necessary to permit debate to begin. Manley said Democrats hoped “the momentum from the House bill will make everyone realize that the Senate should at least have a chance to begin debate.’’ Still, he conceded that there was “no glide path’’ toward getting the Senate to pass the measure.

As the Senate vote draws closer, the fight on the airwaves, where groups for and against the health bill are already spending millions of dollars on advertising, will only intensify. Republicans are also intensifying their opposition as they try to cast Democrats as tax-and-spend liberals, a theme echoed yesterday by Senator Mitch McConnell of Kentucky, the Republican leader.

“Soon, Senate Democrats will propose their own version,’’ McConnell said in a statement. “We don’t know how big it will be or how expensive, but we do know with certainty that it will mean higher premiums, higher taxes, and massive cuts to Medicare to create even more government programs. That’s not reform.’’