Jockeying for position; the internal struggle in Congress will largely determine which health reform bill - and approach - comes out ahead - Cover Story

Business & Health, Jan, 1994 by Steven Findlay

The Rules Committee also sets the terms of the floor debate, including the scope and order of amendments that can be offered. "We encourage committees to work out the differences beforehand," says Rules Committee staff director and majority counsel George Crawford. In any event, he says, the huge scope of health reform will complicate the legislative process and "create some unique problems" that may have to be solved in some unprecedented manner.

The Democratic leadership's aim is to have a full debate on the bills in each chamber of Congress by late July and a vote in August, before the summer recess. It is virtually certain that the House and Senate bills will differ. The conventional wisdom now is that the House version will be more "Clinton-like" while the Senate version will be a scaled-down compromise. It may lack an employer mandate and almost surely will be devoid of price controls and large "bureaucratic" health alliances. It may also seek to phase reforms in over a longer period than the administration wants.

Passage in each chamber by the middle of August would leave time for the traditional joint House-Senate conference committee in September. The purpose here is to reconcile differences between the two bills and send them back for a final vote by late September or early October, before the mid-term elections. If a compromise is reached, passage of a new bill in both houses is still a hurdle, but is made more likely.

Such reconciliation, however, is far from certain and will depend on how far apart the bills are in their approach and structure. If a joint conference can't agree by October, the vote on reform may come in a lame duck Congress (which meets after the November elections) that would feel compelled to act lest the whole process be delayed another year for a newly elected Congress. Alternatively, the 103rd Congress will pass the job of health reform to the 104th, and the whole process begins again.