Healthcare backup plans carry huge risks


White House officials and Democratic congressional leaders are exploring whether to finish their healthcare overhaul without further Senate action in case a Republican victory today in the Massachusetts Senate race deprives them of a filibuster-proof majority.

Under a strategy that carries major political risks, House Democrats would be called on to approve the version that cleared the Senate, allowing the bill to go directly to President Obama for his signature.

The move would end negotiations over how to reconcile provisions on which the two chambers differ.

To placate House liberals, many of whom think Senate leaders made too many concessions to win over conservative Democrats, the Senate would then be asked to pass separate bills to satisfy some of the liberals’ demands, including scaling back a new tax on high-end “Cadillac” health plans. These Senate votes could be held under special procedural rules that would prevent filibusters.

But this strategy remains highly controversial: It could further irritate House liberals, discourage the party’s progressive base going into the November elections, and open Obama and congressional Democrats to charges that they rammed through healthcare despite a rebuff by voters in one of the party’s most impregnable bastions.

“Both progressives and conservatives in the House caucus won’t go for it,” one senior Democratic aide warned Monday, speaking on condition of anonymity because of the explosive nature of the issue.

In addition to bowing to the Senate on the so-called Cadillac tax, House Democrats would have to accept less-stringent restrictions on abortion than they had in their legislation. Many House Democrats had also hoped that the federal government would get primary responsibility for regulating new insurance marketplaces, or exchanges. The current Senate bill gives state regulators this authority.

And House leaders had hoped to provide more subsidies to help low- and middle-income Americans buy health insurance, as they do in their legislation.

But party leaders and other advocates of a health overhaul see few good options if Republican Scott Brown defeats Martha Coakley, a Democrat, for the Massachusetts Senate seat long held by the late Edward M. Kennedy.

“None of this is ideal,” acknowledged Larry C. McNeely II, healthcare advocate for the U.S. Public Interest Research Group, a leading consumer group.

As strategy discussions intensified, Republicans stepped up their attacks Monday. “They are going to try every way, shape and form to shove this bill down the throats of the American people,” House Minority Leader John A. Boehner of Ohio said in a radio interview with “The Scott Hennen Show.”

White House and congressional officials would not discuss any contingency plans on the record, as party leaders mounted a last-minute effort to salvage Coakley’s campaign.

But speaking to reporters in her hometown, House Speaker Nancy Pelosi (D-San Francisco) stressed that Democrats would push ahead even if they lost the Massachusetts seat.

“Let’s remove all doubt,” Pelosi said. “We will have healthcare one way or another. . . . I heard the candidate in Massachusetts, the Republican candidate, say, ‘Let’s go back to the drawing board.’ The drawing board for the Republican Party on health is to tear it up and throw it away and shred it and never revisit it. This is the opportunity of a generation. If this opportunity is not realized, there won’t be healthcare for all Americans.”

Over the weekend, White House Press Secretary Robert Gibbs said the administration remained focused on reconciling differences between the House and Senate bills in preparation for votes in both chambers.

“We think Martha Coakley is going to win this race,” Gibbs said.

A GOP victory in Massachusetts would leave the Senate Democratic caucus with 59 members, one shy of the 60-vote supermajority necessary to overcome a Republican-led filibuster. (The caucus includes two independents.)

Every Republican voted against the Senate healthcare bill last month. And few Democratic strategists believe it would be possible to persuade a GOP senator to cross the aisle at the 11th hour.

Sen. Olympia J. Snowe of Maine, a centrist Republican who backed a healthcare bill in the Senate Finance Committee last fall and would be considered the most likely candidate, was highly critical of the Senate legislation last month.

She has not been involved in discussions to develop a compromise between the House and Senate bills.

Another approach would be for Democrats to rush a compromise healthcare bill through the House and Senate before the results of the Massachusetts election are certified -- a process that could take two weeks -- and possibly a new Republican senator is seated.

But even advocates of such an approach acknowledge privately that it could seriously tarnish the health bill and create an even greater political liability for Democrats heading toward congressional elections.

Finally, the healthcare legislation could be scaled back enough to permit Democrats to use the so-called budget reconciliation process, which allows the Senate to pass a budget-related measure with a simple majority of 51 votes.

The technical requirements of budget reconciliation would leave major gaps in the planned health overhaul, however.

For example, many experts believe it would be difficult to create new insurance exchanges, where Americans would be able to shop for plans that would have to meet basic standards.

These exchanges, which would be open to Americans who do not get health benefits at work, are a centerpiece of the health legislation.

Dramatically changing the legislation would probably also be a lengthy process that could drag on for months at a time when many Democrats, including the president, are eager to move on to other issues -- especially jobs.

“We will aggressively urge Democrats to do the best possible bill quickly,” said Richard Kirsch, national campaign manager of Health Care for America Now, a coalition of liberal grass-roots groups, including labor unions.