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Health Care Reform Update

Chicago — (January 20, 2010) 

Last night, Massachusetts State Senator Scott Brown (R) defeated Attorney General Martha Coakley in the hotly contested U.S. Senate special election in Massachusetts.  Once certified by the Secretary of State, Brown will replace Senator Paul Kirk (D) in the U.S. Senate.  Kirk had been named by Governor Deval Patrick (D) to fill the seat left vacant by the death of Senator Ted Kennedy (D) pending the results of the special election.

As has been widely reported, the election and anticipated seating of Scott Brown has significantly changed the legislative and political landscape surrounding the health system reform debate.  Specifically, the Senate Democrats once “filibuster proof” margin of 60 – which was necessary for the body to pass its health reform bill in December - has been eliminated.  Accordingly, if they choose, Republicans in the Senate voting together will now be able to block consideration of any final reform package resulting from the House-Senate Democratic leadership negotiations.

ASA has learned that starting Tuesday evening, House and Senate Democratic leaders began to meet regarding strategies for moving a health system reform bill forward.  As part of those discussions, this morning Senate Majority Leader Harry Reid (D-NV) released a statement affirming his intention to advance a reform bill through the Senate albeit without referencing a date certain.  “In the coming year, we will ensure all Americans can access affordable health care, deny insurance companies the ability to deny health care to the sick, and slash our deficit in the process,” he said.  It is our understanding the discussions will continue today and tomorrow.

While ASA expects one to two days of uncertainty, we do anticipate the Democratic leadership to announce later this week or early next week their intentions with regard to advancing reform legislation.  Under the current circumstances, we believe that Democrats could choose any number of routes to reform.  We believe that the following are currently receiving the most consideration.

“Reform RIP” – House and Senate Democratic leadership declare the reform effort “dead”, blame GOP obstructionists and move on to other issues.  While an unpopular approach among the majority of Democratic lawmakers due to the time and legislative and political resources already invested in the process, some moderate House and Senate Democrats may push this option.

“Beat the Seat(ing)” StrategyHouse-Senate leaders quickly merge existing House and Senate bills and quickly bring the final bill to the Senate for a final vote while Senator Paul Kirk still holds the Massachusetts seat.  While this strategy remains an option, the work necessary to actually merge the bills, finalize Congressional Budget Office (CBO) scores and address procedural steps would likely require more time than is available to “beat” the arrival of Senator-elect Brown.  Additionally, a number of prominent Democrats have already publicy dismissed this approach.  Senator Jim Webb (D-VA) released a statement Tuesday evening that read: “In many ways the campaign in Massachusetts became a referendum not only on health care reform but also on the openness and integrity of our government process. I believe it would only be fair and prudent that we suspend further votes on health care legislation until Senator-elect Brown is seated.”

“Reconciliation” Rewrite a reform bill so that it could move through the Senate under the 51 vote reconciliation rules.  While considered a viable option supported by some House Democrats, rewriting a major reform bill could involve significant negotiations and modifications to ensure agreement on contentious issues.  Additionally, rules governing limitations on the content of bills considered under the reconciliation process would represent a challenging obstacle to be overcome.  Experts estimate that the reconciliation approach could consume over a month.

“Two bill” strategy – Senate bill is passed by the House of Representatives in its entirety thereby negating additional Senate consideration of reform.  A second reconciliation-friendly (51 votes) “correction” bill containing modifications to the Senate bill is quickly crafted and passed by the Senate and House.  This strategy is popular among many House and Senate lawmakers.  However, it is unclear whether sufficient numbers of House lawmakers would be willing to vote for a Senate package which is viewed as containing a number of troublesome provisions including the tax on “Cadillac” health plans - a provision strongly opposed by pro-labor House members, and problematic abortion language.

It is possible that other health reform strategies will emerge over the coming days.  ASA will continue to carefully follow developments by Democratic negotiators and report them to the membership as necessary.  Additional information will also be available as part of the Thursday, January 21st, 8 pm EDT Health Care Tele-town Hall meeting with ASA President Alexander Hannenberg, M.D.


Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 52,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.

For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at . To learn more about the role physician anesthesiologists play in ensuring patient safety, visit Like ASA on Facebook , follow ASALifeline on Twitter and follow ASA on LinkedIn .



American Society of Anesthesiologists