There are key differences between the House and Senate approaches to Obamacare as explained by Nina Owcharenko and Robert E. Moffit, Ph.D. in a paper published by the Heritage Foundation lists 6 key differences between the two bills. Procedurally, the House passed a version of Obamacare with a public option, an income surtax and with strong language forbidding the use of federal monies to fund abortion. The Senate chose not to take up the House bill and passed a version of Obamacare with no public option, taxes on expensive health care plans and with weak language forbidding the use of federal funds for abortion. Sens. Jim DeMint (R-SC) and Mitch McConnell (R-KY) have since blocked the appointment of conferees to reconcile the differing versions of Obamacare. The options liberals have to get the bill to the President’s desk are therefore limited.

The Senate refused to take up the House bill and many claimed that the House bill was dead on arrival in the Senate. Presumably the Senate bill can’t pass the House, because of the more liberal abortion language, the radically different tax provisions and the lack of a public option. That leaves a so called “ping-pong” strategy where the House can either take up and pass the Senate version of Obamacare or they can take up the Senate bill, amend it, then send it back to the Senate. The Senate would then have the same option: take up and pass or amend and send back to the House. This ping-pong between chambers can happen a few times before the issue loses steam or the bill gets sent back and forth too many times to comply with the rules of the House and Senate.

Don’t forget that the American people absolutely hate this bill. Owcharenko and Moffit write “even if concessions and compromises can be made between the Senate and House versions, public opinion is solidifying against the legislation. A recent Rasmussen poll found that only 34 percent of voters say passing a health care bill is better than doing nothing. This is on the heels of a CNN poll that found 61 percent opposed to the bill and a NBC/Wall Street Journal poll that found that only 32 percent think the health care bills are a “good idea.” Even though both the House and Senate have passed very unpopular bills, it is possible that some of these members will actually listen to their constituents and realize that support for this initiative may be the functional equivalent of political suicide.

Any way you slice it, Obamacare still has a difficult path to the President’s desk, because either the Senate or the House will have to back away from their position on important issues. The liberals are 75% down the road to government control of health care, yet they still need to make it that last 25% of the way. For those who have given up hope, you may be correct to say that this is a done deal, but many Members of Congress would have to back away from strong policy stands on the public option, taxes on health care plans, and abortion for Obamacare to get to President Obama’s desk in time for a victory lap at his State of the Union speech.

This debate will center around many issues including huge taxes increases, economy-killing employer mandates and:

1. Abortion: Congressman Bart Stupak (D-MI) offered an amendment to the House bill to ban all federal funds flowing into the health care system from funding abortion. Senator Reid put language in the bill that allows some funds to go to abortion services by using an accounting gimmick. This issue could take the bill down, because the House approach is far different from the Senate approach. If this bill becomes a referendum on abortion policy, it may fail.

2. Cost: Senator Reid has promoted his bill as costing the federal government $849 billion and as a budget cutting bill. Conservatives in the Senate have pointed out that the costs are more accurately $2.5 trillion over the first 10 years of implementation because the benefits are not even scheduled to be paid out until 2014. There is a huge disparity between the two sides as to the cost of the bill and if it gets bigger and bigger on the Senate floor, then it may suffer a legislative implosion.

3. The Public Plan: Senator Joe Lieberman (D-CT) has pledged to support a filibuster of any bill containing the public option. Senator Olympia Snowe (R-ME) will only accept a public option with a trigger. Other Senators have expressed reservations about different permutations of the public option. A bill with a too strong public option may not have the support to pass the Senate.

4. Wild Card: As with all these debates, there may be an issue that comes out of the blue and becomes central to the bill. There were debates over “death panels” during initial stages of the debates and controversies over coverage for illegal immigrants. Some other issue may be offered as an amendment or may be buried in the 2000 pages of the bill that may become the next controversy to prevent passage.

The week after Thanksgiving, the Senate will start the process of considering and voting on amendments to the bill. This process may go in one of two directions. It is possible that Reid uses the amendment process to buy just enough votes to pass the bill through targeted special interest amendments. Expect Connecticut, Nebraska, Arkansas, and, yet again, Louisiana to receive special treatment in the amendment process. If Senator Reid is able to buy support during this process, the bill will pass and the President will sign Obamacare before his State of the Union.

Scenario two kicks in if opponents of the bill play hardball. If opposing Senators offer non-germane amendments, like the legislation to restore the 2nd Amendment in the District of Columbia or a resolution of disapproval for Attorney General Eric Holder’s decision to try Kahlid Sheik Mohammed in federal courts, then the Senate would be mixing some volatile issues into the health care mix. Regardless the course of action, this bill will either pass or fail as a direct result of the actions of a handful of Senators.

Read more about the five major flaws of Majority Leader Harry Reid’s health care bill here and at FixHealthCarePolicy.org.

Senator Harry Reid (D-NV), Senate majority leader, wants to rush the Senate health care legislation through the process by July 27, 2009. It’s not hard to see why.

After 13 days of intense debate, the Senate HELP Committee just finished work on the Senate bill (The Affordable Health Choices Act) and reported it to the full Senate for consideration. During the Committee consideration of the bill, there were hundreds of amendments, dealing with topics ranging from abortions to funding jungle gyms. Much of the internal Committee debate received little attention in the major media. But the Committee’s decisions, if the Senate bill is enacted into law, will affect every American. Consider some of the key decisions:

Covering Abortion. (Mikulski Amendment #201 ) Sen. Barbara Mikulski (D-MD) offered an amendment that would require health insurers to include “essential community providers” in their networks. They would provide “preventive care services” for women. These entities include providers like Planned Parenthood clinics, which perform abortions. Few Americans would be comfortable knowing that federal dollars would be funding abortions. In effect, this policy is directly contrary to previous congressional funding restrictions on abortion payment, such as the Hyde Amendment. Republican Senators’ attempts to exclude abortions from the bill failed. Based on this amendment, taxpayer dollars used to subsidize insurance for a low-income citizen, regardless of how he or she feels about abortion, can also be spent on an abortion obtained by someone else in the same insurance network. Moreover, under the Senate Committee bill, the federal government would determine the standard benefits that an insurance plan must include in order to exist on the market. In effect, as a result of the Mikulski amendment, all health plans would have to cover abortion services.

Financing Neighborhood Construction. (Coburn Amendment #49 ) To foster creation of healthier communities, the Senate Committee bill would provide federal community transformation grants to state and local governments. However, the legislation offers only broad guidelines as to where the money can go and does not limit the size of the grant. Sen. Tom Coburn (R-OK) offered an amendment that would prohibit the use of grant money to build and maintain sidewalks, parks, bike paths, or street lights. Other federal programs already direct money toward these projects. Dollars designated for improving the health care system, Coburn argued, could be spent on far more constructive areas, such as increasing access to health care. Remarkably, Coburn’s amendment failed on a straight party-line vote, meaning taxpayers’ hard earned dollars can wastefully go towards projects that are already funded by the federal government.

Expanding Bureaucracy. (Coburn amendment #110) The Committee bill grows the size of the government significantly – it creates new administrations and places immense power in the hands of certain bureaucrats. Sen. Coburn’s amendment would have prevented the expansion of government and runaway federal spending by maintaining the current number of bureaucrats. His amendment was defeated. Even as the nation’s unemployment approaches ten percent, the federal bureaucracy will expand.

Expanding Welfare Eligibility. (Coburn Amendment #205) Medicaid is a poorly performing welfare program. Ideally, it should be reformed, not expanded. Sen. Tom Coburn (R-OK) introduced this amendment to ensure that the Committee bill’s provisions do not expand Medicaid eligibility standards and attempt to increase the number of Medicaid enrollees. State and federal budgets are already heavily strained, and the increased burden of covering the cost of more Medicaid services would be unbearable for taxpayers in many states. Coburn’s amendment failed. This means that the federal government and states, both already in budget crises, will be forced to spend even more on Medicaid.

A Taste of Their Own Medicine. (Coburn Amendment #226) For many liberals in Congress, a new public health insurance plan, to compete against private health insurance, is an absolute “must” for health care reform. Virtually all independent analysts estimate that, given the special advantages of taxpayer subsidies and regulation, that the competition would be rigged, and millions of Americans with private health insurance today would be dumped by their employers into the new public plan. Sen. Tom Coburn (R-OK) proposed an amendment that would require all members of Congress and their staffs to enroll in the newly created public health insurance plan. This means that they would be required to give up their private insurance coverage (nationwide there are 283 plans competing for federal employees’ dollars), which is today provided through the popular and successful Federal Employees Health Benefits Program (FEHBP). With many members of Congress openly willing to create incentives that would drive Americans out of their existing private coverage, Sen. Coburn put his colleagues to a test. Although 10 Senate Democrats voted against it, the Coburn amendment passed by one vote. Taxpayers should watch very closely whether this amendment is preserved or buried.

Higher Taxes and Doctors Payment Cuts. (Roberts Amendment #207 , Roberts Amendment #208) Senator Pat Roberts (R-KS) offered two amendments that would have prevented the government from raising taxes, increasing the individual mandate penalty, or decreasing payment rates to Medicare providers to cover the cost of subsidies given to low-income individuals for their insurance premiums and out-of-pocket costs. Otherwise, under the Senate bill, taxpayers would have to shoulder the burden of increased taxes and physicians would be vulnerable to even lower government reimbursement rates for practicing in Medicare. Both amendments failed.

Blocking Anti-Rationing Amendments. (Roberts Amendment #1 , Coburn Amendment #9, Enzi Amendment #7) The Committee bill calls for an increased role of comparative effectiveness research (CER). A number of Senators fear that federal officials could use the data to determine payment, treatment, and coverage decisions, subordinating professional medical judgment in the treatment of patients to regulatory or budgetary considerations. These three amendments would have prohibited the use of CER to mandate coverage, deny care, or ration. CER, if used as a rationing tool, would obviously interfere with the traditional doctor-patient relationship. All three amendments failed on straight party-line votes. You can learn more here.

The giant Senate and House health bills would impact the personal lives of 300 million Americans. Ordinary citizens should understand that these measures are not merely focused on ways to control costs and expand coverage; they touch on how and what kind of care Americans will get, and under what circumstances they would get it. The disposition of these Senate amendments is just one indication of how members of Congress really feel about some of the most contentious issues in health care policy. It is time for every American to read these bills.

This post was co-authored by Julius Chen.

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