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House Votes on Health Reform: What’s Next?

By the incredibly close margin of 220 to 215, the US House of Representatives adopted health reform legislation on Saturday evening, November 7, 2009. In the end, abortion restrictions were added…and liberals were forced to accept these and provide the margin of victory.

The content of the House bill is of little significance. However, its passage is an historic event, creating a near-certainty that President Obama will be signing final legislation in the next 3 months.

Everyone’s attention will now return to the other side of Capitol Hill. Senate Majority Leader Harry Reid has only one task: find the combination of health reform provisions that can command 60 votes in the Senate. He knows the answer is not in the House bill.

To get to 60 votes, Reid will need to agree to giving states the option of joining a government-run insurance plan or accept a mechanism where a government-run insurance program is triggered only if insurance reform doesn’t reduce premiums. Not unlike the House, President Obama will be needed to persuade Senate liberals that this is a better outcome than no legislation at all.

Holding 60 votes may be as challenging as getting 60 votes. News stories have mentioned the possibility that Senators might offer 2000 amendments, regardless of what package Senator Reid offers. Leaving aside the weeks of Senate floor time this would require, every vote would hold the potential to break apart the 60 vote majority that Senator Reid would have labored to put together.

Sharp limits on amendments will be required. Perhaps, the 60-vote majority will have to agree to a text beforehand and then oppose all amendments. The same problem would recur in House-Senate conference…so there will probably be no conference. Instead, four to 10 weeks from now, President Obama will be back on the House side, persuading liberal members that the Senate bill is the best possible. He will be urging them to vote to accept that bill when it comes back to the House for consideration.

So, the House bill means nothing, but its passage will push forward a political process that Democratic leadership cannot allow to fail. They will have no choice but to twist arms until the votes and the process makes success possible.

Where is FDA legislation in all of this? Some version of follow-on biologics will be in the final legislation. The House bill won’t matter. The specifics will be those agreed to in the Senate over the next few weeks.

Where is FDA in all of this? Advocates need to strongly and continually reinforce the relevance of the agency in a political world that will be dominated by implementation of health reform. The arguments may seem obvious: safe and effective drugs, biologics and devices are an essential part of preserving and improving human life. This will be true in a reformed system as much as it is today. The difficulty is knowing whether any Members of Congress will be listening.


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