Health Care Overhaul's Uncertain, Super-Majority-Free Future

Experts disagree over future legislation after upset election victory.

January 20, 2010, 7:00 PM

Jan. 21, 2010— -- With Republican Scott Brown's victory in Massachusetts on Tuesday, Republicans in the Senate captured a seat long held by Democrats, and, perhaps more importantly, the possible 41st vote necessary to filibuster any new health care bill.

But while the future of a health care overhaul remains unclear, experts are divided as to how to read the tea leaves in public opinion on the issue following a vote from a state that already has universal health care. Brown, then a state senator, voted in favor of the measure when the Massachusetts legislature passed it in 2006.

Brown has vowed to halt the current version of health care reform, passed by the Senate on Dec. 24, saying he did not think the current plan was a good one for the country -- or Massachusetts.

"We already have 98 percent of our people insured here," Brown said Wednesday afternoon, repeating one of his campaign themes. "We know what we need to do to fix it. But to have the one-size-fits-all plan that is being pushed nationally -- it doesn't work."

Experts were split on whether health care overhaul could continue forward at this point.

"President Obama's already unpopular health plan didn't lose just one vote in the Senate. It lost maybe a handful of votes in the Senate and perhaps a dozen or more in the House," said Michael Cannon, director of health policy studies at the Cato Institute.

"Antipathy toward the Obama plan was the number one reason for Brown's victory, and that has vulnerable Democrats in Congress running scared," he said. "They are now far more likely to vote against the Obama plan, particularly since the elections in New Jersey and Massachusetts show that Obama can't help them on the campaign trail."

But others disagree.

"Health reform is not doomed. It just depends who does it," said Uwe Reinhardt, a professor of economics and public affairs at Princeton University. "The task will always be much, much more difficult for Democrats, because they are suspected of plotting government hegemony just breathing. It is much simpler for Republicans to do the same thing."

State of Opposition

To be sure, nationwide numbers have shown the public to be divided on the issue, with a slight majority opposed to the measure.

But it remains unclear how those numbers translate to Massachusetts, traditionally one of the most Democratic-leaning states in the union, but one that has some unusual circumstances when it comes to health care overhaul.

During his campaign, Brown said the health-care bill passed by the Senate would force Massachusetts to subsidize care in other states.

"It is a good point that Massachusetts residents didn't 'need' national reform," said David Dranove, a professor of health industry management at the Kellogg School of Management at Northwestern University. "But they must have been furious about having to pay for healthcare in Nebraska and Louisiana on top of paying for their own healthcare."

He also noted that Massachusetts voters "could see that the national reform effort was a badly compromised version of their own reforms," noting that Democrats in Congress struck some deals that he feels voters found unpalatable.

But some also noted the fact that Massachusetts has had some level of health care reform may be a sign that voters did not cast their votes based on that issue -- and perhaps politicians shouldn't interpret it to mean that.

"I do find it ironic that many people outside of Massachusetts are interpreting this vote as a message that those living in the state oppose health care reform, when a very similar system is very popular inside that state," said Dr. Aaron Carroll, director of the center for health policy and professionalism research at the Indiana University School of Medicine. "If they were truly opposed, you should have seen at least one campaign running on a platform of scrapping their system. None did."

Second Life Or Dead On Arrival?

While some may see health care overhaul as a lost opportunity, others see the vote as a setback that can be overcome.

Reinhardt noted that in the past, Republican administrations have pushed bills through Congress that brought price controls set by the federal government. Under Ronald Reagan the target was the hospital sector, and under George H.W. Bush it was doctors.

"Both times it went without a huge public outcry. But now imagine if a Democratic president -- e.g., Bill Clinton or Obama -- had done the same thing. He would swiftly be denounced as trying to impose Soviet-style pricing on American hospitals which, in effect Reagan's [pricing systems] were," he said.

"Moral of the story: There is a double standard here," Reinhardt said. "Perhaps only Republicans can get health reform done, because only they can get away with doing even Soviet-style policies."

Other ideas for a bill passage have been floated.

Some proponents of health reform have held out hope of persuading Maine Sen. Olympia Snowe, a Republican, to vote for a bill, and others wanted to speed through health care reform before Brown was seated, although Obama has nixed that idea.

"Here is one thing I know, and I just want to make sure this is off the table," he told ABC News' George Stephanopoulos on Wednesday. "The senate certainly shouldn't try to jam anything through until Scott Brown is seated. People in Massachusetts spoke. He's got to be part of that process."

Leadership Unclear

Even Democrats in the Senate do not appear to have a clear plan for how to proceed right now.

In response to a question from ABC News correspondent Jonathan Karl about whether he was committed to finishing the health care bill and confident he could pass it on to the president, Senate Majority Leader Harry Reid replied, "I am confident that health care is an issue in this country. We are going to do everything we can to alleviate the pain and suffering of people who cannot afford health care and who want to maintain what they have."

He then noted that the House had until Dec. 24, 2010 to pass the bill the Senate had passed at the end of last year and send it to the President.

His representative clarified afterward.

"We are still committed to getting health care done," Reid spokesman Jim Manley said.

But Brown himself has given some hints that even if the current incarnation of health care reform is not something he will vote for, it does not mean he will oppose any proposal.

"I think it's important for everyone to get some kind of health care," he said Wednesday. "It's just a question of whether we're going to raise taxes, cut a trillion from Medicare, we're going affect veterans' care -- I think we can do it better."

ABC News' Political Unit in Washington contributed reporting. The ABC News Medical Unit is based in Needham, Mass.

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