The Road Ahead: What's Happening in Congress?

While the House has narrowly passed a comprehensive health reform bill, and the Senate is consumed with its most intense and fast-moving debate over a major domestic initiative in decades, Ropes & Gray completes its first annual cycle of quarterly newsletters addressing the politics and substance of health reform. Last week Senate negotiations produced a major breakthrough with announcement of a deal to accept an alternative to the controversial public plan option. This compromise is only one of many reached in recent weeks in the closed-door negotiations that are taking place between individual Senators on a parallel track to the public debate on the Senate floor. These individual agreements have been wrapped up in a single, comprehensive “manager’s amendment” that is expected to be brought to a vote before adjournment. As of this writing, the debate has taken a temporary hiatus as the Senate leadership awaits the Congressional Budget Office’s analysis of the cost of the manager’s amendment, which for many Senators will decide whether they vote for it. If 60 votes can be garnered for the amendment, it is likely that the Majority Leader will move to final passage of the bill, with some hoping that can occur as early as next week.

As Democrats begin to coalesce over the contents of the bill, prospects that it will pass the Senate before the end of the year are on the rise. It is now widely anticipated that the House will reluctantly accede to many—if not all—of the compromises reached in the Senate in the interest of sending a bill to the President. If so (and it is still a big “if”), we may be on the verge of an historic overhaul of the health care system that will affect every American, every employer, and every segment of the health care industry. But, even if a Rose Garden signing ceremony takes place, substantial policymaking lies ahead. Despite more than 2,000 pages of legislative text, the details of the revamped system remain to be filled in at the agency level—primarily HHS, which will be charged with undertaking a massive implementation effort on a scale not seen in recent memory. Because the devil is always in the details, it will be important not only to understand the final legislation when and if a bill is signed into law, but also to monitor closely the implementation of those provisions of most interest to your organization.

That’s where Ropes & Gray can help. In addition to our Health Reform Resource Center, where you can access all of the important legislation, amendments, cost estimates, and other analyses in real time, we provide webinars, client alerts, a side-by-side comparison of the House and Senate bills, and other useful tools as the debate proceeds (look for a timeline for implementation in the near future). We will continue to publish our quarterly Health Reform Matters newsletter through next year. In the meantime, contact your regular Ropes & Gray attorney to discuss how we might help you with tailored analyses of the impact of the bill on your organization and help you stay on top of developments through the implementation phase.

In this edition of Health Reform Matters, we begin by examining the major points of differences between the House and Senate approaches to the bill (“Differences Remaining in House and Senate Approaches”). Although ultimately the Senate may have more clout in negotiations over the bill’s final contours, the willingness of the various wings of the Democratic party in the House to follow the Senate should not be taken for granted. In “Delivery System Reform: Do the House and Senate Bills Deliver?,” we take a closer look at the major provisions in the bills to undertake fundamental restructuring of the health care delivery system. We pause to check in on the views of the major constituent groups toward the turn that reform has taken in "Current Stakeholder Perspectives on Health Reform.” And finally, in “Finding a Way to Pay for Health Reform,” we review the health care savings, the new revenue sources, and the tax law changes that are likely to be tapped to finance the nearly trillion-dollar legislation.

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