The House is not about to pass the Senate's version of the health overhaul bill. The election of Republican Scott Brown to the Massachusetts Senate seat formerly held by Ted Kennedy pretty much puts a fork in a massive bill that's been nearly a year in the making.
Following what was reportedly a fairly rowdy meeting of House Democrats, Thursday, House Speaker Nancy Pelosi of California said the votes for the Senate bill simply aren't there.
"Unease would be a gentle word in terms of the attitude of my colleagues towards certain provisions of the Senate bill," she said.
And so far at least, the idea of scaling back and reaching out to Republicans doesn't seem likely to pay off. At least not while Republicans like House Minority Leader John Boehner of Ohio smell electoral blood in the water.
"Listen, our goal is to stop this monstrosity," Boehner said. "And we're working with our members so that we don't find ourselves in a position where they're able to pick off a few of our members and to get this bill passed. "
One option that seems to be gaining some traction is the idea of pulling out the most popular pieces of the health bill and passing them separately. President Obama even hinted at such a strategy in an interview with ABC news on Wednesday.
"I would advise that we try to move quickly on those elements of the package that people agree on," the president said.
That may sound good. But in practice, says health policy analyst Jeff Goldsmith, it comes with its own set of political perils.
"Each one of those pieces has barbs attached to it," Goldsmith said. "You can say that health insurance reforms are really very popular across a broad spectrum, but then when you put them in — you know, like eliminating pre-existing conditions or lifetime caps — not only do you not have the health plans at the table, but [opponents] are going to come at you hammer and tongs."
In other words, powerful interest groups that have so far stayed mostly on the sidelines could declare full-out war.
At the same time, Goldsmith said, many of the pieces of the bills only work in conjunction with other pieces, making picking and choosing problematic. In particular, hospitals, drug companies and other health-provider groups agreed to take pay cuts in Medicare because they knew they would recoup that money through other provisions of the bill that ensured that millions more people would be getting private insurance.
"If they don't have the healing balm of millions of paying customers to ... salve their wounds, they're not going to sit still for the cost containments in this bill," Goldsmith said.
The real challenge for lawmakers going forward will be to decide whom they can afford to disappoint, Goldsmith said.
For example, requiring insurance companies to take people with pre-existing health conditions — without also requiring that everyone have coverage — wouldn't cost very much and would be very politically popular. After all, with no mandate, the government wouldn't have to provide subsidies for those with lower incomes. But it would make insurance companies furious. And, Goldsmith said, it would probably cause all premiums to rise, since people would most likely wait until they got sick to buy insurance.
While Congress ponders its options, lawmakers should keep in mind waiting too long is also risky. Lawmakers are eager to get on to other agenda items, like jobs bills and financial regulation. They were hoping to have health care wrapped up by next month. About all they know now is, that's not going to happen.