A Health-Care Reality Check Slows Congress

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Mark Wilson / Getty

Senator Chuck Grassley, center, speaks while flanked by Senator Max Baucus, left, and Senator Jay Rockefeller during a press conference about the State Children's Health Insurance Program

Whether or not health-care reform actually passes in the end, this may be remembered as the week when the reality of the challenge such a massive overhaul poses finally dawned on lawmakers. And the reality is this:

It's all about the dollars. Coming up with a bill that doesn't add to the deficit is turning out to be even harder than members of Congress thought it would be.

The yellow caution light has come from the Congressional Budget Office, the fiscal scorekeeper for everything proposed on Capitol Hill. In recent days, the CBO has issued preliminary estimates suggesting that both major bills in the Senate — including the one being worked on by the Health, Education, Labor and Pensions (HELP) Committee and the one by the Finance Committee — are not only going to add significantly to the deficit, but also that they'll do so without delivering what lawmakers have promised in terms of bringing down health-care costs and covering the uninsured.

The first thing to bend in the face of this new realization is the accelerated, ambitious schedule that key committees have set for themselves. Senate Finance Committee chairman Max Baucus, who had breezily told reporters as recently as June 16 that he would have a bill ready by the end of the week, suddenly announced on June 17 that he had decided to "slow things down" and that his committee may not begin the formal process of drafting its bill until after the July Fourth congressional recess. If that's the case, it is hard to see how he can meet his other goal of seeing the legislation pass the Senate by the end of July.

Delay may be awkward, but moving too hastily with a half-baked bill can be worse, as the HELP Committee is learning the hard way. The committee forged ahead with a markup — a formal drafting session — on June 17 despite a CBO estimate that its bill, as it stands, would increase the deficit by $1 trillion over the next 10 years and still leave the number of uninsured about two-thirds as high as it is now. Senator Chris Dodd, filling in for ailing committee chairman Ted Kennedy, hadn't even read his formal opening statement before he was interrupted by Republicans demanding a halt to the proceedings.

"This is a joke," said Arizona Senator John McCain. "This is the most incredible markup I've been to in my years in the Senate and in Congress. I suggest we not move forward until we have some provision on how we're going to pay for it." New Hampshire Republican Judd Gregg added that he didn't know who had written what he had seen of the bill, "but if it had been Rube Goldberg, Ira Magaziner [the architect of the failed 1994 Clinton health-care plan] and Karl Marx, you might have gotten this product."

Watching what happened to the HELP Committee, you could understand why the Finance Committee would decide to delay its own markup. After all, it had been warned by the CBO that an early draft of its bill would have an even larger price tag than the HELP Committee's — it would increase the deficit by more than $1.6 trillion over the next decade. So Finance Committee members will be spending the next few weeks trying to reduce the price tag. It is looking, for instance, for ways to make sure that people who now get coverage from their employers cannot drop it in favor of being insured through a government program (which would, in many cases, put at least part of their health costs on the back of the taxpayer). Finance Committee members also are considering how generous to make the basic benefits that would be offered under health reform, since the more medical services that they insist be offered, the more it will cost the government. Additionally, they are looking for other ways to squeeze money out of the Medicare program.

Meanwhile, White House officials say they are content to watch this ugly phase of the process — one of many it is likely to go through before it is over — from the sidelines. "It's going to look like a mess for a few weeks," said an official. "But overall, we think this is helpful. CBO has sent a signal that everyone needed to hear: This is not just an intellectual exercise."

With reporting by Jay Newton-Small / Washington