After months of buildup, the historic debate on health care reform opens on the Senate floor Monday - but the C-SPAN cameras won't see the real action.
The next phase in the Democrats' health care push will be waged in the privacy of the Senate leadership office, where Majority Leader Harry Reid (D-Nev.) will attempt to do something that has eluded him all year: negotiate a compromise on the public insurance option that can garner 60 votes and win over a public still leery of reform.
"There is the inside fight and the outside fight," said Jim Kessler, a former top aide to Sen. Chuck Schumer (D-N.Y.) and vice president for policy at Third Way. "The inside fight is getting to 60, and the outside fight is winning the battle of public opinion."
The debate starts at 3 p.m. Monday with each side offering one amendment - a sign of how difficult the debate will be, since the two sides couldn't agree to terms of the debate beyond the first two amendments.
Republicans want six weeks of debate - which would be enough to push the final vote past Christmas - and have an arsenal of stalling tactics. But Democrats can short-circuit the debate all at once, simply by reaching a deal on the public option and filing cloture on the bill, which would set up the final crucial test vote before final passage.
Asked when he thought the debate would end, Sen. Ben Nelson (D-Neb.) said, "When there are 60 votes."
Nelson, who has said he will vote against the bill because of the public option, will be a prime target of Reid's backroom negotiations. But as the pre-Thanksgiving vote to send the bill to the floor showed, finding a middle ground is no small feat. Crafting a version that pleases four centrists - Nelson and Sens. Mary Landrieu (D-La.), Blanche Lincoln (D-Ark.) and Joe Lieberman (I-Conn.) - and maintains the Democratic left flank may well take until Christmas.
Each senator brings demands to the table. Nelson has said he could support a public option that allows states to "opt-in." Landrieu has suggested she could live with a "trigger" that kicks in if private insurers don't expand coverage fast enough. But Lincoln and Lieberman have sounded more staunchly opposed to the public option, making it harder for Reid to fashion a compromise that gets him to 60 votes.
Another target for Reid is Sen. Olympia Snowe (R-Maine), a trigger supporter who could also be persuaded to join Democrats if they accept the changes to the public option advocated by centrists.
There is one idea that supporters hope could rally the centrists: Call it the nonpublic "public option." It's an idea from Sen. Tom Carper (D-Del.) for a national insurance program that is neither run nor financed by the government. It could win over moderates because it wouldn't be a direct government expansion, but it would also satisfy liberals because it would be a national health insurance program designed to compete with private insurers from Day One.
It's possible that the public option will be dealt with through a manager's amendment, offered near the end of the debate, that ties up loose ends on the bill. It could include tweaks to the public option, ways to toughen up abortion restrictions in the bill (another concern of Nelson) and any other targeted attempts to secure a single senator's vote.
Reid will get backing from war rooms on Capitol Hill and in the White House, where operatives with a coordinated strategy stand ready to amplify the floor debate. "Our focus is to get the bill off the floor as soon as possible in a form that is most consistent with the president," said a senior administration official. Crafting a public option compromise "is largely what is taking up the time."
And the White House is already prepared for the likelihood the bill won't make it to Obama's desk by year's end, because even after the Senate passed the bill, it would still have to be negotiated with a more liberal version in the House - which includes a public option and a different funding mechanism to pay for reform.
Beyond finding 60 votes, Reid will have several other tactical objectives. He will need to give Republicans their say while preventing a total slowdown. Reid will look to shield his vulnerable members from casting votes that will haunt them later. And he must keep so-called poison pill amendments from passing by offering palatable alternatives.
But Reid isn't negotiating in a vacuum. Senate Minority Leader Mitch McConnell (R-Ky.) has threatened to filibuster amendments, which could both shine a spotlight on unpopular amendments and drag out debate for weeks. Democrats are also expected to filibuster some amendments.
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"As Sen. McConnell has made clear, we'll have a free-ranging, open debate, with amendments from both sides," McConnell spokesman Don Stewart said Sunday.
Sen. Tom Coburn (R-Okla.), perhaps the most prolific amendment writer in the Senate, has filed only two so far: to require all members of Congress to enroll in the public option and to require members to sign a form indicating they have read the bill.
"He has hundreds of amendment ideas and is looking forward to a full and open debate," Coburn spokesman John Hart said.
Republicans also have other tactics at their disposal. For instance, they could flood the floor with amendments or demand that amendments be read word for word. Reid can defend against those tactics by blocking amendments or leaving the Senate in session 24 hours a day to paint Republicans as round-the-clock obstructionists.
Democratic leaders assigned senators to lead messaging and amendment teams in six areas: the middle class; health insurance reform; children, senior citizens and Medicare; fiscal responsibility; business and small business; and the truth squad.
Republicans have taken a similar team approach and will target the more than $400 billion in Medicare cuts, the more than $100 billion in industry taxes and the impact on health care premiums.
Democrats are expecting the Republican amendment strategy to mirror the Senate Finance Committee markup, where senators sought to eliminate the proposed taxes and spending cuts. These amendments not only undermine the funding mechanism for the bill, but they also put politically vulnerable Democrats in the difficult position of voting to maintain unpopular elements.
Democrats also expect a series of amendments on hot buttons such as abortion, medical malpractice and immigration.
"We will have amendments to improve the bill, but they will put up amendments to set up 30-second attack ads and to score cheap political points," Reid spokesman Jim Manley said.
One wild card in the debate is the expected release this week of a Congressional Budget Office study of the bill's impact on premiums for all Americans. The CBO notified Senate offices last week that a report was expected "early" this week.
Sen. Evan Bayh (D-Ind.) and numerous Republicans had requested the analysis, and the timing of its release has caused anxiety among Democratic reform proponents.
Attempting to get ahead of the news, the White House released a four-page analysis Saturday by Massachusetts Institute of Technology economics professor Jonathan Gruber, who used CBO data to conclude that premiums on the individual market could drop by $200 to $500 annually.
But the report did not address the small-business and large-group markets, where many health policy experts expect premiums to continue to rise for most Americans - just at a slower rate than under the current system.
Even with the possibility of a protracted and difficult debate, Kessler said he sees a silver lining for Democrats.
"There isn't a single Democrat who doesn't want to pass major health reform," Kessler said. "There are just a few who aren't sure this is the way to do it. You don't have any folks who are skunks at the garden party who are going to defect. All the folks on the fence are truly in play."