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With Health Care Bill All but Passed, Time for Backroom Deals

David Lightman and William Douglas

Senate GOP leaders Mitch McConnell, Lamar Alexander and Jon Kyl will have no role in combining the House-Senate health care bills. | Associated Press

WASHINGTON - With Senate passage of health-care legislation now virtually certain, Washington lawmakers and interest groups are scrambling to influence one of Congress' most mysterious but most powerful institutions - the conference committee.

The Senate is expected to pass its version of the $871 billion health-care overhaul early Thursday, after 58 Democrats and two independents agreed Tuesday to cut off another Republican-led debate.

If the bill passes, it will need to be reconciled with the version the House of Representatives passed on Nov. 7. That job falls to a House-Senate conference committee, a group that likely will consist of a handful of senior lawmakers loyal to party congressional leaders, and working behind closed doors.

To most Americans, the conference process is an enigma, rarely taught in history or civics lessons. Even the "School House Rock" classic animated step-by-step primer, "I'm Just a Bill,'' skipped over the conference committee's role.

On Capitol Hill, however, it's a tradition steeped in late-night, closed-door deals and howls of protest from the frozen-out minority party.

"Probably the best part of the sausage-making process is the least understood and the most important," said former House Budget Committee Chairman Jim Nussle.

Nussle, an Iowa Republican and a former director of the White House Office of Management and Budget, said it isn't unusual for a chairman to call one official, open a conference meeting with all Democratic and Republican appointees present and then quickly adjourn the session.

The conference then usually goes behind closed doors, oftentimes without telling the minority conferees - in health care's case, Republicans - when or where the meetings are being held, Nussle said.

While health-care committee members haven't been named yet, it's widely expected that they'll include Sen. Christopher Dodd, D-Conn., one of the Senate bill's architects, as well as: Majority Leader Harry Reid, D-Nev.; Senate committee chairmen Max Baucus, D-Mont., and Tom Harkin, D-Iowa; and House committee chairmen Charles Rangel of New York, and George Miller and Henry Waxman of California, according to Harkin.

The Senate version is likely to dominate, because the conference needs the support of party moderates to get the 60 Senate votes it eventually will need to overcome procedural hurdles.

"Anybody who understands this process knows how hard it is to get 60 votes," said Sen. Kent Conrad, D-N.D., the chairman of the Budget Committee. "So it's clear the bill will need to be close to the Senate version."

Former Rep. Barbara Kennelly of Connecticut, now the president of the National Committee to Preserve Social Security and Medicare, agreed.

"The Senate has taken the House hostage, that's all there is to it," she said. "Do we have health-care reform in the bill the way we like it? No. I have to be for the bill because it's a starting point.''

Conferees are considered loyal to their party leaders, and in the Democrats' case, to the White House. While administration officials aren't part of the health-care conference, Chief of Staff Rahm Emanuel, health care expert Nancy-Ann DeParle and others are expected to be in close touch.


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"Every conference I've been on for 30-plus years has had White House involvement," Harkin said.

At the White House, press secretary Robert Gibbs Tuesday wouldn't get specific about President Barack Obama's role, saying, "I am not going to get into from here . . . what those negotiations may look like."

However, he said, "Health-care reform is not a matter of 'if.' Health care reform now is a matter of 'when.'"

The major flashpoints are well known: The House version has tough limits on federal abortion funding; the Senate bill is less restrictive. The House includes a public option; the Senate doesn't, and while the House would impose an income tax surcharge on the wealthy, the Senate opts for a higher Medicare payroll tax for higher-income wage earners and an excise tax on expensive insurance policies.

This much is likely: Whatever happens will unfold in secrecy after some tough bargaining.

Paul Ginsburg, the president of the Center for Studying Health System Change, a nonpartisan research group, predicted that fights would go well beyond those that are now obvious.

For instance, the insurance exchanges, or marketplaces where consumers could shop for coverage, are structured differently in the two bills. Also likely are differences over how to create savings in Medicare. The two bills approach the problem differently.

The internal dynamics of a conference can sometimes be reminiscent of Reginald Rose's "12 Angry Men," a play about tension in a deadlocked jury, where stamina, personality, ego and sometimes stubbornness can play major roles, said former Sen. Bob Kerrey of Nebraska.

"People like myself who have run for office before, we have 25 percent more capacity for self-delusion than most people," said Kerrey, now the president of the New School in New York. "In conference, it comes down to, 'If they get to know me, they'll support me."

Fatigue could also become a factor, Kerrey said, particularly among Senate conferees. The House adjourned last week for a lengthy holiday break, but the Senate has worked almost nonstop since Thanksgiving and is poised to work up to Christmas Eve.

The average age of the 100-member Senate is 61.7 years old, according to the Center on Congress at Indiana University. The average age of the 435-member House is 56.

"Fatigue is a factor," Kerrey said. "I have trouble staying awake after 10 p.m."

(Margaret Talev contributed to this article.)

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