Party leaders are trying to close in on the 216-vote threshold they need for the House to clear a Senate-passed health care overhaul bill. However, there are a few issues still being sorted out: 

·         Medicaid funding – making Medicaid funding equitable to all states;

·         Costs- Blue dog coalition of centrist Democrats has concerns the bill is too expensive and far-reaching;

·         Immigration concerns – the bill, in its current form, does not let illegal immigrants buy coverage on newly created insurance exchanges; 

·         Abortion – there are concerns if bill language on abortion is restrictive enough;

·         Fixes/Reconciliation/Sidecar bill – members in the House are seeking assurances this bill will pass after the overhaul health bill is signed (if this method is chosen).

The fixes in the reconciliation bill will include changes to make healthcare more affordable for the middle class; eliminating special deals; closing the “doughnut hole” for seniors in the prescription-drug entitlement; and changing the funding mechanism to rely less on an excise tax on so-called Cadillac insurance plans. 

There are a number of procedural options on the table, but at the time of writing, Pelosi said that she favors the “deem and pass” strategy.

That strategy means that rather than passing the Senate bill and then passing the fixes, the House will pass the fixes under a rule that says the House “deems” the Senate bill passed after the House passes the fixes.

The strategy, for some, means certain members can claim they did not vote on the Senate Health Care Overhaul bill, they only voted on the reconciliation package. However, the vote on the reconciliation package functions as a vote on the Senate bill.

This strategy became an option since there are not the votes in the House for the Senate bill without the reconciliation package. But the Senate parliamentarian said that the Senate bill must be signed into law before the reconciliation package can be signed into law.

The House Budget Committee passed the fixes/reconciliation with a vote of 21-16.