How President Barack Obama’s State of the Union speech will impact healthcare reform

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

President Barack Obama’s State of the Union speech Wednesday night will likely focus on job creation and the economy and not — as many Democrats once hoped — on congratulations for the passage of healthcare reform.

How President Barack Obamas State of the Union speech will impact healthcare reform In the week following the election of Republican Scott Brown to the U.S. Senate — which destroyed the Democrats’ 60-vote, filibuster-proof hold in the upper chamber — talk on the Hill has turned away from healthcare reform as senators work to bring a jobs bill to the floor in February.

“I don’t think I know any more this week than I did last week,” Sen. Ben Nelson (D-Neb.) told reporters, when asked about the progress of passing a healthcare reform bill any time soon.

Senate Majority Leader Harry Reid (D-Nev.) said on Tuesday that there’s “no rush” to reach a final agreement on healthcare reform.

Still, several Senate Democrats said they hoped the president would address healthcare reform in his televised speech from the House of Representatives and that he should tie the issue to jobs.

“Healthcare is a jobs bill,” said Sen. Mary Landrieu (D-La.).

Sen. John Rockefeller (D-W.Va.) agreed. “Actually, healthcare is the greatest job creator there is,” he said.

Sen. Sherrod Brown (D-Ohio) told reporters he’d like the president to provide some “direction of where to go” on healthcare reform during his prime time address.

Sen. Olympia Snowe (R-Maine) agreed that Obama needs to make clear his revised healthcare agenda in the face of the critical, one-vote change in the Senate.

“Obviously, he has to make the decisions on how to proceed on healthcare,” she told reporters.

The original plan — to combine the healthcare bill passed by the Senate and the bill passed by the House — was derailed by Brown’s election, so now Democrats are considering a new procedure to enact healthcare reform.

One option is to use a process known as reconciliation, which is generally used for budget bills, and only requires a simple majority of votes to pass, as opposed to the 60 votes often necessary to pass a major, non-budget bill.

Republicans say that resorting to reconciliation would make Democrats severely unpopular in the mid-term elections in November, and Democrats are wary of using reconciliation because it would mean having to strip substantive provisions from the healthcare bill.

“I’m not open to reconciliation that is being envisioned,” said Sen. Claire McCaskill (D-Mo.) “I’m not going to say that I would absolutely not vote for reconciliation, as some sort of two-step process,” she told reporters, referring to a proposal to pass a bare-bones healthcare reform using reconciliation and then modifying it afterwards through normal congressional procedure.

McCaskill signaled that she would be more willing to support another approach: passing a scaled-down version of the current healthcare reform bills.

“It’s better for us to take a bite of the apple that is not so big,” McCaskill said.

But others acknowledge the difficulty of taking a piecemeal approach because so many elements of the bill are tied to other elements through a series of interrelated deals.

For instance, insurance companies only agreed to a proposal forbidding them from denying coverage based on a preexisting health condition in exchange for a provision that would guarantee them more customers by requiring everyone to have insurance.

“That is an integrated whole that we thinks works as a whole,” House Majority Leader Steny Hoyer (D-Md.) said at a Tuesday morning event at the National Press Club. “It is difficult to take small pieces and chop them up.”

Another option being floated to pass reform: Convince members of the House to pass the exact version approved by the Senate.

While Hoyer has said that option would be better than nothing, other members of the House have expressed opposition to the idea. The two bills differ on several fronts, including abortion funding and how to pay for reform.

While lawmakers clearly are looking for guidance from the president on how to proceed with healthcare reform, Obama’s State of the Union will likely be short on specifics.

“These speeches are usually full of generalities that are fleshed out later,” said Sen. Ben Nelson (D-Neb.)

During his prime time address, the president will also likely tout his new proposal: a three-year freeze on discretionary, domestic spending.

While it would have some effect on the deficit, the spending freeze wouldn’t apply to entitlement programs and paying off national debt, which account for about 85% of the federal budget, Hoyer noted.

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  • Diane J Standiford

    The more I hear, the less I know. All Americans bear some responsibility for this confusing state of health care reform. We have made our desires as hard to figure out as the changes coming our way.

  • Christopher

    Part of health care reform will involve addressing the shortage of primary care physicians. Well here is my solution and willingness to implement it:
    Christopher M. Glenn, MD
    Professional Career Personal Statement

    I am a board-eligible physician trained in general internal medicine. I am currently seeking an entry-level attending position in an office, clinic, community health center, or hospital based practice with the responsibility to care for inpatients and/or outpatients. I am especially interested in practicing urban primary care general internal medicine; although I am open to practicing in alternative environments and clinical settings.
    Future opportunities to engage in clinical research training activities, teach, and be involved in community outreach activities are also desirable where applicable

    I completed my residency training in general internal medicine at Advocate Illinois Masonic Medical Center (Chicago, IL.) in June 2002 followed by a post-doctoral research fellowship in cardiac physiology at The University of Illinois College of Medicine (Chicago, IL.) which I completed in August 2005. I have not practiced medicine since completing my residency although this was not my initial intention.
    Practicing clinical medicine has always been my primary career objective, although achieving this objective was postponed because I unexpectedly had difficulty passing USMLE Step 3 despite multiple attempts. The reasons for such difficulty may have been multi-factorial but were primarily viewed by me as a personal and professional challenge that had to be overcome. I confronted the challenge of passing the exam with perseverance, sustained optimism, improved test preparation, personal sacrifice, a heightened sense of humility, and an unwavering passion to practice medicine. I subsequently passed USMLE Step 3 in April 2009 and was issued a full, unrestricted New York State medical license on November 24, 2009.
    Since completing my post-doctoral research fellowship I’ve served as a medical development associate & community outreach liaison (an administrative consulting position) for a small medical practice. My responsibilities included general business development and community service activities directed at promoting health education and public safety.

    Although I am currently an inexperienced clinician, I am an experienced health care industry professional with approximately 14 plus years of work experience (10 of which was gained prior to attending medical school) and have served in a variety of positions that have included laboratory, marketing, management, clinical study coordinator, and administrative experiences. I completed my medical education and residency training without interruption, promotional delay, or need for clinical remediation. During my residency I received two awards, issued by the teaching faculty, which reflected my performance as a resident regarding matters of clinical competency and compassion. The awards were Internal Medicine Associates (honorable mention) and Hand Holder Award.
    I have enjoyed and dedicated myself as a passionate health care professional and I am enthusiastically prepared to resume my clinical career in order to fulfill my primary career objective and I believe, I will be able to fully and safely execute my responsibilities independently after a short period (2-3 months) of clinically-focused supervision in a rigorous clinical environment. I look forward to the privilege of practicing medicine. I hope I’m a suitable match for your practice/organization or that someone is to help move beyond the rhetoric regarding this issue.
    I can be conveniently reached at

  • Anonymous

    Terrific. More people should write punditry/resume’s

    My favorite bit was when he looked at the GOP members and asked if it was always going to take a super-majority to get any business in Washington. Then saying, “that’s not leadership.”