Fancy Footwork: The Many Steps Between The Democrats And Health Care Reform

We're less than a week away from the House vote that could seal the deal on health care reform, but a number of key procedural hurdles still stand in the way, as does the related, but more fundamental task of actually rounding up the 216 votes Speaker Nancy Pelosi will likely need to succeed.

So let's walk through all the (complicated) steps: The ultimate goal remains for the House to pass the Senate health care bill along with a series of amendments, which will be fast-tracked using the budget reconciliation process. Yesterday, the House Budget Committee approved a shell bill and sent it along to the Rules Committee, where its language will be stripped and replaced with the language of the reconciliation fix. That fix is still being tweaked behind the scenes as leadership goes back and forth with the Congressional Budget Office in search of a score that does not drastically alter the cost-estimate of the Senate health care bill.

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Once the final score is in, Rules Committee Chair Louise Slaughter will determine exactly how to structure the final vote on reform. Slaughter and Pelosi--and, according to Pelosi, the majority of the Democratic caucus--would prefer to use what's known as a "self-executing rule."

Here's where things get complicated. Instead of requiring Democrats to take separate votes on the Senate health care bill and the reconciliation fix, a self-executing rule would allow the House to do the whole thing in a single vote. The rule would be written in such a way as to "deem" the Senate bill passed, if the House votes to pass the reconciliation bill. And voila. Health care reform.

Rank and file Democrats think this would spare them from the political peril of voting for the Senate bill, and all of its unpopular provisions. But whether they're right about that or not, Republicans have taken to calling the parliamentary maneuver the "Slaughter Solution," suggesting it's an unprecedented and undemocratic way around standard procedure. (In fact, self-executing rules are fairly common, and, as a memo from Slaughter's office demonstrates, they're used more commonly by the GOP than by the Democrats.)

In order to do any of this, though, House leadership and the White House will need to turn out the votes. And right now, despite sounds of optimism, they don't have them. Pelosi says that's because the final language of the reconciliation bill is still being edited. House Democratic Caucus Chair John Larson says the votes are there, and have been all along--but he takes that as an article of faith.

But Rep. Jason Altmire (D-PA)--an in-play freshman who voted "no" on the House health care bill in November--told Politico yesterday that leadership is still seeking votes from the hard-line opponents of reform in their own caucus, suggesting, he said, they're still a way's off from the needed 216. And, of course, there's still Stupak's posse, many members of which are still holding out over the Senate bill's abortion language.

So when will all this happen? Democrats have committed to putting the final language on the internet for 72 hours before holding a final vote, and if they stick to that, it won't happen until Friday at the earliest. But it could be a long weekend.