Final health bill to arise in secret

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 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.

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.

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

At the White House on Tuesday, press secretary Robert Gibbs wouldn't get specific about President 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.