By John Sawyer

Dan Hawkins and I were meeting recently with a top Democratic aide in the Senate, just before the Senate Finance Committee markup began – we were discussing the Senate timeline for passing health care reform.

“We’ll spend a week marking up the bill in Finance, pass it out late Friday or early Saturday, merge the bill together with the HELP bill Saturday afternoon, and go to the floor for two weeks of debate, with a vote just before the Columbus Day recess,” said the aide, a knowing glimmer in his eye.

Good to see optimism still lives even in the United States Senate.  Then again, maybe what we witnessed in this description was the cynicism of a Capitol Hill veteran – it’s a universally understood truth in Washington that Congress (especially the Senate) usually won’t get anything done without a deadline.  With Columbus Day approaching, we’re still likely a week or two from a Senate floor debate and vote on health reform.  But we’re closer than we’ve ever been.

All five Committees of jurisdiction have finished debate on health care reform (the Senate Finance Committee finished at 2:08 AM last Friday morning – I have an email from Lupita to prove it – and will vote later this week).  Various provisions designed to strengthen and expand health centers and improve access for our patients are contained in the various versions of the bills.   Yet we’re a long way from a Rose Garden signing ceremony.

So what happens now?

The Finance Committee Vote

Originally scheduled for Tuesday, the final vote in the Senate Finance Committee will likely now be later this week.  There are 5 Senators who can accurately be described as “on the fence” – a good roundup of those folks is here.  Votes aren’t the only thing being counted this week – the Committee is still waiting for the official “score” (read: “cost”) from the Congressional Budget Office.  Despite the delays, the safe money at this stage is that Finance Committee Chairman Max Baucus will have the votes he needs to get the Finance Bill out of Committee.

The Merge, aka the Smoosh

Even before Committee work finished in the Senate, the process of reconciling the Finance Committee legislation with the package passed in July by the Senate HELP Committee was well underway.  This process, run by Senate Majority Leader Harry Reid, has one goal: crafting a bill that can get 60 votes on the Senate floor.  Easier said than done, however.  Major differences exist between the more centrist Finance version and the liberal HELP version, including various health center-related provisions.  NACHC’s recommendations for the blending of the two Senate Bills can be found here.

Floor Debate

Debate on the Senate floor could take several weeks – and is an unpredictable process.  Liberal Democrats will likely bring the “public option” forward for a vote if it’s not in the merged package; Senators who didn’t have a chance to vote on a bill in Committee will bring their own policy ideas to the floor debate; and certain Republicans could try and load up the bill with “poison pill” amendments on controversial issues like abortion, immigration, and taxes.

Whip Counts and a Vote

Eventually the moment will come, and the Senate will vote on a health reform package.  Because of an almost certain filibuster from Republican opponents, conventional wisdom is that that vote will need 60 votes to pass the Senate, as that’s the number needed to overcome such a filibuster.  Holding together a coalition of 59 or 60 Democrats (depending on whether Sen. Olympia Snowe of Maine votes yes) is a tough task, to say the least.