President Obama is going to address another Congressional gathering today. The audience will be more friendly this time: It will be the Senate Democratic caucus. But the stakes will be just as high as they were when Obama spoke to Republican House members last week.

Health care is bound to come up at the meeting. I assume Obama will raise it during his prepared remarks; if not, he'll get questions about it. And the big controversy right now is whether the Senate is willing to amend its bill through the budget reconciliation process. It's the only way to make changes to health care at this point, since the Republicans have vowed to filibuster the final vote--and, thanks to the election of Scott Brown in Massachusetts, they have the forty-one votes necessary to sustain it. (In reconciliation, a minority can't block the final vote.) And such changes appear to be necessary, because the House has made clear it won't approve the Senate's bill without some changes.

The problem is that Senate Democrats aren't very happy about taking a reconciliation vote right now. Some worry that the move smacks of partisan politics at a time when the public wants, or says it wants, bipartisanship. Some worry it will seem like trying to bend legislative rules, at a time when voters are clearly angry about the deals Democrats made with special interest groups and some of their own members in order to pass the original bill. And some just want to be done with health care reform, because voters are clearly tired of it and want to hear about jobs instead.

The anxiety is, as you might expect, most pronounced among senators who represent more conservative states and/or are up for re-election this year. Arkansas Senator Blanche Lincoln, who is probably the most vulnerable Democrat running this year, has made clear she'd prefer not to take a reconciliation vote on health care. Her Arkansas colleague, Mark Pryor, has said similar things, as have Indiana Senator Evan Bayh and Louisiana Senator Mary Landrieu. The Democrats can afford up to nine defections and still prevail. But you can conjure up five possible to probable "no" votes pretty quickly--in addition to Bayh, Landrieu, Lincoln, and Pryor you'd include Connecticut's Joe Lieberman.*

The best arguments for moving forward are the ones all of us have been discussing over the last week. All of these senators voted for health care reform already. Republicans will attack them for it no matter what. Their best bet is to pass the bill into law, since that will give them an accomplishment they can tout and clear tangible benefits they show to voters. (As Kevin Drum noted in a must-read analysis, this isn't merely speculative. New polling data suggests Democrats do no worse--and perhaps a little better--politically if they pass a bill. And I'd argue the poll question actually understates the jump, since there's no way for people to know how they'll vote ten months from now.)

Voting for reconciliation will also change the media narrative and clear a path for passing more legislation going forward, even with a "mere" majority of 59 votes.

But there is at least one other reason the Senate ought to go forward with reconciliation.

Harold Pollack is a professor at the University of Chicago School of Social Service Administration and Special Correspondent for The Treatment.

There must be 100 smart analyses of last week's State of the Union speech. Many of my blogosphere friends were happy with it. I was pretty dismayed. I thought the President needed to push much harder and with greater specificity for a comprehensive bill. A week later, I feel even worse.

The origin of my disquiet was ably expressed by Brown University professor James Morone in Wednesday morning's Los Angeles Times. Morone provided the best analysis of that address, even though his essay went to print before word one was spoken. Morone is a gifted scholar who works at the interface between history and political science. If you haven't read him, stop reading this column and do so.

His op-ed "Seeking their inner Trumans" identifies a crucial political problem.

The Democratic leaders have not gotten credit for running this difficult reform through the daunting congressional gantlet. It hasn't been pretty -- Democratic leaders are talking ruefully about sausage-making -- but they played the inside game brilliantly.

But they forgot to tell their story to the people…. The Republicans told their story with exquisite skill. "Death panels," socialism and "government takeover" were all colorful ways to opt for private markets over government policy.

What is remarkable -- given the eloquent man in the White House -- is that Democrats were too busy dealing to come up with a counter story…. Not just once, in a complicated speech, but every day and in ways that connect….

Part of the President's task was to place that inside game in broader perspective, to remind voters that there was an honorable purpose to all that sausage-making. Clawing for 60 votes is sordid when the goal is to pass another bloated agriculture or a fighter jet the Pentagon doesn't want. It's quite another thing when the goal is providing health insurance coverage for 30 million people.

They're not mine. They're Ezra Klein's. And he nails it. Read both of them. Then read the David Herzenhorn article from the New York Times that Ezra references. And then try, with a straight face, to argue the Republican Party has any serious interest in bipartisanship.

The one place where the Senate bill is more conspicuously liberal than its House counterpart is on abortion policy. And, wouldn't you know it, that one provision could undermine the latest effort to pass health care reform.

Michigan Democrat Bart Stupak, who voted for the House bill, has said he can't vote for the Senate bill because of its less restrictive language on abortion. And he's said that many like-minded Democrats would do the same.

Nobody is sure how many would actually follow Stupak's lead, but the buzz around Capitol Hill is that it could be between ten and fifteen Democrats, particularly since it'd make a politically convenient excuse for members who are growing more reluctant to support health reform anyway. If that happened--and if Speaker Nancy Pelosi couldn't get some members who originally voted "no" to vote "yes" this time around--the Senate bill won't pass the House.

But, as I explain in a new Bloggingheads segment, there are ways out of this dilemma. The odds of success aren't terrific, but they're not ridiculously low, either.

By the way, the segment is part of a broader discussion on health care I had with Slate's Timothy Noah. If you haven't checked out his coverage yet, you should--starting with this article about how Romneycare killed Obamacare.

For most of the last year, time has been health care reform's enemy. Could it now be reform's friend? That's the gamble reform's proponents in the administration and Congress are making now.

For most of the last year, the Obama administration and its chief allies in Congress have been trying to pass health care reform as quickly as possible. And, as we all know, they haven't been terribly successful. Deadlines slipped, negotiations stalled, and the public grew increasingly disenchanted.

When the Senate passed its health care bill on Christmas Eve, none of this seemed to matter. Some sort of agreement between the two houses seemed inevitable. But those negotiations also dragged on until, well, you know the rest of the story: Scott Brown beat Martha Coakley, Senate Democrats lost the ability to break unified Republican filibusters, and health care reform went from near-certainty to the longest of long shots.

After a few days of ambivalence and indecision, Obama and congressional leaders have announced they intend to push ahead with reform. But they've made clear that they're no longer in a rush. The White House and Congress are talking about the budget and the economy. Chief of Staff Rahm Emanuel suggested health care could wait until after a jobs bill and financial regulation. Democrats have talked about "letting the dust settle" and having a "cooling off" period.

Some of the people making these statements clearly don't want to be talking about health care reform, period. To them, delay is just a way of easing reform into death. But others say they have a specific plan in mind:

Austin Frakt is a health economist at Boston University. He blogs at The Incidental Economist, which he created.

The purposes of comprehensive health reform are noble: expansion of coverage and control of costs. Yet, the latest attempt to begin to address those goals is near death. For nearly a year Democrats shepherded bills through the complex legislative process, revising and merging them to accommodate the congressional process and political realities. Ultimately two bills, similar in broad structure and differing only in detail, passed the chambers of Congress.Yet, at the brink of completion support for them has waned. What can be learned from this experience?

First, it is worthwhile appreciating how unlikely it is that policy-makers have brought health reform legislation this close to passage. It doesn’t clearly benefit all influential interest groups, a condition that normally dooms major reform. To have even pursued it was, therefore, a political risk. That Democrats, and Obama, took responsibility for attempting to solve the large and important problems of the uninsured and health care costs is laudable. In doing so they managed to mollify the concerns of major stakeholders.

In the days immediately after the special Massachusetts election, which gave Senate Republicans the ability to block votes on legislation, the prospects for reform looked so bleak that one reliable source emailed me a one-word message: “Dead.”

But within 24 hours, that same source had emailed me another one-word message: “Alive.”

And that’s a pretty good description of where things stand today, at least based on what I've gleaned from conversations with insiders over the last week.

According to these sources, Democrats have made progress--more progress, certainly, than might be evident from all the dire headlines of the past few days. There seems to be a plan in place for enacting reform, even with the Massachusetts setback.

But it’s not an easy plan to execute, at least in this political environment. And it’s not clear--to me and to many of the people I’ve interviewed--whether Democrats in the House, Senate, and administration are sufficiently committed to making it work.

Rahm Emanuel thinks health care reform can wait. In an interview with the New York Times, Emanuel suggested that Congress would deal first with jobs, then banking regulation, and then circle back around to health care reform. As Ezra Klein observes:

The timetable Emanuel is laying out makes little sense. The jobs bill will take some time. Financial regulation will take much longer. Let's be conservative and give all this four months. Is Emanuel really suggesting that he expects Congress to return to health-care reform in the summer before the election? Forgetting whether there's political will at that point, there's no personnel: Everyone is home campaigning.

Moreover, there's a time limit on health-care reform. The open reconciliation instructions the Senate could use to modify the bill expire when the next budget is (there's disagreement over the precise rule on this) considered or passed. That is to say, the open reconciliation instructions expire soon. Democrats could build new reconciliation instructions into the next budget, but that's going to be a heavy lift. The longer this takes, the less likely it is to happen. And Emanuel just said that the administration's preference is to let it take longer. If I were a doctor, I'd downgrade health care's prognosis considerably atop this evidence.

My colleague Jonathan Chait agrees, and offers this helpful analogy:

Let's call this the "My boyfriend is going to do a world tour with his rock band, then have a totally platonic weekend in Vegas with his ex-girlfriend, then join the Army, and then we'll get married" plan. Anybody see any potential problems here?

Timothy Jost is a professor at Washington and Lee University School of Law. He posts regularly on the Politico health reform arena and on Georgetown University’s Legal Issues in Health Reform blog.

Although President Obama's primary health reform message in his State of the Union was "do not walk away from reform,” “finish the job” and “let’s get it done,” he also said, “But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.” At this invitation, congressional Republicans rose to their feet with John Boehner waving his hand, as Newsweek reports, “appearing to almost expect being called upon.” 

So what are the Republican’s “better ideas”?

In November, 2009, the House Republicans submitted to Congress HR 4038, “The Common Sense Health Care Reform and Affordability Act.” It weighs in at 220 pages, less than one tenth the size of the current Senate bill. It is mostly a compendium of the same tired health reform proposals that Republicans have offered for years: association health plans, interstate insurance sales, limits on the ability of people injured by medical negligence to obtain justice, and more tax benefits for health savings accounts. It also repeals the federal comparative effectiveness council established by the stimulus bill, repeals the individual market guaranteed issue provision of HIPAA, undermines HIPAA’s group health plan health status discrimination prohibition by allowing reductions in premiums of up to 50% for participants in wellness programs, and adds yet one more prohibition against federal funding of abortion (which is already illegal). 

It does include a few newer ideas: support for state reinsurance programs, incentives to the states to reduce premiums in the individual and small group markets and to reduce the number of uninsured, internet “health plan finders” to help people find and compare insurance, and a handful of insurance reforms.

Let's take a closer look at these proposals, one by one:

In order to prevent the Senate's forty-one Republicans from blocking a vote on health care reform, Democrats may try to pass some elements of reform through the budget reconciliation process. But just how easy would that be? In particular, even with reconciliation, could a minority of Senators still find ways to obstruct a vote--or at least delay one?

TNR put the question to Treatment contributor Jeff Davis, who publishes and edits Transportation Weekly and who happens to be an expert on the legislative process. Here's what he says:

The Congressional Budget Act of 1974 established a centralized budget system within Congress for the first time. The law declared that the annual budget blueprint setting spending and revenue targets (the budget resolution) and legislation to amend existing law to reach the targets established by that blueprint (a reconciliation bill) were so vital that they would be exempt from the Senate’s normal rules of debate--setting time limits on the duration of floor debate (50 hours for the budget resolution, 20 hours for a reconciliation bill) which, of course, had the effect of lowering the threshold for action from the 60 votes necessary to close debate on a normal bill to a simple majority (51 in a full Senate if the Vice President is against you, 50 if he is with you).

The 1985 Gramm-Rudman-Hollings law added to this, declaring that the budget was so important that once a budget was established, legislation that would violate the terms of that budget would henceforth require 60 votes in the Senate, not the normal 51, at least until the passage of a new budget with new targets. And that same year, the Senate declared that the reconciliation bill’s fast-track procedures were too inviting a vehicle for unrelated items, so that chamber established the “Byrd rule” requiring 60 votes to put any provision in a reconciliation bill that does not have as its primary purpose a change in federal spending or revenues.

The interaction of 51-vote and 60-vote requirements in the Senate makes it impossible to predict, with certainty, the exact boundaries of what kind of health care reconciliation bill could pass that chamber. And even though a reconciliation bill is on a fast track, there are still plenty of opportunities for delay in the Senate.

 Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access Weblog and is a regular contributor to the Treatment.

As an advocate for health reform in California, I’ve seen health reform proposals die. I’ve seen it die by vote, and I've seen it die by veto. In 2004, an expansion of employer-based coverage narrowly lost in a referendum, getting an excruciating 49.2 percent of the vote. In 2005 and 2006, Governor Schwarzenegger vetoed bills for universal children’s coverage, and a framework for a single-payer system. All of these were final blows.

This doesn’t seem to be one of those times. Not yet, at least.

I admittedly have déjà vu from our most recent effort. After years of opposing health reform--a position to which he has returned--Governor Schwarzenegger made 2007 his year of health reform, spending much of that year trying to involve Republican legislators despite implacable ideological opposition. Only by late summer did he give up, and start to negotiate directly with the Democratic majority. A proposal--with structural similarities to the federal bills--was finally negotiated through the fall and passed out of one legislative house in a special session in late December. But the proposal struggled in the second chamber, with opposition from both the left and right, as some argued it was time to move on and focus on budget and economic issues. The proposal died in a Senate Health Committee vote two years ago, in late January.

The similarities are a bit eerie, but the differences are why I have hope.

Via Plum Line, here's how House Speaker Nancy Pelosi described her strategy on health care reform today:

You go through the gate. If the gate's closed, you go over the fence. If the fence is too high, we'll pole vault in. If that doesn't work, we'll parachute in. But we're going to get health care reform passed for the American people.