By guest blogger Jim Kaufman, vice president for public policy, N.A.C.H.
The 1990s failed effort to enact health care reform has played prominently in what President Obama and Congressional leaders did, and did not do in their effort to enact sweeping health care reform legislation this year. When this process began last January, there were so many things that could have derailed their efforts, even with significant majorities in both chambers, but Congressional leaders were able to overcome these challenges to stand on the brink of passing sweeping reform.
However, the failure to move quickly and now the loss of Senator Kennedy’s seat to Republican State Senator Scott Brown has cost the Democrats their 60 vote majority in the Senate. The loss of the Massachusetts seat means that if House and Senate leaders are able to hammer out the difference between the two bills, the compromise package would need to go back to the House and Senate for final approval. Therefore, assuming both parties vote en bloc as was seen on previous floor votes related to these bills, health care reform would die under the threat of a Senate filibuster.
As a result, President Obama and Congressional leaders are forced to develop Plan B to enact reform. As been reported by the media, while there are options besides going back to the Senate for another vote, each of these options has pitfalls.
Option #1: House simply accepts the Senate bill. Since the Senate’s reform package was amended to a previously passed House bill, procedurally the House can simply accept the Senate’s amended bill, as is, and send the final package to the President for signature. However, while this is probably the best option from a procedural standpoint, it will be difficult for Speaker Pelosi to convince House Democrats to accept the Senate bill. Key House members have already expressed concerns over the Senate’s structure for the Exchanges and the failure to improve access to care for enrollees in Medicaid, making it very difficult for them to accept this package.
Option #2: Budget reconciliation. The benefit of reconciliation is that you only need 51 votes in the Senate compared to the traditional 60 votes. However, it is expected that the reform bill would need to be stripped down because the rules governing budget reconciliation limits the provisions to those that directly impact federal revenues and expenditures. Under these rules, the most powerful person in the country related to health care reform may be the Senate Parliamentarian. The Parliamentarian will decide if a provision is germane to reconciliation. For example, he will decide if insurance reforms that are the cornerstone of the overall package directly impact federal expenditures and can be included in a reconciliation bill.
Option #3: A third option is a combination of both – moving the Senate bill alongside a budget reconciliation bill. Under this option, the House accepts the Senate’s bill, but the provisions they want changed are moved through reconciliation, again only requiring 51 votes. The major obstacle with this option is whether the outstanding issues that the House wants addressed pass the germaness test of the Senate Parliamentarian?
Option #4: A final option to enact reform, the one that is least palatable to Democrat leaders who have invested tremendous political capital in a large, sweeping reform bill is moving a much smaller, scaled down package. If one assumes that the Massachusetts voters sent a message to Washington on the direction of reform, a scaled bill may only include steps towards insurance reform and smaller Medicaid expansions. However, this scaled down approach would require at least one Republican, maybe Senator Olympia Snowe who voted for the reform efforts in committee, to support the bill
The bottom line is, after the loss of Senator Kennedy’s seat, President Obama and Congressional leaders need to find a new path to enact health care reform. They must choose a path that avoids the need for another 60-partisan vote in the Senate or a path that can attract bi-partisan support - the one Republican vote needed to enact a final health care reform package. The saga continues…
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