Tuesday, March 9, 2010

Healthcare Process Outline

Despite all the coverage, there still seems to be a lot of confusion about where the current reform stands, process-wise. Here is a drastically simplified outline that I have been keeping in my head. I thought I should write it down and that maybe someone else could benefit from it.
  • Both the House and the Senate have passed health care bills. They are different.
  • Before a bill can become law, the House and Senate have to pass the same bill and the President has to sign it.
  • The election of Scott Brown in MA meant that there was no way for the Senate to pass the House version of the bill, or even a modified Senate version that the House could agree to.
  • This means the action is now in the House.
  • All that would have to happen for the health reform to become law is for the House to pass the Senate version and the President sign it. That's it. Health care reform would be law.
  • The problem is that it will be very difficult for Nancy Pelosi to get enough Democratic votes to pass the Senate version of health reform. (She likely won't get any Republican votes)
  • You'll notice up to this point, there has been no mention of Reconciliation, the hot topic of late. That's because technically the Democrats don't need to use the reconciliation process to pass health care, they just need the House to pass the Senate bill.
  • Democrats do, however, most likely need reconciliation in order to entice enough Democrats to vote for the Senate bill.
  • The Democrats enticed by reconciliation fall into three main groups:
  1. Those that want to protect labor unions from the Cadillac tax in the Senate bill
  2. Those that want to insure that no federal money pays for abortions (lead by Stupak of MI)
  3. Those that want to focus on cost control (these are the Blue-dog Democrats)
  • The idea is to offer some changes to the Senate bill to appeal to these three groups. The changes would have to be passed in a separate bill after they pass the original Senate bill.
  • It is this separate bill that could be considered under the reconciliation procedure in the Senate.
  • Reconciliation is reserved for items that affect the budget, so it is not entirely clear that the abortion provision are eligible for consideration under reconciliation.
  • Reconciliation is not subject to the Senate's filibuster rules, so a bill can pass with only 51 votes, so that is why this is being considered.
I wrote that fast, so you'll have to forgive me if I forgot anything. It's clear that the action is now in the House. At this point, it is not clear whether anything will pass or not. I would be highly skeptical of anyone that tells you either outcome is certain.

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