I have to say it’s been interesting watching the political process for the past 18+ months. For me, it started with Senator Baucus’s “Call to Action” white paper on what he believed would be the essential elements of healthcare reform and Tom Daschle’s book “Critical: What we can do about the Healthcare Crisis” (remember that guy? Ever wonder what the process would have been like if he had become Secretary of Health and Human Services instead of Sebelius?). These works were meant to be base cases worthy of being a jumping-off point for discussions. The Baucus paper was released November 12, 2008, and the book was released in 2008. For some Democrats, this saga started in 1993 when the Clintons attempted to tackle healthcare reform. For the historical buffs, the start date could be pinned with 1965’s social security act (the creation of Medicare and thus the ever-present looming tweaks to the system) or even earlier (Obama frequently cites Teddy Roosevelt).
Obama’s 2009 budget helped to kick-start the great healthcare debate, which has gone from bipartisan Senate Finance committee talks, to reconciliation threats, to August town halls, to House and Senate passages, to Scott Brown’s election, to where we are today. It’s been a winding journey, and I do feel we are nearing the final forks in the road.
Scott Brown’s election in Massachusetts to take over Ted Kennedy’s seat brought the healthcare reform bill to a screeching halt. The House had previously passed their version of the healthcare bill. The Senate had passed their own version as well. As the legislative process dictates, the two arms of Congress were hammering out compromises in conference committee when the Republicans gained this seat. Normally, a single bill comes out of conference committee and both the House and Senate pass it again to send it to the President. In this instance, with only 59 Democrats remaining, the Senate would be unable to pass the bill again, so suddenly the options became limited.
1) The House can pass the Senate version as-is, without any amendments. This requires 216 House votes
2) The House passes the Senate version as-is, without any amendments and both the House and Senate pass another bill (via reconciliation) to incorporate all the changes they would have made. This requires 216 House votes and 50 Senate votes.
3) Start over. This requires 216 House votes and 60 Senate votes.
The finals steps began with Obama’s healthcare summit on February 25th, 2010. It was meant to be a bipartisan conversation between Democrats and Republicans to push the legislation forward. It was televised on cspan, and all 6.5 excruciating hours are available on the web (AM Session and the PM Session) for those that enjoy mind-numbing pain. Both sides made a couple good points, but they were few and very far between, and I found the demeanor and points of some members of each party to be saddening. Right now though, healthcare reform is stuck in an odd catch-22. Option 3 (start over) has been pulled off the table by Democratic leaders, including Obama. Option 1 (House pass the Senate version only) is untenable for some House members whether that has to do with abortion language (Bart Stupak), pork barrel spending (“Cornhusker kickback,” “Louisiana Purchase,” or the “Florida carve-out”), or reelection fears (Dems in Republican districts). So that leaves Option 2 – the Senate version with a sidecar of amendments. With 216 remaining Democrats who voted “yes” for the House-version of the healthcare bill, Democrats are walking a very fine line as to whether or not they can pass healthcare legislation.
Reconciliation is a tricky beast. Originally conceived as a way to hasten budget cuts, it limits its scope to budgetary matters only. Unfortunately, the tool has been perverted and abused by both parties to pass legislation with only a simple majority rather than the usual 60 votes it takes in the Senate. Ignoring whether or not you believe reconciliation can or should be used as part of the healthcare reform process, there are at least 2 main issues that Democrats are coming to grips with.
1) No one is sure what is permissible through reconciliation. One example of an issue that is NOT permissible is abortion funding. This obviously creates some issues for someone like Stupak who has openly stated that he can not vote yes on the existing Senate language regarding abortions. For him, he needs assurance that these provisions will be changed when it’s all said and done.
2) There is a large distrust between the House and Senate chambers. It is probable that the House must vote on the Senate bill before taking up the sidecar bill (ie. a bill must be law before another bill can be written to amend the law). The big fear for House members is that they pass the Senate version, and then the Senate fails to pass the sidecar bill, which means House members are stuck without their changes.
3) A litany of other issues that include Medicare Advantage cuts , Medicaid funding, controlling costs, and other items.
As our lawmakers tussle with the best course of action, I think it’s fair to say that politics and the political process have overtaken policy issues at this point. There’s a soft deadline to move this legislation forward in the next week or two. As of Tuesday 9:00PM ET March 16th, that means a House vote on Saturday. We’ll see what happens though. I salute anyone with the fortitude to continue following the politics of healthcare reform. It’s been a long March.