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Reconciliation Is More Common Than You Think

February 24, 2010 - by Eric Naing

Republicans have recently taken to referring to the reconciliation process as the “nuclear option” for health care but if you look at its recent history, you’ll find that reconciliation isn’t the unprecedented event that the nickname suggests.

As a quick refresher, the budget reconciliation process allows senators to pass a bill related to revenues and the budget with only 51 votes – or 50 votes and the vice president’s tie-breaking vote.

A must-read story from NPR today quotes Sen. John Kyl [R, AZ] as saying that the budget reconciliation process “was never designed for a large, comprehensive piece of legislation such as health care, as you all know. It’s a budget exercise, and that’s why some refer to it as the ‘nuclear option.’”

To refute this claim, NPR provides a helpful timeline of times when Congress used reconciliation to pass significant health care bills:

A History Of Reconciliation

For 30 years, major changes to health care laws have passed via the budget reconciliation process. Here are a few examples:

1982 — TEFRA: The Tax Equity and Fiscal Responsibility Act first opened Medicare to HMOs
1986 — COBRA: The Consolidated Omnibus Budget Reconciliation Act allowed people who were laid off to keep their health coverage, and stopped hospitals from dumping ER patients unable to pay for their care
1987 — OBRA ‘87: Added nursing home protection rules to Medicare and Medicaid, created no-fault vaccine injury compensation program
1989 — OBRA ’89: Overhauled doctor payment system for Medicare, created new federal agency on research and quality of care
1990 — OBRA ’90: Added cancer screenings to Medicare, required providers to notify patients about advance directives and living wills, expanded Medicaid to all kids living below poverty level, required drug companies to provide discounts to Medicaid
1993 — OBRA ’93: created federal vaccine funding for all children
1996 — Welfare Reform: Separated Medicaid from welfare
1997 — BBA: The Balanced Budget Act created the state-federal childrens’ health program called CHIP
2005 — DRA: The Deficit Reduction Act reduced Medicaid spending, allowed parents of disabled children to buy into Medicaid

Furthermore, Ezra Klein points to an analysis of reconciliation showing that from 1981 to 2005 “there were 19 reconciliation bills, 11 of which were signed by Republican presidents, five of which were signed by Democratic presidents, three of which were vetoed by Democratic presidents, and none of which were vetoed by Republican presidents.”

As a point of clarification, the term “nuclear option” was previously coined by Republicans during the Bush administration to describe a parliamentary maneuver changing the Senate’s rules to eliminate the 60-vote threshold for overcoming a filibuster.

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