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Health Care Reform Enters Final Stage, Could be Law by End of the Week

March 14, 2010 - by Donny Shaw

Let the endgames begin! The pieces of the process puzzle for finishing health care reform are falling into place. The votes are being whipped. And, after 14 months of national obsession with health care reform, White House Press Secretary Robert Gibbs’ statement on Sunday that in one week the health care bill will be “the law of the land,” actually seems plausible.

Here’s the latest on what to expect this week — both politically and procedurally — and when to expect it.

The Process

At 3 p.m. ET today, the House Budget Committee kicks off the final push to pass health care reform by holding a mark-up session for the “Budget Reconciliation Act of 2010” (2,300-page PDF), which is a “shell” bill containing the reconciliation instructions that were sent to the Budget Committee in October by the House Ways and Means, Education and Labor Committees. Notably, it includes a public option and adds the unrelated “Student Aid and Fiscal Responsibility Act,” which you can learn all about here. The Budget Committee’s mark-up is largely procedural in nature — in order to use the budget reconciliation, which is not filibusterable in the Senate, they are starting out with the language that was reported out of the committees as required by the 2010 budget resolution. The legislative text they are marking up is essentially a blank slate that is procedurally necessary to kick off the budget reconciliation process. It will be replaced with new language further down the line in the reconciliation process.

The Budget Committee is hoping to complete the mark-up by midnight in order to give the next committee that will be dealing with the legislation, the House Rules Committee, a 48-hour layover period, as is customary. During the Budget Committee mark-up, Democrats and Republicans will each be allowed votes on 10 non-binding motions to instruct the Rules Committee. They are expected to be used mostly for scoring political points and should be dealt with relatively easily on party-line votes. Democrats outnumber Republicans on this committee nearly by a nearly 2-to-1 ratio.

The House Rules Committee will take up the budget reconciliation bill next, probably on Wednesday. That’s where it will really begin to take its final shape. The Rules Committee will most likely make in order a subtitle amendment containing new legislative text that has yet to be released by the Democrats, which will contain the Obama proposal for reconciling the Senate and House bills, drop the public option, keep the student loan reform bill, and may have some new stuff we haven’t yet seen (we’ll keep you posted).

Besides setting up the adoption of the new text for the reconciliation bill, the Rules Committee’s job will be to determine the exact procedural rules that will govern debate and votes on the reconciliation bill when it goes before the full House of Representatives. The big rules decision will be whether or not to use the controversial “self-executing rule,” which would allow for the Senate health care bill (H.R.3590) to be considered passed by the House once the reconciliation bill is approved. In other words, it would allow for the House to approve the Senate bill, with all its noxious state-specific provisions and the more conservative revenue and subsidy provisions that are opposed by many House Democrats, without them actually having to take a stand-alone vote on it. Technically, they would only have to vote on the fixes to the bill that are contained in the reconciliation bill, which removes the state-specific provisions and make several other changes that bring it more in line with the House bill.

Whether they put the reconciliation bill and the Senate bill together or keep the bills separate, a vote will likely take place by the end of the week, or possibly the weekend. President Obama was scheduled to go to Guam on March 18, but he has delayed the trip until March 21. That gives the House until Sunday to pass the Senate health care bill and get it signed into law. The latest reports on the Senate Parliamentarian indicate that he has decided that the Senate bill must become law before the Democrats can use the budget reconciliation process to pass their package of fixes that will bring several provisions closer to what the more liberal House wants. Of course, if the House decides to use the self-executing rule and roll the bill together, that won’t be a problem.

All that will be left at that point is for the Senate to pass the budget reconciliation bill. The 51 Democratic votes that will be needed appear to be in the bag. The only thing standing in the way will be obstructionsist tactics from Senate Republicans, who are planning on offering an endless stream of non-germane amendments to gum up the works. That could essentially shut down the Senate, requiring Vice President Joe Biden to use his role as President of the Senate and put things back in order. Things could get messy here.

The Votes

With the 51 Democratic votes lined up for the reconciliation bill in the Senate, vote counting on health care reform is all about the House. There are essentially two areas that the Democratic House leadership is working to shore up the final votes — abortion and assurance that Senate Democrats are committed to following through with the reconciliation bill.

On the abortion issue, Democratic leaders in the House are making the case that, procedurally, they can’t change the bill’s language on abortion at this point without starting over with a new bill. Since it’s pretty clear that starting over would mean not passing a bill this year, the leadership is telling pro-life House Democrats that they must either accept the Senate’s abortion language or be prepared to vote to kill health care reform for years to come.

There are roughly 12 House Democrats that have pledged for months to vote against the health care bill unless it contains the Stupak abortion language form the House bill, which restricts all insurance plans selling on the new exchanges from offering abortion coverage, even if the abortion coverage is kept separate and paid for entirely with private money. However, as Rep. Bart Stupak [D, MI-1] himself says here, some of those 12 are already starting to soften their position.

As for building trust that the Senate will indeed pass the fixes to the bill after it becomes law, Speaker Rep. Nancy Pelosi [D, CA-8] told The Hill that she is seeking “certain assurances” from the Senate before the House takes place, though she didn’t elaborate as to what those assurances are. Presumably, House Democratic leaders are looking for assurances that the Senate Democrats are willing to use whatever procedural moves might be necessary to overcome Republican obstruction and get the reconciliation bill through the Senate. Majority Whip Sen. Dick Durbin [D, IL] told Meet the Press on Sunday that those assurances are forthcoming. “When Nancy Pelosi goes before her caucus it will be with solid assurance that when reconciliation comes over to the Senate side, we’re going to pass it,”

The important thing to remember in all this is that Nancy Pelosi has only lost one big vote in the more than three years she has served as Speaker of the House. That was on the original TARP bill, which she ended up getting passed a few days later in a revised version. Pelosi and the House Democratic leadership are masters at whipping up votes, so statements like this one that the votes will be there when the time comes should be taken seriously.

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  • craines 03/15/2010 6:29am

    This will be an interesting week, Just to make a note on a personal level I had a yearly checkup and I have yearly scheduled tests, I had to drop all but two because of the out of pocket cost. The only reason I’m considering the two is so I can keep getting my prescriptions refilled.

    I like most people I know need affordable health care, I wont know until later down if this is the health care we all need or not. But I do know this has to be done and if any changes need to made they can do that later.

    If nothings done, we could lose everything if anything serious happens. s@#$% happens all the time around my house.

    Pass this bill


  • wayneaw 03/15/2010 7:59am

    There is language in this bill that affects all military retirees in a very negative way. After spending an entire career with our lives on the line most of the time, I am sickened to read that this bill will cancel all of the promises that were made to us when reenlisting time after time. Our representatives need to honorable people and honor those promises made about health care to YOUR veteran retirees. Specifically Tricare-for-Life.

  • Comm_reply
    donnyshaw 03/15/2010 8:03am

    That bill is just a shell. The text will be replaced with the reconciliation bill Democrats are negotiating.

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