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Health Care Bill Summary: Follow the Endgame

March 18, 2010 - by Donny Shaw

UPDATE: Hey all, hope you find this post useful. Stay tunde to the OpenCongress Blog all weekened (3/20-3/21) as the updates on health care reform as they roll in. RSS here.

[Original post below]

The 72 hour clock has begun to tick, all the materials for the final bill are online, a House vote is tentatively set for Sunday, President Obama has again postponed his Asia trip, and the votes are steadily flipping in the direction of getting this bill done and signed into law.

Here’s everything you need to keep up with health care reform as it approaches the finish line:

  • The Senate Health Care Bill (the foundation of health care reform) — H.R.3590, Patient Protection and Affordable Care Act
  • Budget Reconciliation Bill (package of fixes to Senate bill) — H.R.4872, Reconciliation Act of 2010
  • Full Text of Reconciliation Bill — read the full bill text, uniquely available here on OpenCongress as a page on the open Web (we had to manually rip the text from a .pdf document, and it’s still a bit messy, but readable).
  • Summary of Reconciliation Bill — How the bill would amend the Senate health care bill and how it would affect current law, in plain English.
  • The CBO Score — How the budget numbers of the final bill stack up against previous iterations.

A Note on Process

Congressional bills are essentially amendments to the law. The reconciliation health care bill is unique in that it will be an amendment to a pending bill (the Senate health care bill), or an amendment to an amendment. But since the final text of the reconciliation bill is itself an amendment to the underlying “shell” text that was required by Democrats under the budget reconciliation rules, it will be an amendment to an amendment to an amendment. And, who know, there may even been floor amendments offered when this comes up in the House. Those would be amendments to amendments to amendments to amendments.

The House Rules Committee is scheduled to meet on Saturday to propose the rules that will govern the floor debate on Sunday. Their biggest decision will be whether or not to propose a self-executing rule, which would either allow the Senate health care bill to be considered adopted by the House when the rule is approved, or it would allow for the Senate bill to be considered adopted when the House approved the reconciliation bill. Democratic leaders are saying that no decision has been made yet on using the self-executing rule, in either form, and that they still may require the House to place a stand-alone vote on the Senate bill.

The full House will have to vote on the “rule” governing the debate. Once the rule passes, the health care reform debate will begin in earnest. As soon as the House passes the Senate bill, be it"deemed" in the rule or by a stand-alone vote, it will be available for President Obama to sign into law, having passed both chambers of Congress in identical form. The House will then have to approve the reconciliation bill — if they haven’t already done it in a bundle with the Senate bill — and then send it over to the Senate for a vote. Things could get messy there. Budget reconciliation rules allow for a maximum 20 hours of debate (no filibuster) and limited amendments. But Republicans aren’t going to let that stop them from gumming up the works.

“The Senate is where Republicans have been plotting for months to sentence [the health care bill] to a painful procedural death.,” reports Politico. “Republican aides have been mining the Senate’s arcane parliamentary rules for an attack that aims at striking elements both broad and narrow from the bill, weakening the measure and ultimately defeating it. Their goal is to force changes that leave Senate Majority Leader Harry Reid (D-Nev.) without 51 votes to pass it, or at the very least, that drive it back to the House for a second vote that drags out the process and saps Democratic resolve.”

As I reported a few weeks ago, there are some potential pitfalls with using budget reconciliation. Six of them to be specific, and they are all spelled out in the “Byrd Rule,” named after Sen. Robert Byrd [D, WV]. Any provision that falls under any of the 6 parts of the Byrd Rule won’t be eligible for passage under budget reconciliation and can be stripped from the bill by “points of order” being raised on the floor. Of the 16 budget reconciliation bills that have been attempted in Congress since the Byrd Rule took effect in 1985, 29 points of order have been raised to remove provisions, with 19 of them succeeding and resulting in provisions being removed.

Senate Republicans are planning to basically exploit the Byrd Rule in order to hold a de fact filibuster within the budget reconciliation rules. It’s possible that they will raise more points of order against the reconciliation health care bill than have been raised in the Byrd Rule’s 25-year history. One possibility for the Democrats at that point would be to appeal to the Senate Parliamentarian to simply dispose of all amendments that “are dilatory or which on their face are out of order.” Like I said, it could get messy. (For a pleasant amount of more background & readable analysis of the House and Senate versions of the bill [plus the Reconciliation Bill], look back over our Blog coverage from the past couple days.)

The AP puts the process in picture form (read left to right):

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