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Like most big pieces of legslation, the health care reform bill (a.k.a. the Affordable Care Act) shunts a lot of specific policy decisions off to different agencies and regulators to be made after it becomes law. Yet, as soon as things move out of Congress and the big political battles end, hardly any attention is paid to to the process by which legislation actually starts to take effect.

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As I reported earlier, the "deem and pass" strategy that House Democrats are considering using for passing the Senate health care bill, allowing them to pass it without actually taking a separate vote on it, isn't unprecedented. It has been used at least 6 times for in the past 20 years for enacting what the Congressinoal Research Service calls "significant substantive and sometimes controversial propositions," mostly by Republicans.

But it has never been used in the way the Democrats are considering using it -- to pass a bill through the House that doesn't have the votes to pass on its own. As the research below shows, 4 of the 6 uses of the "deem and pass" process, also known as the "self-executing rule," were approved unanimously by voice vote. The other two passed with votes to spare. These are on the 6 supposedly controversial uses of the rule that CRS gives. It appears that the process has mainly been used to speed up adoption of Senate amendments that would have been easily approved under normal procedure.

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