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Health Care and Reconciliation

February 11, 2010 - by Donny Shaw

House Speaker Nancy Pelosi [D, CA-8] has been busy firming up the groundwork for finishing health care through the budget reconciliation procedure. She recently told Roll Call:

“We have set the stage for that. It’s important for us to remind the American people of the inconsistency that the Republicans have in saying this is unusual. No, five times President Bush used it. … This is what the Republicans did to pass their bills, their tax cuts for the rich,” Pelosi said.

“It’s up to us to make sure the public knows that this is not extraordinary. And the public knows that a constitutional majority is 51. It would be a reflection on us if we could not convince people that this is not an unusual place to go.”

She’s factually correct. The budget reconciliation process has been used has been used 21 times by both Democratic and Republican Congress’ since its establishment in 1974, including 5 times under President Bush. And although it has mostly been used to adjust the tax code and entitlement programs, it has also been used to implement a major overhaul of the student loan system.

There’s an even stronger argument in defense of doing health care with budget reconciliation, though, is that the procedure was specifically created by the 1974 session of Congress so that future Congress’ would have a way to bypass filibusters and enact policies that they included in their budgeting plans each year. Henry Aaron (.pdf) explains in the New England Journal of Medicine (via Yglesias):

The idea of using reconciliation has raised concern among some supporters of health care reform. They fear that reform opponents would consider the use of reconciliation high-handed. But in fact Congress created reconciliation procedures to deal with precisely this sort of situation — its failure to implement provisions of the previous budget resolution. The 2009 budget resolution instructed both houses of Congress to enact health care reform. The House and the Senate have passed similar but not identical bills. Since both houses have acted but some work remains to be done to align the two bills, using reconciliation to implement the instructions in the budget resolution follows established congressional procedure.

This, of course, leaves to the side the question of whether the Democrats can use budget reconciliation for health care. Everything done in reconciliation has to be ruled by the non-partisan Senate Parliamentarian to satisfy the “Byrd Rule,” which requires everything done under reconciliation to be more than incidentally related in substance. But that’s a separate issue, and one that the Senate rules have a procedure for working out.

Some congressional Republicans even seem to think that comprehensive health care reform makes sense to basically roll into the overall budget plan. House Budget Committee Ranking Member Paul Ryan [R, WI-1] has been pushing his Roadmap for America’s Future Act as an alternative to Obama’s latest budget proposal. It would do stuff to taxes and entitlement programs, but it would also reform the heath care system by offering tax credits for individuals buying insurance, allowing insurers to sell across state lines, creating state-based exchanges, among other things. I’m guessing that if the Republicans were in the majority and they wanted to pass that over the objections of the Democrats, they would not hesitate to use reconciliation.

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