The New Health Dialogue

We do not pretend to be experts on the congressional budget reconciliation process, but we know who is -- Sen. Kent Conrad (D-ND), chair of the Senate Budget Committee and Sen. Robert Byrd, (D-WV), who helped write the reconciliation rules and knows pretty much everything you ever wanted to know about Senate procedure, past and present.

In the past few days, both of these influential Democrats explained why reconciliation is perfectly appropriate to make changes to the already-passed Senate health care reform bill -- so long as those changes reduce the deficit.

As Budget Chairman, Conrad has watched a lot of misinformation trickle out about reconciliation and he wrote in a Washington Post op-ed over the weekend to set the record straight, “Reconciliation is not being considered for passing comprehensive health-care reform…What the president and others have suggested is that, after the House [passes the Senate health care reform bill], reconciliation could then be used to pass a much smaller “fixer” bill to allow for modifications to the comprehensive bill.” According to Conrad, a “fixer” bill would still have to affect revenue or spending and reduce the deficit to be approved via reconciliation on an up or down majority vote.

 Byrd, the chamber’s champion and master of legislative procedure, told The Charleston Daily Mail that he may support budget-related changes to the Senate health care reform bill using reconciliation. Like Conrad, Byrd confirmed that the reform bill in its entirety could not utilize the reconciliation process as so many of the larger bill’s provisions are not budget-related policies. But Byrd wrote “Yet a bill structured to reduce deficits, by, for example, finding savings in Medicare or lowering healthcare costs, may be consistent with the Budget Act, and appropriately considered under reconciliation.” He also noted that the big Senate bill has already been passed by a supermajority of 60 senators.

 Conrad, too, cited examples of bill provisions that would be appropriate for reconciliation: “[c]hanges to improve the affordability of health care or adjust the amount of federal aid going to states for Medicaid.”

Another expert in this process is the Senate parliamentarian. The parliamentarian serves as the referee in the budget reconciliation process, because he decides whether a particular idea fits the procedural criteria. Any senator may demand that a bill’s provision be deleted if it has only an “incidental” budgetary impact. The decider is the parliamentarian, whose rulings stand unless overridden with 60 votes. (Ultimately Vice President Biden, as president of the Senate, has final decision authority about reconciliation rulings. But no vice president has ever exercised this authority, so it probably won’t happen this time.)

Last week, President Obama called for an up-or-down vote on health reform legislation, and hopes to see such a vote scheduled by March 18th, before Congress’s two-week Easter recess. This week Obama went on the road to bolster public support for reform. Speaking from Pennsylvania today, the president said,

So how much higher do premiums have to rise until we do something about it? How many more Americans have to lose their health insurance? How many more businesses have to drop coverage? How many more years can the federal budget handle the crushing costs of Medicare and Medicaid? When is the right time for health insurance reform?

We agree, Mr. President. The time is now.