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The Role of Reconciliation

I don't think, as Marc Ambinder says, that the "big question mark [in health-care reform] is reconciliation." The people I've spoken with seem pretty unanimous in the belief that if Democrats go to the reconciliation process in health-care reform, they're trying to craft a small win out of a large loss.

For reasons relating to the technicalities of the reconciliation process, there's pretty wide consensus that things like insurance market regulations and health insurance exchanges and delivery system reforms would be struck from any bill that travels through reconciliation. And if health-care reform happens but doesn't include a ban on preexisting condition discrimination or a new way for small business to purchase health-care coverage, I think it will be hard to judge that a success.

In talking with folks involved in this issue, reconciliation's role seems less about securing a win than preventing a loss. Its presence in the process protects against an outcome in which Democrats attempt health-care reform and end up with absolutely nothing. A fallback strategy that ends with a bill through reconciliation would probably be a large expansion of public programs like Medicaid and S-CHIP. You may even see health care for all kids, or the Medicare age lowered to 55. It would be, in other words, something, anything, that the Democrats could brag about as being a major step forward on health-care coverage. But it probably wouldn't be health-care reform.

By Ezra Klein  |  July 8, 2009; 1:24 PM ET
Categories:  Health Reform  
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Comments

How about lower the medicare age to zero?

Posted by: Drew_Miller_Hates_IDs_That_Dont_Allow_Spaces | July 8, 2009 2:24 PM | Report abuse

You could even do -0.75, and maybe get some Republicans on board.

Posted by: Drew_Miller_Hates_IDs_That_Dont_Allow_Spaces | July 8, 2009 2:25 PM | Report abuse

I like that "lower the age to zero" idea myself. WHY are they making this so difficult?

Posted by: katiebird36 | July 8, 2009 3:01 PM | Report abuse

A strong public plan can get through reconcilation. In many ways that is the best possible thing for single payer advocates. The public plan ends up the only good plan out there. The private insurance companies still pulling all sorts of tricks and costumers fleeing in mass to the public option.

Posted by: JonWa | July 8, 2009 5:05 PM | Report abuse

If they possessed the intestinal fortitude couldn't the Democrats simply replace the parliamentarian with a partisan hack and ram through whatever they want in the reconciliation process? Didn't the Republicans used to fire Parliamentarians left and right until they got what they wanted?

Posted by: mike777 | July 8, 2009 6:10 PM | Report abuse

Ezra--
I think that you are unduly pessimistic about this, and wrong on Senate Rules. Your otherwise excellent article from The American Prospect makes what I think is a crucial mistake. You argue that rulings on the Byrd Rule are made by the Senate parliamentarian, but I do not know where you get this idea.

Interpretations of Senate Rules are made by the CHAIR, not the Parliamentarian (at least according to the Congressional Research Service report on the Byrd Rule). That means that they are made by Joe Biden. The Chair's rulings can be overruled, of course, but motions to overrule can themselves be filibustered.

The issue is not really one of Senate rules; it is whether Senate Democrats will countenance Biden ruling that some sort of comprehensive health care reform package, including new regulations on health care insurers do not have an "incidental" effect on the budget. As a matter of plain English, such a ruling would clearly be true. As a matter of politics, it would mean vesting the President of the Senate with crucial power.

The problem is that the Republicans, when they had a majority and the Vice Presidency, made it very clear that they were prepared to do the same thing. It's not as if Democratic forbearance now will result in GOP forbearance if and when the Republicans regain the majority and the Presidency.

You suggest that lowering the Medicare age to 55 might be allowable under reconciliation: this is PRECISELY the sort of change that has been ruled merely "incidental" to the budget (in that case, it was a motion to raise the eligibilty age for Medicare) -- a fatuous argument. Why was such a provision struck? Because Senators have traditionally not wanted to open up reconciliation (except of course for a tax cut, but never mind). But that's a political question, not a question of Senate rules.

The bottom line is that the Democrats can use reconciliation to pass health care reform if they want to.

I attempted to address this in my own blog post:

http://www.samefacts.com/archives/democrats_in_congress_/2009/07/help_on_the_way_health_care_and_budget_reconciliation.php

Posted by: JonathanZasloff | July 8, 2009 9:53 PM | Report abuse

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