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.
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