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The Two-Bill Strategy


The Wall Street Journal reports that Senate leadership is considering a two-bill strategy for health-care reform. The first bill would include reform's more difficult and controversial elements. The public option would be there, and the subsidies, and the revenues, and the Medicare and Medicaid cuts. This bill would be passed through the budget reconciliation process, which requires only 51 votes for passage. The second bill would follow the normal order, and include health-care reform's least controversial elements, which also happen to be the elements that aren't really related to the federal budget and so aren't permitted in the reconciliation process: the insurance market regulations, the health insurance exchanges and so forth.

The idea is that the first bill could get 51 votes with little problem but might not clear 60, so it needs to travel through reconciliation. The second bill could clear 60 easily, so it can be pursued outside reconciliation, which is a good thing, given that it's probably ineligible for the reconciliation process.

This strategy has always puzzled me a bit. Reconciliation is the most controversial move you can make in health-care reform, as it cuts the minority's power entirely. If you go that route for most of the bill, it seems unlikely that a couple of Republicans will lend you their votes to finish the job. But if they would, or if you can get 60 Democrats to hold strong and break the filibuster, then why couldn't you get that in the first place, bypassing reconciliation altogether? To put it simply, if you have the votes for this strategy, you don't need to pursue it, and if you don't have the votes for it, then you're stuck anyway.

The one potential answer is that reconciliation isn't about bypassing the GOP at all. It's about bypassing a handful of centrist Democrats. Angry Republicans won't support a consensus-oriented second bill after being cut out of the important work of the first. But Democrats like Kent Conrad might, as reconciliation won't specifically have hurt them, even as its real point was to take the process out of their hands and put it back in the hand of the Democratic Senate Leadership. In this telling, the problem is that you can get 60 Democratic votes for a bad bill but not a good bill. So the question is whether you can get a good, but incomplete, bill through reconciliation and hold 60 votes for the non-controversial legislation that would fill in the holes.

But I might well be missing something here.

Photo credit: J. Scott Applewhite -- Associated Press Photo.

By Ezra Klein  |  August 20, 2009; 10:55 AM ET
Categories:  Health Reform  
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Next: Ted Kennedy's Vote


The first bill that should be passed is the one that you can get 60 votes on. The other bill can be done through reconciliation.

Posted by: maritza1 | August 20, 2009 11:07 AM | Report abuse

'To put it simply, if you have the votes for this strategy, you don't need to pursue it, and if you don't have the votes for it, then you're stuck anyway.'

I don't quite understand this. Is the idea behind this plan not that they don't have the votes for cloture on the public option but they do have it on an up/down vote i.e. they have the votes (the votes to get to 50) but they need to pursue it to avoid a filibuster?

It seems pretty clear to me that this idea is about bypassing the Liebermans and the Carpers who oppose the public option.

Posted by: benjp | August 20, 2009 11:12 AM | Report abuse

I agree with first poster, PROVIDED you are sure you have the 50 votes necessary to do the other with reconciliation. Problem I see is that the one key element in the non-reconciliation package will be controversial with conservadems, and that is mandatory participation, without which the whole deal falls completly apart.

Posted by: exgovgirl | August 20, 2009 11:13 AM | Report abuse

This is going to be a giant give away to the insurance companies. They'll get a mandate that we all have to have insurance and everything else will fall apart.

Posted by: obrier2 | August 20, 2009 11:17 AM | Report abuse

What Baucus and Conrad (and Bayh) need to deliver is universal coverage, aka the individual mandate. That gives the insurers their huge new captive market. That bill has to be paired with new regulations and the health exchanges, but not the public option (you are now saying the public option can be done through reconciliation?) and not the Medicare and other cost savings. There might be 50 votes plus Biden for a reconciliation bill that includes the public option and Medicare cuts or the panel that would make such cuts, but it is a gamble. Kennedy's possible replacement is another factor, as he has asked that the law be chnaged to allow an interim appointment.

Would the split occur in the conference or before? The reconciliation bill has to originate in the House, if it is a new bill.

Maybe the strategy is to report something, anything out of Finance, strip it before it goes to the floor so that it is the 60-vote bill, and then wait for the House to initiate reconciliation. That seems to give the Blue Dogs huge leverage.

Better if the progressives hold firm and the House passes something with the public option. Then let it be split in conference, if that is possible. Waxman's hearings on executive compensation and other extravagant spending in the insurance industry seems like a move towards that direction.

We need more info on how reconciliation would work.

Posted by: Mimikatz | August 20, 2009 11:28 AM | Report abuse

My first reaction is that I don't like this strategy.

First, it's awfully complicated. Most people won't understand it.

Second, and more important, why let Republicans take credit for voting to pass the popular stuff (no rescissions) and then blame us for all the hard stuff (taxes, public option)?

Posted by: Sophomore | August 20, 2009 11:31 AM | Report abuse

I agree that the thrust of the reconciliation bill is to bypass Lincoln, Nelson, Lieberman, Bayh, and the other bought-and-paid-for 'moderates' (in the pocket of big health insurance companies). My guess they have counted noses and think they can get to 50 - assuming that Kennedy/Byrd not voting, and the moderates voting no. They don't have to worry about a filibuster on reconciliation, so that's moot. Sen. Snow may be a wild card, but probably No. They can get 8 moderates voting no and still pass the bill.

The question is how much does the reconciliation bill poison the well for the second bill. That may be the real test. They must assume that the Dem. moderates wouldn't dare vote to maintain the filibuster. That's a huge bet and one I wouldn't take money on. If the filibuster is defeated, they can probably get to 50 (all they need) and may even get some GOP votes. But ending the filibuster on the non-reconciliation bill will be the trump card of the moderate Dems, and they may well be willing to play chicken on that vote to prevent the reconciliation bill from being brought up and possibly passing.

My gut feel is that Obama doesn't have the guts to run this risk - the risk of no bill at all (and he undoubtedly thinks that the progressives in the House wouldn't dare defeating the House bill).

Posted by: JimPortlandOR | August 20, 2009 11:37 AM | Report abuse

This strategy may give the political cover necessary to get Democratic senators like Conrad. If Conrad is worried that his constituents would be upset with him voting for the public plan, say, then he could say that he voted against the public plan. He ONLY voted for the insurance exchanges, preventing insurance companies for charging more for pre-existing conditions, etc.

Posted by: RichardHSerlin | August 20, 2009 12:00 PM | Report abuse

Depends on whether Obama makes the calculation that a bad bill is better than no bill. Seems like the 60-voter should go first, and he should dare the bought and paids to vote against ALLOWING the sentate to vote on end to pre-exisiting condition discrimination, end to recission, etc. How many of them are up next year and want to face opponent ads accusing them of being in favor of allowing insurance companies to cancel your insurance after you get brain cancer because you didn't reveal you had acne when you were 17?

Not optimistic Obama has the balls to go for it, but I sure hope he does.

Posted by: exgovgirl | August 20, 2009 12:23 PM | Report abuse

I like the strategy, I like the fact that maybe Reid has some guts. And I do think that Obama has the balls to do this. But Jim has the salient much does the reconciliation bill poison the well for the other bill? At the end of the day, I truly believe that Republicans want a defeat of this issue, pure and simple. Their goal is no Obama win. So I do not think you pick up any Republican votes in the other bill, no matter how controversial. So can it get 60 Dem votes?

Posted by: scott1959 | August 20, 2009 12:32 PM | Report abuse

This makes political sense. If the vote on the "bad bill" is 51-49, that means the Democratic caucus can let as many as 8 senators who are from conservative districts and/or who face tough re-election fights in 2010 vote against it without killing it.

One of the perks of big majorities is that you don't need every vote every time. If Ben Nelson wants to vote against it, it helps him get re-elected, he's with you most of the time on other issues, and you don't need his vote to win, let him vote against it.

Party unity is extremely important -- you don't need 60 divas always wanting it their way -- but health care is really, really, important.

I like this strategy.

Posted by: MisterSavannah | August 20, 2009 12:34 PM | Report abuse

I like this plan, which bets on a very strong proposition -- the notion that moderate senators of both parties like the opportunity to be on both sides of controversial issues. It's not hard at all to imagine Ben Nelson and Olympia Snowe's hearts all aflutter at the opportunity to vote for universal health care and against paying for it.

The only catch is if the right succesfully pushes the notion that a vote for "non-controversial" bill is a de facto vote for the communistic, grandma-killing, abortion-requiring public option that will turn America in an Islamic Nazi regime.

Could they get away with doing that to a scheme that the mods on both sides really really want to work? I'm not sure, but one could certainly see it happening.

Posted by: DSinMD | August 20, 2009 1:30 PM | Report abuse

****The question is how much does the reconciliation bill poison the well for the second bill. That may be the real test. *****

To echo someone above, I would have thought the obvious strategy is to do the non-reconciliation bill FIRST.

Posted by: Jasper99 | August 20, 2009 3:32 PM | Report abuse

The irony in all this is that you can get all the mod Dems and even some Rs to vote for the insurance regulations and the mandate to appease the private companies, but then they won't vote for the payment reforms in Medicaid/Medicare/Public option tha will actually move to control costs. So who really are the fiscal conservatives here?

But I do agree: do the insurance reforms first, then the reconciliation.

Posted by: jshafham | August 20, 2009 6:02 PM | Report abuse

Another hare-brained scheme. Or should I say Harry-brained.

Posted by: bmull | August 20, 2009 9:20 PM | Report abuse

I'm not sure the split bill idea is a credible threat. As far as my understanding goes, it would be really hard to do anything substantial. They'd have to figure out a way to make medicare have a psuedo public option. Expand the age to zero (or wherever schip cuts off) and have a sliding scale for payment according to income for people under 65. Then taxes to help pay for it.

Anything less ambitious is useless. It isn't the things that you can get through reconciliation that are the hard parts of reform. A stand alone public option can't go through reconciliation. An exchange can't go through reconciliation. Insurance regulation can't go through reconciliation. The 50 vote threat is useless unless the dems are willing to go big.

Posted by: NeonBlack1 | August 21, 2009 12:01 AM | Report abuse

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