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The unintended consequences of reconciliation

Joe Lieberman's compromise, it seems, is no compromise. And he's infuriated so many Senate and House Democrats, not to mention so many in the Democratic base, that his bitter reversal might have made the prospects of any compromise a lot more remote. Based on chats I've had today, tensions are higher, both in the House and the Senate. And as the grudge begins to seem more personal, the liberals are both more resistant to being rolled, and more worried about it. It's one thing to swallow your own pride, after all. It's quite another to infuriate your base.

Democrats will look toward Olympia Snowe at this point, but if nothing works out, they may have to open the question of reconciliation once more. The irony is that the strange workings of the reconciliation process would strip the bill of the parts that Lieberman, Snowe and others favor and replace them with the exact policies they oppose.

For a detailed primer on the reconciliation process, head here. The short version is that reconciliation, which short-circuits the filibuster, can only be used for legislation that directly affects the federal budget. Anything that "indirectly" affects the budget -- think insurance regulations, like the ban on preexisting conditions -- would be ineligible.

What would be eligible? Well, Medicare buy-in, for one thing. Medicaid expansions. The public option. Anything, in short, that relies on a public program, rather than a new regulation in the private market. That means we'd probably lose the regulations on insurers, many of the delivery-side reforms, the health insurance exchanges, the individual mandate and much else.

Reconciliation, in other words, tips the bill towards an expansion of the public sector rather than a restructuring of the private sector. That makes it much less congenial to conservative Democrats and moderate Republicans (not to mention more conservative Republicans). But it also doesn't need as many of their votes, as it can pass the Senate with 50, rather than 60, in support.

To be very clear, this is not a trade I'm eager to see reformers make. You lose too much in reconciliation, and gain too little. The exchanges are too important, and so too are the insurance regulations and delivery-system reforms. But if Democrats end up in reconciliation, this bill is going to get a lot worse from the perspective of its skeptics.

By Ezra Klein  |  December 14, 2009; 5:22 PM ET
Categories:  Health Reform  
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Next: Lieberman: Medicare buy-in 'duplicative'

Comments

Yeah, but what's to stop them from combining the reconciled bill with a regular bill including the exchanges, the insurance regulations, and delivery-system reforms?

Posted by: StevenAttewell | December 14, 2009 5:27 PM | Report abuse

Good, then, let's scare the living hell out of the skeptics by plausibly threatening reconciliation! Hopefully they'll be more willing to bend. If not, I'm for doing it and then coming back for the other reforms in another bill! The conservative Dems and the Republicans should know that we're serious about getting something done this year, and we'll take reconciliation if we can't get anything else.

Posted by: agowen100 | December 14, 2009 5:31 PM | Report abuse

Steven beat me to it. Why not strip out the public option / buy-in, pass and sign that, and do the rest separately?

And no one has told me why they shouldn't force a real filibuster. And strip Lieberman of his posts. I'm aware of the difficulties and downside, but it is the best thing that they can do to energize the base for 2010.

Posted by: AZProgressive | December 14, 2009 5:32 PM | Report abuse

Yeah, maybe we're missing something here, Ezra. It seems like a no-brainer. I'm also for stripping Lieberman of his posts. I'm just livid at the moment.

Posted by: agowen100 | December 14, 2009 5:34 PM | Report abuse

can you filibuster a bill after it's reconciled in conference? If you drop the public option and medicare buy-in in this bill, can't you reintroduce it in conference? Please answer this question for me because it's wrecking my brain. It seems so simple to me.

Posted by: lagnappe | December 14, 2009 5:34 PM | Report abuse

I say, go for it. Then, once that's done and signed by Obama, Sen. Reid can introduce a simple, one-sentence-long bill that bans rescission. I believe I have heard a majority of the Republican Caucus claim to support banning rescission, and golly gee I wish I could vote for it if the rest of this 2,000-page bill weren't so bad. Well, now their bluff is called. Either they vote against it, and get slammed in the court of public opinion, or they vote for it, and clear the way for a bill of all the other non-reconciliation stuff passing with Mike Enzi's hallowed 80-vote majority.

Posted by: tomveiltomveil | December 14, 2009 5:35 PM | Report abuse

I thought the point of the Reconciliation strategy was to pass the insurance reforms (preexisting conditions, exchange, etc.) by "Regular Order" and pass the "budget-affecting" portions of the bill separately. Why would the one preclude the other?

Of course, the right thing to do would be to secure the _50_ votes (plus Biden) needed to change the Senate rules and kill the Filibuster altogether. The mere credible threat of that was enough to make Harry Reid cave in the past, why doesn't he think it could work now?

Posted by: LorneGuyland | December 14, 2009 5:36 PM | Report abuse

Everybody's asking the same question.

Posted by: agowen100 | December 14, 2009 5:37 PM | Report abuse

Reconciliation? Really? So Dems are going to take a bill that only 40% currently support and drive the support even lower by ramming it through the reconciliation process? I don't buy it. At all. If this bill doesn't get 60 votes it will die.

Sounds like scare tactics to me

Posted by: MBP2 | December 14, 2009 5:41 PM | Report abuse

40% of whom? What are you talking about?

Posted by: agowen100 | December 14, 2009 5:43 PM | Report abuse

If StevenAttewell's idea is actually feasible, seems like exactly what we need right now.

I'm sick and tired of begging the Snowes, Nelsons, Conrads etc. As for Leiberman, what I would like for him to do to his lying self can't be politely said here.

Posted by: mark_cohen | December 14, 2009 5:48 PM | Report abuse

Reconciliation can be used for ANYTHING.

For example, a true single-payer or robust public-option plan could be enacted and we wouldn't have to worry about private plans because if they didn't compete with the gvmt plan they'd go out of business.

Posted by: Lomillialor | December 14, 2009 5:50 PM | Report abuse

If the Democrats don't do something drastic soon, their entire agenda will effectively be controlled by one Senator from a tiny-ass state (that, not coincidentally, is almost completely unrepresentative of either the party or the country). If I were a traditional blue state Democratic congressman I would be livid right now because Joe is actively in the process of murdering such Dems' turnout rate. It doesn't matter if you think you're voting for Barbara Boxer or Russ Feingold (or any lefty/moderate congressperson) next year -- what you're getting is Joe Lieberman's policies. It would be as if every Republican attempt to legislate under Bush had been effectively dictated by Arlen Specter.

I've been reluctant to throw a lot of blame at Obama through this process, but it now seems very very clear that he at least misunderstood Congress. Between the months of waste time caused by Max Baucus, the waffling of Harry Reid, and Lieberman's pocket veto, his decision to pursue a heavily legislative strategy now seems laughably poor. This is crisis time both for him and the party -- if they don't take some major steps (like, publicly declaring that Dems who don't stop the filibuster should not expect Presidential or DSCC help), I think it is very likely that the Obama presidency will end in 2012.

Posted by: NS12345 | December 14, 2009 5:57 PM | Report abuse

Reconciliation needs to be used! Lieberman needs to be stripped of All power as an example to others. Democratic party needs to get a back bone and push All legislation through or face a very disgruntled base.

Posted by: raypc800 | December 14, 2009 6:04 PM | Report abuse

Lieberman is not only an obstructionist. His intent is to have the Democrats lose their majority. It's that simple. He's fooling everybody.

The only real option here is to either kill the filibuster or force through a strong public option through reconciliation. There's no "regulator" like competition stripping away your clients en masse.

At this point, an FDR or a Lyndon Johnson would force it through. Obama appears weak with no idealogical spine and no influence at all on the parties involved. Weak presidents lose elections. Weak party members (compared to Republicans who are in lock-step with each other) do as well.


Posted by: BoazW1 | December 14, 2009 6:06 PM | Report abuse

We're at this point because Reid and the rest of the Senate Dems seemingly took reconciliation off the table months ago which is how nitwits like Lieberman, Lincoln, and Nelson have felt free to hijack this process. If the conservadems had faced a credible threat to use reconciliation from the beginning, perhaps some of this nonsense could have been avoided. I hope Reid will locate his balls in time to use reconciliation, but I'm not optimistic.

Posted by: redwards95 | December 14, 2009 6:09 PM | Report abuse

The ban on discrimination based on preexisting conditions is the most important reform in the health care bill being considered by Congress. Discard this and there will be no health care reform bill.
Starting over would be preferable to passing a virtually worthless bill.

Posted by: Aprogressiveindependent | December 14, 2009 6:13 PM | Report abuse

Single payer would directly effect the federal budget, would it not? If only there were 50 dems who could line up behind this, even as a bluff...

Posted by: nwgates | December 14, 2009 6:13 PM | Report abuse

If you push the Medicare eligibility age to zero, what use are the exchanges? This should be the new policy, Medicare for all. Make the insurance reforms irrelevant by eliminating health insurance companies.

Can anyone possibly tell me what is in this bill that we would want to salvage if the Medicare eligibility age were zero?

Posted by: bcbulger | December 14, 2009 6:13 PM | Report abuse

You're right that it's not to be a preferred course of action.

But as it stands, we have no alternative if Joltin' Joe says no.

Lieberman and the Republicans need to have a choice between voting for blll A, a compromise bill that includes private sector regulations or n-- or bill B, which is a massive expansion of the public sector that the conservatives will like a whole lot less.

If they're going to play hardball, play hardball.

Posted by: adamiani | December 14, 2009 6:14 PM | Report abuse

Like many of the other commenters today, I also wanted to let you know how much I appreciate your work. Yours is the one must-read blog I visit almost every day for health care, and the only reason I link to the Washington Post anymore. Keep up the good work!

Posted by: TEL1 | December 14, 2009 6:27 PM | Report abuse

the problem with losing the cvontrols is thats a product the R's want the D's to own

we are heading toward budget/financial meltdown on healthcare and greatly expanding it without cost controls will exacerbate that exceedingly; just what the R's want to prove that social programs can not be run by the gument

Posted by: etownyellerdog | December 14, 2009 6:52 PM | Report abuse

This isn't too bad:

* reconcilliation on the PO & Co.

* roll all the other things into a bill and dare Joe, Snowe & Collins to vote against Recission, Pre-Existing Issues, etc.

Populist on both sides.

Is it going to happen? Unlikely because it puts the White House's Big Pharma Deal right in the crossfire.

John

Posted by: toshiaki | December 14, 2009 7:05 PM | Report abuse

If you imagine a bill that can pass reconciliation, i think it's an open issue whether that bill can pass the house. Are there folks in the house that reluctantly agreed to the public option to get the insurance reform? That being said, the important thing to make clear is that health care reform is going to pass. You can't stop it you can't obstruct it. Your only chance to impact the bill is to work to improve it. If reconciliation insures that something passes it's good leverage.

Posted by: windshouter | December 14, 2009 7:07 PM | Report abuse

Step one: Strip the public option and Medicare buy-in and anything else Joe doesn't like from the bill.

Step two: Pass said bill.

Step three: Load all the great things Joe doesn't like into a bill that can pass via reconciliation. No opt-out, no triggers, just a public option for everyone.

Step four: Pass the reconciliation bill.

Step five: Strip Joe Lieberman of his chairmanship.

Do that and let's just see the obstructionists try to pull these shenanigans on the climate change bill.

Posted by: MinnesotaBulldog | December 14, 2009 7:22 PM | Report abuse

AGAIN,

can't we just reintroduce the public option tion and other provisions during conference when we have to reconcile the senate bill with the house?

Posted by: lagnappe | December 14, 2009 8:00 PM | Report abuse

You do want to make sure that the liberals know, and keep in mind, however, that if the initial bill has no public option, it can be added later, via reconcilliation, without needing the votes of Joe Lieberman, Olympia Snow, or Ben Nelson. It will only need a mere 50 votes, plus the V.P. to break a tie. As a result, not only can it be added later, a much stronger version can be added later.

Posted by: RichardHSerlin | December 14, 2009 8:58 PM | Report abuse

I finished reading this blog entry and it occurred to me within seconds that:

A) Reconciliation for those parts.

B) and a 2nd Bill for the other parts.

Now, this seems so obvious to me that perhaps there is some problem with it. Or...perhaps EK just doesn't always rotate problems. An engineer's attitude is any problem is only some work to go ahead and find a solution. So, when something seems difficult, that only means you work a bit more, etc.

Posted by: HalHorvath | December 14, 2009 11:39 PM | Report abuse

So you could set up a single-payer system with reconciliation?

Posted by: JayGR | December 15, 2009 9:01 AM | Report abuse

I don't think the Democrats in Congress are suicical enough to resort to reconciliation. The radical progressives are the only faction of their party that want them to resort to the tactic but the smart Democrats realize if they force Obamacare down the throats of Americans who don't want it, it will cost them the 2010 elections and most likely 2012 as well. It also opens Pandora's box for all future, controversial legislation. If reconcilation is used to pass Obamacare, when the GOP regains control in 2010 they can use reconciliation to pass whatever legislation they want. If a GOP president is elected in 2012, they can use reconcilation to repeal Obamacare.

Posted by: TomR4 | December 15, 2009 10:16 AM | Report abuse

Of course, TomR4 is correct. After all, look at what happened after "radical Democrats" implemented Medicare against Republican warnings about socialism.

Wait, Medicare is one of the most popular programs around. Hmmmm...

Posted by: SaltyDawg79 | December 15, 2009 11:52 AM | Report abuse

At this point, reconciliation is the ONLY WAY to get SOME real reform into the health care legislation that's pending in the senate. AND, to jam leiberwocky's obstructionism in his backside...deep.

If not reconciliation - kill the legislation all together.

Posted by: rbaldwin2 | December 15, 2009 12:27 PM | Report abuse

(Please forgive my naievete), but it almost sounds like a question of semantics ...

Every single aspect of the bill has an associated cost, or revenue generation, it's just not written in a way that shows the direct impact each item/section has to the budget. Couldn't it be written that way? If so, would that allow passage via Reconciliation?

I also like other folk's suggestions that we just concentrate on passing single payer/PO via Reconciliation, which would handle all the insurance reforms (pre-existing conditions, coverage denials, rescissions, etc.) through the "competitive" process.

Posted by: onewing1 | December 15, 2009 2:41 PM | Report abuse

Funny that Saltydawg cited Medicare. Those informed on the know how horribly inefficient it is, resulting in massive cost overruns and fraud. Medicare proves beyond a shadow of a doubt that the government is 100% incapable of providing health care and cutting healthcare costs a the same time.

Obamacare would be no different. Sure it would increase the number of people insured and that is a positive, but that IS NOT the reform that the large majority of Americans want. Those already insured want lower healthcare costs. Period end of story.

There is absolutely no chance whatsoever that Obamacare will lower health care costs and Americans have figured that out. That is why they oppose it.

Posted by: TomR4 | December 15, 2009 2:57 PM | Report abuse

Bah...first line should read "Those informed on the issue..."

Posted by: TomR4 | December 15, 2009 2:58 PM | Report abuse

@TomR4:

I think the smart (and the not-so-smart) Democrats know that if they DON'T pass decent HCR, they will lose in 2010 or 2012.

And, history has already shown (as cited by someone above), that Repubs already have used Reconciliation to cram through legislation when they were the majority. I fully expect they will do so again, REGARDLESS of what Dems do on HCR while they are (in name only) "The Majority".

Posted by: onewing1 | December 15, 2009 3:02 PM | Report abuse

Onewing: You are misinformed on the GOP usage of reconcilation. It has ONLY been used for votes on budget resolutions, not major legislation like Obamacare. Don't even try to equate the two as the same.

If Obama and the Democrats were smart, they would reach across the aisle and adopt one or two GOP measures to make the reform package truly bipartisan. You know that won't happen though since the trial lawyers donate a lot of money to the Democrats. The end result is a highly partisan bill that independents and conservatives know is a piece of crap.

Posted by: TomR4 | December 15, 2009 3:22 PM | Report abuse

ezra, this blogger suggests the bill be split in two:

"Put the Medicare-whatever/public option in one bill. Get it through reconciliation. Put the other stuff, private market regulation, in another bill. Get that through the 60-votes/even-Lieberman-and-Snow-will-vote-for-it path."

http://tinyurl.com/y8jlr8u

please advise if this is a plausible option.

Posted by: dailykos2 | December 15, 2009 4:03 PM | Report abuse

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