Health Care's Family Feud

Making sense of what’s next on health care

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    NEWSLETTERS

    TK
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    House and Senate Dems are like a distrustful couple.

    To understand the machinations behind Monday’s health care announcements, imagine an unhappy young couple trying to cut corners, all the while chaperoned by well-meaning, buttinsky aunts who keep bumping into one another.

    House and Senate Democrats are the distrustful couple; the Congressional Budget Office and Senate parliamentarian the two strait-laced aunts with conflicting advice on the do’s and don’ts that lie ahead.

    And as the House Budget Committee kicked off the process Monday afternoon, the rampant confusion is a lesson in the fact that cutting corners is never a good start in Congress.

    The time-honored legislative process would have been for the House and Senate to conference on their respective health bills, reach agreement, vote and then send the package onto President Barack Obama. But with the loss of the late Sen. Ted Kennedy’s seat in Massachusetts, Democrats no longer have a filibuster-proof 60-vote majority in the Senate, and the party leadership has concluded that a shortcut is needed if comprehensive reform is to be enacted.

    To cross the finish line, the House is taking a two-pronged approach that means sending the Senate’s unvarnished version of reform to Obama and then immediately initiating changes in a second sidecar bill that invokes budget “reconciliation” privileges to circumvent the threat of a Senate filibuster.

    It will be a huge lift, but Senate Democratic leaders are sworn to come up with the 51 votes needed; if so, the final result will be as close to a compromise as the two sides can hope for at this stage.

    Trying to slow this train, Republicans are pulling all levers to sow doubts in the House that the second bill will make it through the Senate — a nightmare for Democrats. The past week has seen Washington a twitter over what the two aunts are up to — neither of whom talks publicly, which adds to the confusion.

    The preferred solution for Democrats would be for Obama to hold off signing anything until the sidecar health bill has cleared Congress — something neither CBO nor the parliamentarian’s office rules out.

     

    CBO typically scores bills against current law but there are precedents for doing the same with legislation that is still on its way to the White House, having cleared the House and Senate. And despite recent press reports, Senate Parliamentarian Alan Frumin has been open to several ways that reconciliation could be accomplished without the big Senate bill first being signed.

    The path gets more confused when the two aunts start advising on how to get there.

    CBO has said nothing officially but it’s clearly signaled that the most practical approach would be for the reconciliation bill to be written to directly reference the larger Senate bill.

    For example, since the House wants higher health insurance subsidies than the Senate, referring to the Senate bill provides context for changing the parameters of what are really new structures for government, such as proposed insurance exchanges. From CBO’s own standpoint, the certainty of the policy effect would be greater if it is written in specific reference to the Senate bill.

    But for the parliamentarian, this is the hardest route to defend if Democrats truly want to avoid having an early bill signing.

    Frumin has privately argued that if reconciliation is to change law, what it changes must truly be law — not simply a bill on its way to the president. He’s pointed to alternative routes such as amending the underlying Social Security or Medicare statutes on which much of the Senate bill rests. But if the bill is written to specifically build on the Senate bill — thereby helping with CBO scoring -- then Obama will have to sign it into law before Senate action.

    A compromise might yet be found, but after weeks of trying different drafting approaches, the House appears resigned to moving ahead with an approach that directly references the Senate-passed bill.

    “We’re in the process of -- actually contacting every single Democratic senator,” said Senate Majority Whip Dick Durbin (D-Ill.) on NBC’s “Meet the Press.” “When Nancy Pelosi goes before her House Democratic Caucus it will be with the solid assurance that when reconciliation comes over to the Senate side, we're gonna pass it.”