Healthcare reform: Obama's march is still on

President Obama is pushing for passage of healthcare reform by month’s end. Is ‘reconciliation’ that obscure?

Charles Dharapak/AP
President Obama rolls up his shirt sleeves before speaking about healthcare reform at Arcadia University in Glenside, Pa., on Monday.
Rich Clabaugh/Staff/Congressional record

Defying the inertia of a gridlocked Congress, President Obama is calling on Democrats to move healthcare reform in March, even if it means doing so without a single Republican vote.

“The United States Congress owes the American people a final, up or down vote on health care,” the president said in a speech on health care reform at Arcadia University on Monday. “It’s time to make a decision. The time for talk is over. We need to see where people stand.”

Republicans called a “Project Code Red,” firing off “robocalls” to the districts of vulnerable Democratic lawmakers, especially those who voted against healthcare reform last year. Mr. Obama this week launched a battery of presidential visits to states and districts where swing votes are to be found, beginning with Missouri and Pennsylvania.

But inside Washington, the outcome could turn on one of Congress’s most obscure and controversial procedures. It’s called “reconciliation” – a process that allows the Senate to ban filibusters, limit debate to 20 hours, and pass legislation by a simple majority vote.

With the prospect of health care winning no Republican votes in either the House or the Senate, supporters say the Senate has no choice but to pass the bill by any means at hand.

“It would be my hope that we would be able to resolve the issue without resorting to reconciliation,” said Sen. Arlen Specter (I) of Pennsylvania on the Senate floor on Monday, adding that the institutional integrity of the Senate – notably, protection of minority rights – is better protected “without going in that direction.”

“But if you have to fight fire with fire and since it is a legitimate means, then we can use it,” he said.

The key to passing a bill through reconciliation is surviving the blizzard of points of order, rulings, and appeals – and the political backlash of using a procedure intended to rein in deficits in order to move a massive reform package.

“The administration and its allies in Congress have tried repeatedly to jam this vision of healthcare through Congress without success. Now they’re doubling down. They’ve got one more tool in their arsenal, and they’re deploying it,” said Senate Republican leader Mitch McConnell in a floor speech on March 4.

The Senate has used reconciliation to pass 19 budget measures since 1980, according to the Congressional Research Service. The intent of the 1974 law is to give lawmakers a fast track to bring revenue, spending, and debt-limit levels in line with budget policies. But over time, reconciliation has been used to make broad policy changes on issues ranging from overhauling welfare to enhancing health benefits for children.

“[Healthcare reform] deserves the same kind of up-or-down vote that was cast on welfare reform, the Children’s Health Insurance Program, COBRA health coverage for the unemployed, and both Bush tax cuts – all of which had to pass Congress with nothing more than a simple majority,” said Obama in a White House speech on March 3.

All those bills did in fact move via reconciliation, but most had substantial bipartisan support.

The 1996 welfare reform passed the Republican-controlled Senate 74 to 24. Insurance coverage for unemployed workers passed as part of the Consolidated Omnibus Budget Reconciliation Act on Nov. 14, 1985, 93 to 6. The Children’s Health Insurance Program passed as part of the Fiscal 1998 Budget Reconciliation, 85 to 15.

The 2001 and 2003 Bush tax cuts marked a shift toward using reconciliation to pass bills that lack broad bipartisan support. The Democratic minority saw in those votes a break from the expectation that reconciliation was to be used primarily to influence budget outcomes, not as a tool to advance a partisan agenda.

Senate Republicans didn’t need to resort to reconciliation to pass the 2001 tax cut. The $1.35 trillion bill, which reduced all income-tax rates and created a new 10 percent tax bracket, passed 62 to 38, with 12 Democrats voting with all Republicans. But by 2003, the Senate mood had turned sharply partisan, heading into a presidential election year. The second Bush tax cut, which extended tax cuts to business, narrowly passed, 51 to 49.

Republicans predict that healthcare reform, without bipartisan support and “jammed through” by reconciliation, will have no staying power. Obama says Americans don’t care about procedure, only results.

“There’s a way healthcare reform can pass without a single Republican vote and yet in a few years have Republican support,” says Julian Zelizer, a congressional historian at Princeton University in New Jersey.

Medicare is now a bill that Republicans support, even though many opposed it in 1965. What determines whether a bill is durable and gains support is if it’s a good bill,” he says. “If healthcare reform is an effective bill, you’ll see those Republicans flip.”

Speaking on the floor Tuesday, Senator McConnell disputed charges that Republicans are voting against healthcare reform to be obstructionist.

"This debate was supposed to be about bringing the cost of health care down – about keeping health care costs from bankrupting families and government. So if you’re looking for a reason as to why Americans overwhelmingly oppose this bill, and why Democrats are having such a hard time rounding up votes within their own party for this bill, it’s because no one believes this bill will lower the cost of health care. It’s that simple.”

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