In a bid to move these issues, House Democrats inserted into their version of a budget bill the option of a fast-track process called reconciliation.
If deftly used -- that means getting past complex procedural objections -- it can squash a Senate filibuster and move big bills on a simple majority vote.
"We want a robust [healthcare] initiative about prevention, about biomedical research, about health IT, about community health centers reaching out, personalized, customized care," said House Speaker Nancy Pelosi at a briefing on Thursday. "I think the best prospect for that to happen is to do it under reconciliation."
No issue so inflames partisan passions, especially in the Senate where the standard of 60 votes for major legislation is now the norm.
Democratic power play?
"If they want to steamroll the minority, obviously, some kind of reconciliation vehicle would be the best way to do that," said Senate Republican leader Mitch McConnell. "However, it's a big gamble, because if you do it with no bipartisan buy-in at all, you own the whole thing politically."
The scenario would play out like this: The House passes a budget bill with reconciliation instruction; the Senate does not. But House and Senate conferees agree to include reconciliation in the final version of the budget resolution -- without the issue ever being debated on the floor of the Senate.
Anticipating this move, 33 senators -- eight Democrats and 25 Republicans -- sent a letter to the Senate Budget Committee earlier this month urging that reconciliation not be used to enact clean energy reform.
"Enactment of a cap-and-trade regime [dealing with greenhouse gas emissions] is likely to influence nearly every feature of the U.S. economy," they wrote in a March 12 letter. "Legislation so far-reaching should be fully vetted and given appropriate time for debate, something the budget reconciliation process does not allow."
"I'm prepared to vote against anything I do not agree with on substance or process," says Sen. Ben Nelson (D) of Nebraska. "The budget is not where you should settle major climate change or health reform."
Senate Democratic leaders say they will not include reconciliation in their version of the budget resolution, but they're not ruling it out.
"We're keeping everything on the table," said Senate majority leader Harry Reid at a briefing on Thursday.
'Reconciliation' limits debate and amendments
Introduced in the Congressional Budget Act of 1974, reconciliation was designed to help Congress reduce the deficit. It cuts off debate in the Senate at 20 hours and limits the scope of amendments.
But more recently, it's been used on a broader range of issues. Since 1980, reconciliation has been used 18 times, including to move the Bush tax cuts in 2001 and 2003, and to advance a measure to open the Arctic National Wildlife Refuge to exploration and drilling in 2005.
What's driving the move to use it in the current budget context is the scale and scope of the president's proposed reforms -- and the toxic partisan climate that persists on Capitol Hill.
"In the absence of reconciliation, health care and energy reforms are likely to be watered down to the point of meaninglessness," says Ross Baker, a political scientist at Rutgers University in New Brunswick, N.J.
If the reconciliation provision stays in, it signals "the tactical dominance of the House" in the new Congress, he adds.