Democrats Debate Whether to Use Reconciliation to Pass Health Reform Provisions

Janice Simmons, for HealthLeaders Media , March 1, 2010

In his radio address on Saturday, President Obama, fresh from the seven-hour bipartisan healthcare summit held two days earlier, said: "It is time for us to come together. It is time for us to act." However, in the entire speech, one word was missing: reconciliation.

But it wasn't missing from the discussion of health policy leaders talking on the Sunday news shows.

Using budget reconciliation, a parliamentary procedure, the Democrats could move ahead to vote on healthcare reform in the Senate—circumventing a Republican filibuster. The tactic would allow a measure to pass by a simple majority vote of 51—rather than the 60 votes needed to break a filibuster, which could now be the case in the Senate with the election of Sen. Scott Brown (R-MA).

Budget reconciliation was created in 1974 to make it easier for the Senate to pass bills for lowering the nation's deficit. Since then, it has been used 22 times to vote on other issues, and every president since Jimmy Carter has signed bills into law achieved through reconciliation. Under current rules, Social Security cannot be considered under reconciliation (but Medicare can).

"Just because it's been used before for lesser issues doesn't mean it's appropriate for this issue," said Senate Minority Leader Mitch McConnell (R-KY) on CNN's "State of the Union." "There are a number of other Republicans who do not think something of this magnitude ought to be jammed down the throats of a public that doesn't want it through this kind of device."

Sen. Jon Kyl (R-AZ), quoting former Senate Majority Leader Robert Byrd (D-WV)), about the reconciliation rule, said its application in this case would be an "outrage that must be resisted," he said. "It has been used several times before, but primarily to balance the budget. It is a budget procedure," he said on Fox News Sunday.

While not directly saying that reconciliation will be the path of choice, Nancy-Ann DeParle, director of the White House Office of Health Reform, said on NBC's Meet the Press that: "We're not talking about changing any rules here. All the president is talking about is, do we need to address this problem, and does it make sense to have a simple up-or-down vote on whether or not we want to fix these problems?"

"Our first hope is that we could actually get some movement from our Republican colleagues as a result of the summit. At the summit, we heard a lot of Democrats, including the president, embrace many of the ideas of Republicans. Hopefully we could get some movement very shortly on that," said Sen. Robert Menendez (D-NJ) on Fox News Sunday.

But in the absence of that, it may be possible to "proceed on a simple majority vote that has been used many times by Republicans in the past, including for the passage of the Bush tax cuts and changes to Medicare that were some of the biggest cuts in Medicare," Menendez added. "We'd really like to get a bipartisan bill. In the absence of that, the American people, I think, have said in the polls that they want to see move forward on healthcare reform."

However, not all Democrats appear supportive of the reconciliation process.

"Let's just understand the question of reconciliation,” said Senate Budget Committee Chairman Kent Conrad (D-ND) on "Face the Nation." "I have said all year as chairman of the Budget Committee, reconciliation cannot be used to pass comprehensive healthcare reform. It won’t work. It won’t work because it was never designed for that kind of significant legislation. It was designed for deficit reduction."

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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