Things are heating up for those of us following, participating in, and blogging on the process to enact comprehensive health reform. Hearings over the past few days, including those in the Senate Finance and HELP Committees, and the House Energy and Commerce Committee, focused on topics critical to any reform package: improving access to care, reforming the insurance market, and long term care issues. However, it was the House Budget Committee’s passage of its annual budget resolution that really lit up the debate.
As the FY 2010 budget process continues to unfold, a parliamentary argument involving the use of budget reconciliation instructions has imploded in both bodies of Congress. While President Obama met with Senate leaders to defend his top budget priorities, comprehensive health reform being chief among these, Democrats on the other side of Capitol Hill were laying their own set of rules for passage of health reform legislation.
Both the House and Senate budgets contain a deficit neutral reserve fund, or placeholder, to enact health reform. However, only the House budget blueprint, which passed out of the House Budget Committee on Wednesday night, contains reconciliation instructions. The use of this parliamentary procedure would enable passage of health reform in the Senate with only a majority of votes (as opposed to the 60 votes needed to invoke cloture). Chairman Conrad’s mark did not contain reconciliation instructions on health reform, but Majority Leader Reid has not ruled out employing reconciliation to enact reform.
Also, with the introduction of the new coalition of 15 moderates in the Senate led by Senator Evan Bayh of Indiana and created to “work with the Senate leadership and the new administration to craft common-sense solutions to urgent national problems,” it appears that enactment of meaningful health reform is increasingly dependent on the Democratic leadership’s ability to heed the concerns of those in their own party, not just those of their Republican colleagues on the other side. In fact, Senator Ben Nelson, a member of the moderate coalition, called the use of reconciliation to enact health reform “a deal-breaker.”
The stakes are high and the need for reform is very real. But as the political maneuvering continues, we are left asking what the prospects for true reform – reform which includes consensus building on polarizing key issues such as an individual mandate, the availability of a public plan, paths to expanded coverage, and the all-important sources of revenue and savings– really are.
