Critical Condition

NRO’s health-care blog.

March Madness


After two and a half months of relatively light Congressional activity on the health-care front, Democrats are apparently gearing up for a hyperactive March.  According to Inside Health Policy (subscription required), the period between now and Easter will be filled with a series of complicated steps that will all need to work perfectly in order for the Democrats to pass their health plan before Congress leaves for its spring break. First, the president will be issuing his revised new proposal, which will be converted into legislative language and then scored by CBO. By March 19, the House would then pass the health bill that the Senate passed back in December — and that the House has repeatedly said they did not like and would not pass — with the assurance that the Senate would go forward and fix it in accordance with some type of bicameral compromise. The House would then have to act again, by March 21, and pass a reconciliation bill amending the Senate bill that the House would have just passed.

At this point, and only after the House had acted twice, the Senate would take up the reconciliation bill changing the original Senate bill to reflect the president’s new proposal. This bill would be considered under the reconciliation process, with 30 hours of debate and passage via a simple majority rather than the 60 votes the Senate typically requires. Effectively, this process will use the passage of the Senate bill to enable the reconciliation vehicle to proceed and become the new health-care law.

The pitfalls in this crazy quilt process are numerous. The House could fail to pass the Senate bill. As a result of two resignations, a death, and a defection, Speaker Pelosi only has 216 votes right now, which is the bare minimum of what she needs, and the Democratic bills have not gotten any popular since the House last voted in November. In addition, House members are often reluctant to take tough votes without some assurance that the Senate would act, and this process would require them to act twice before the Senate moved at all. The Senate must also come up with the votes, not just for the policy, which is probably doable, but also for using the reconciliation process in this way, which a number of Senate Democrats have objected to in the past. And then there is the reconciliation process itself, in which provisions must be ruled germane to budget reconciliation by the Senate parliamentarian. This parliamentary review could result in what a former Senate parliamentarian has called a “Swiss cheese” bill, in which a variety of provisions of the bill are ruled not germane and thus moved out of the final product. In a bill as complicated as the health-care bill, this Swiss-cheesing of the final product could have significant and unpredictable consequences on the working of the bill should it become law.

It looks as if the House Democrats are the key to this whole procedure. They are bringing March in like a lion on the health-care-overhaul front. But in order for the scheme to succeed, the House Democrats will have to act like lambs twice before the Senate deigns to proceed.


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