If history is any guide, perhaps Senate Democrats should have pushed through health care reform with a simple majority vote awhile ago.
Under current law, according to the Congressional Research Service, The U.S. Senate can pass measures by simple majority rule if it is voting on “budget resolution policies affecting mainly permanent spending and revenue programs.”
Seems to me that health care costs are about as permanent as death and taxes.
This process of simple majority rule is called reconciliation though it has nothing to do with the two parties of Congress reconciling irreconcilable differences.
Notes National Public Radio, “By writing Obama’s health care plan as a budget bill, Democrats can prevent a Republican filibuster in the Senate and advance the bill with a simple majority instead of the 60-vote supermajority they no longer have.”
In today’s utterly partisan environment, reconciliation seems essential to getting much of anything done. The alternative is to allow a 41-vote minority of the Senate to bluster, obfuscate and block any piece of legislation in perpetuity that it doesn’t like.
So does this concept of a simple majority vote somehow undermine the historical foundations of American democracy? Does it make a mockery of the rules of Congress? Is it a threat to the nation?
In a letter to President Obama Monday, NPR reports, Utah Republican Senator Orrin Hatch wrote: “The use of expedited reconciliation process to push through more dramatic changes to a health care bill of such size, scope and magnitude is unprecedented.”
Only NPR also reports that Hatch is simply wrong — dead wrong.
Ever heard of COBRA? It’s the system that allows workers to hold onto their health insurance for a transition period if they lose a job. So where did it come from? It was one amendment of the vast Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, NPR reports, though it didn’t take effect until the next year. That same law included legislation that required hospitals to accept Medicare or Medicaid payments for patients who showed up in emergency rooms but were unable to pay. That, too, was a big deal.
Two big pieces of the health care puzzle, in other words, both passed through reconciliation.
And there’s lots more, NPR reports. It even supplies this nifty chart on its web site:
For 30 years, major changes to health care laws have passed via the budget reconciliation process. Here are a few examples:
1982 — TEFRA: The Tax Equity and Fiscal Responsibility Act first opened Medicare to HMOs
1986 — COBRA: The Consolidated Omnibus Budget Reconciliation Act allowed people who were laid off to keep their health coverage, and stopped hospitals from dumping ER patients unable to pay for their care
1987 — OBRA ’87: Added nursing home protection rules to Medicare and Medicaid, created no-fault vaccine injury compensation program
1989 — OBRA ’89: Overhauled doctor payment system for Medicare, created new federal agency on research and quality of care
1990 — OBRA ’90: Added cancer screenings to Medicare, required providers to notify patients about advance directives and living wills, expanded Medicaid to all kids living below poverty level, required drug companies to provide discounts to Medicaid
1993 — OBRA ’93: created federal vaccine funding for all children
1996 — Welfare Reform: Separated Medicaid from welfare
1997 — BBA: The Balanced Budget Act created the state-federal childrens’ health program called CHIP
2005 — DRA: The Deficit Reduction Act reduced Medicaid spending, allowed parents of disabled children to buy into Medicaid.
Julie Rovner ends her excellent historic overview on NPR with these words: “In fact, over the past three decades, the number of major health financing measures that were NOT passed via budget reconciliation can be counted on one hand …. Using the (reconciliation) process to try to pass a health overhaul bill might not be easy. But it won’t be unprecedented.”
So enough of the dance marathon already. It’s time to push a vote, Democrats. Come November, the public can register either its pleasure or displeasure with the outcome. But there’s one thing that Democrats, who do still hold significant majorities in both houses, can be sure of. Tthe American people are smart enough to know that paralysis is not a policy.
It’s far better for the country — and for pure political preservation — to take a chance and fail than to simply stand pat.