Passing Health Care Reform: reconciliation

[TayTay]

There are a lot of reports flying around about the hows and whys of passing health care reform in the Congress. One thing that we hear about a lot is having the Senate Democrats pass health care as part of the budget reconciliation process. This is hardly a great way to pass something as huge as health care reform. Reconciliation should be a last resort when all else fails and it should be done with the understanding that we will only get about 25 - 40% of what we want under that process.

The budget for the US govt, really 13 budgets, is passed under a 2 part system. In the US Senate, a budget resolution is passed in the first part of the year that lays out a framework for the overall amounts of money to be spent. This includes rough figures on how much each of the 13 federal agencies of the govt, agriculture, defense, etc., are going to get for the year. After this budget resolution is passed, each federal agency then has it's separate budget submitted for the legislative process. Hearings are held and the final budget goes through a committee "markup" session where members of the committee can offer amendments to the budget bill to alter funding. The markup bill can then go to the Senate floor for passage, be "reconciled" with the US House version and one final, identical bill that has passed both Congressional chambers can go to the President for his signature.

The process of matching up the budget resolution with the actual funding bills is what is called reconciliation. The US Senate has put in place rules that govern what can and cannot be added to a bill during this process. These rules were actually strengthened this year with the adoption of more stringent "pay-go" rules that stipulate that any monies added to the budget have to be paid for or offset with a cut to money elsewhere in that department.

The Senate officially added the Byrd Rules to their governing rules of order in the 1985-86 session. This rule states that anything that adds to the budget can be challenged during Senate floor debate and subject to a ruling by the Senate Parliamentarian for adding cost to the bill, or for other reasons. It is the Byrd Rule that would make submitting health care reform as an amendment extremely hazardous. The Republicans would almost certainly object to the HELP or the House bill as an amendment. The way to resolve a challenge is with a 3/5th vote or 60 Senators. That would be the same as a filibuster on the whole bill. So, the only way through reconciliation would be for a series of amendments, who knows how many, that could all be challenged under the Byrd Rule. We could wind up with a mandate without insurance company reforms, for instance.

Anyway, for the wonky among you, I tracked down the info on the Byrd Rule. There is a huge amount of misinformation on how the Senate works out in liberal blogland. There are a lot of voices who think it is easy for the Senate to just pass something as massive as hc reform under the budget reconciliation process. It is decidedly not easy and it could result in a disastrous bill that is far worse than anything we have seen proposed yet.

Congress Research Service: http://budget.house.gov/crs-reports/RL30862.pdf">Byrd Rule in the Senate

Except from the Byrd Rule on a post I did for DU : G , http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=132&topic_id=8593429&mesg_id=8593429">link here

[karynnj]

1. Wow - Thank you for this

There really is a huge amount of ignorance out there. I haven't read the Byrd Rule link, but will. On the disastrous bill scenario, I wonder if reality will lead to "trades" - though as the Republicans are really content with changing nothing, we don't have a lot of leverage.

This does make me think less badly of Conrad and Baucus, who were trying to avoid this.

[TayTay]

3. We can't pass health care under reconciliation

Yes, the Health, Education, Pensions and Labor department budget could have the health care bill attached to it as an amendment, but it would be challenged under the Byrd Rule in a nanosecond. If the Parliamentarian rules that the hc amendment *is* allowable, we would still be in a world of hurt. (And it is highly, highly unlikely that the Parliamentarian would say that such a massive entitlement program is "budget neutral" as it is. I mean, seriously, how could anyone rule that way without it being seen as a breaking of the definition of "budget neutral." Either we change the rules honestly or we live by them. We can't rule by trickery, it will come back and bite us in the arse, I promise you.)

So, imagine the HC bill as a series of amendments. The public option would be challenged as not "budget neutral" and would need 60 votes, which it probably would not get. Any changes to drug coverage for Medicare, never mind changes that affect all coverage, would also almost certainly face a "budget neutral" challenge under the Byrd Rules. 60 votes, again.

What might get 60 votes could be scary. Health Savings accounts, which many liberal reformers despise, might get 60 votes if a Republican proposed it. (The Repubs might just do this. They love HSA's.) Mandates, which the insurance companies would love, might just get this while an amendment that limits what an insurance company could charge might not pass.

So, I hope bloggers in liberal-land understand the dangers of the reconciliation process. It is a very, very last resort. And it would be a fundamentally different bill that would go through that anyway.

Oh, and thanks for kind remarks. :blush: :blush:

[karynnj]

4. You might want to add the first three paragraphs as a reply to your GD post

The people insisting that anything can pass with 50 votes or that filibustering means they can be made to have to speak continually in the Senate are simply not fact based.

One thing it does is that it makes me less upset that cap and trade was not handled in the same way in the budget making reconciliation impossible. I now see that was giving up less than I thought.

You deserve all the compliments you have gotten - the Senators, seriously working to pass anything worthwhile, have to operate under the real rules - even if at times they will anger the purist partisans. It is great to know what they really are. Thanks again.

[TayTay]

6. I was thinking of doing a whole separate post on reconciliation

as that thread has already sunk. I am still "laying out the pieces" of this in my mind. It really is an immense undertaking with an enormous amount of moving pieces. I haven't even written about the House version yet and that alone is enormous and complicated.

I wonder if we have the facility on the blogs to deal with complications in the process. Americans don't like complicated things and actually seem to believe that things put in short form are "truer." This is not so, but it is enormously appealing to people to think that if only we could find a way to uncomplicate things and put them in plain language, then we could deal with them easily and with some semblance of unity.

[karynnj]

8. It is an ambigious enormous undertaking

It might be more suited to Daily Kos than to DU. It should be worth a try and helpful as something to link to if compromises are made in September.

I agree completely that there are many people believe simple lies over complicated truths. (Look at 2004 - among the left, anything short of promising to send every plane and ship we had to immediately remove every American from Iraq and Afghanistan within in a week of inauguration was seen as supporting the war.) Or look at the responses to this pretty reasonable article - http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=102&topic_id=4022022&mesg_id=4022022

Here, I think some on our side used "public option" as a cure-all. It is possible to have a bad plan with one and it is possible to have a good plan without one, if there were other ways to insure real competition. Dean's site and advocacy was great, but his "without a public option, it is not reform" can come back to bite us.

[Luftmensch067]

2. This is very useful -- I've been wondering how this worked...

I finally made two calls this morning -- one to Senator Kerry's office to thank him for his hard work for the best possible health care package and one to Senator Baucus' office to ask him to do all he can to preserve a public option as part of whatever comes out of Finance. I can't find anything on Google News to support this, but the very nice aide in Senator Baucus' office told me that late last night they announced that 60 House Democrats said they won't pass anything that doesn't contain a public option element. I don't know what this means, exactly, for the whole process, but this aide seemed to think it was rather momentous. She said she didn't know what Senator Baucus would do, but she thought there might be hope.

[TayTay]

5. The politics of health care reform: why co-ops?

Co-opts have not been proposed as a way of driving progressives crazy in the health care debate. Honest. It is becoming increasingly apparent that the Republicans have no intention of voting for anything that has the words "health care reform" on it in this session of the Congress. Period. So, it appears that Dems are going to have to go it alone. That is where the co-ops come in.

The Democratic Party is now and has always been a "coalition" party. We represent labor groups, but we also represent suburban groups that don't have the traditional concerns of the working poor and middle-class at their heart. There is, of course, great strength in being a coalition party. This can be an incredible way to take disparate parts of the country and make policy by trading off regional concerns. It can also be a pain in the arse as the different parts of the coalition assert themselves to get what they want in a bill, without regard for what others want. They seek primacy and, depending on their standing in the power structure, can really annoy everyone else.

The http://www.nytimes.com/2009/08/19/health/policy/19repubs.html?_r=1&hp">New York Times has an article in the paper today (9/19/09)that says that Dems may "go it alone" on health care. This increases the chances that something like a co-op might pass instead of the public option. Going it alone on a separate, stand-alone health care bill, will mean that the Senate has to have 60 votes to pass this legislation. (BTW, sadly, it is entirely possible that Sen. Ted Kennedy might not be able to be there for a vote. The fact that he was not in attendance at his sister's funeral last week is a bad sign.)

We have to keep the Nelsons, Pryors, Lincolns and Landreiu's on-board then in order to pass a Dems-only bill. We would also have to pick up at least one, and possible as many as 3, Republicans. Our best bets among Repubs are the "girls from Maine" Snowe and Collins and maybe Voinovich or one of the retiring Repubs. They will NOT vote for the public option. Snowe has said that she might vote for a trigger to implement a public option, however. (This is what infuriated some liberal groups when Sen. Kerry was seen as actually discussing this with Sen. Snowe, albeit in a non-defining, informal chat. Imagine the nerve of Sen. Kerry, actually trying to get a vote for health care reform, the traitor. :sarcasm:)

http://www.bangordailynews.com/detail/116398.html">Sen. Snowe is a deeply respected US Senator with a lot of gravitas and standing for both parties. She is the one Senator who could really decide if we get a vote on this bill this year. If she goes along with a bill, it will be much easier for the Bayhs, Nelsons, Lincolns and so forth in the conservative wing of the Dem Party to also vote for that bill. The idea of co-ops is NOT popular with Republicans, but Olympia Snowe seems to see some value in them. This could be a key to getting her vote on an overall bill. If she goes, she might take Collins with her and that might be the votes we need to get this package across.

It's vote counting. We have to get 60 votes. That is going to be damned difficult. I can understand the liberal anger at not getting the public option. However, this is not the fault of the progressive members of the Congress and it is not a case of selling out. There are people with genuine commitments to their arguments, albeit conservative ones, on our side of the aisle. It is disingenuous and a dangerous illusion to pretend that ALL Democrats are liberals in pursuit of change. That is not reality. (How many Democratic Senators voted for the Bankruptcy Bill in '05, or other onerous bills since then? )

IT is also damaging to the debate and to the idea of progressive change, to pretend that all Members of Congress are strictly beholden to lobbyists when it comes to deciding how to vote. (That argument can be easily used against progressives, btw. To pretend otherwise is hypocrisy. We may laugh at the RW using the ACLU as a bogey-man, but it is the mirror image of what we accuse the Repub folks of doing. ) Mary Lincoln probably believes what she is saying. She is from a conservative, Southern state and it is hard to imagine that her constituency is pressing her to enact bracing health care reform. As our system of governance makes each Senator and Rep accountable to their own voters ONLY, it is hard to enforce any party unity on this. (We do not have a parliamentary system here. We do not rule by Party identification. Those are informal associations in the US, under Congressional rules, where each member votes individually. Yes, they may vote Dem each time, but that is a choice, not a requirement of office.)

Health Care reform, or health insurance reform, was always going to pass as a coalition effort. We are hyper-focusing right now on how the process works, but it was always going to work this way. This is a massive, massive change. It was never going to happen by shoving it down the throats of 535 individual Members of Congress. Our system of government simply does not allow for that.

[beachmom]

20. Here is an article on what co-ops are:

First and foremost, they are non-profits. The thing is, I don't know how I feel about co-ops, but the way Liberals in La La Land pounced on it makes me highly suspicious of their certainty. Basically, somebody like Krugman told them they were bad, and without any analysis or reflection, they all gave it a thumbs down. That is another example of how liberal activists have really turned me off. They don't think, just react.

http://www.cnn.com/2009/HEALTH/08/19/health.care.coop/index.html

[Blaukraut]

7. I'm confused

I thought the 60 votes were only needed for cloture, but the actual passage for a bill after cloture only requires a majority. So where does reconciliation come in?
I would think that the Dems will vote for cloture if the bill includes a public option, even if some (blue idiots) will vote no on the actual passage.
Tay, can you clear that up for me, because there are two scenarios floating around now. The reconciliation and the one I mentioned.
Oy, my head!

[TayTay]

9. These are two different scenarios and the Blue Dogs stuff as well

Scenario one, there is the HELP bill, which passed the committee and is waiting to come to the Senate floor when the funding or tax part of the bill, which is the responsibility of the Senate Finance committee, is added. (We do not have a bill without the Senate Finance Committee report on this. That committee, under Senate rules, is charged with coming up with the payment structure on health care.)

Any bill that appears on the floor is subject to the rules of the Senate. These rules include "endless debate" unless cloture is invoked. Endless debate *is* a filibuster, as we all know. The HELP bill, as it is, would almost certainly be filibustered and it almost certainly would not muster the vote to "shot off debate" via a cloture vote. The Senate Finance Committee is attempting to "modify" the bill in advance with tax and funding provisions, but no doubt also wants to alter parts of the bill that the HELP committee put out.

The HELP bill can be and most certainly would be filibustered. The cloture vote almost certainly would fail. If, by some miracle, the cloture vote passed, then the vote on the underlying or actual bill would be a simple majority to pass.

Reconciliation is confusing because it can refer to two separate things. I talked about it as it relates to the budget process. Reconciliation is also the process whereby a bill passed by the US House and a Bill passed by the US Senate that are NOT identical are made one. In that case a conference committee is created to iron out the difference between the House and Senate versions of the bill in something also called, reconciliation. (Sorry for the confusion. Both terms, referring to different things, can be said to apply to the health care debate at different times.)

During the deliberations over the budget of the US, there is a process call reconciliation. The rules for that differ from the regular rules of order that govern debate on the Senate floor. You do indeed need only 50+1 or a simple majority to pass legislation, long as said legislation obeys the rules of the budget process, including the Byrd Rule. If an amendment is offered on the floor, during the debate, that appears to not be budget neutral, it can be filibustered according to the Byrd Rule.

Now I fear entering wonk land, never to return. (That was always a possibility for me, wasn't it, lol!) There is an arcane way to get health care through on reconciliation, but I very much doubt it would work. That would be to simply incorporate it into the budget bill as a whole, without amendments. But that would have to pass the committee and pass the leadership and the very process itself would give Senators a great platform from which NOT to vote for it. (Seriously, it is a bad way to pass a bill. Even Bush the Deceiver did not pass legislation this way.)

We have heard people who are angry with the Senate Finance Committee ask that the committee just release the damn bill and let it be handled in reconciliation because any bill is better than no bill and the problems can be fixed in reconciliation. Maybe. That is not a cure-all. Which reconciliation do they mean, the budget or as a stand-alone bill? Each presents it's own problems.

BTW, the Blue Dog Caucus only exists in the US House. They have 435 members and find it useful to form associations. The Senate, with 100 members, does not usually do this. So, while Ben Nelson is most assuredly a Blue Dog at heart, he is not one in actuality as no Blue Dog Caucus exists in the US Senate.

[Blaukraut]

10. So if both bills (Senate and House) go to conference

And become one bill to be voted on in both houses (am I getting that right?) and let's say the bill manages to get a public option included in conference, does it have to be a part of the budget process and fall under the Byrd rule or can it be voted on as stand-alone legislation, and thereby bypassing reconciliation? Would it then require 60 votes for cloture and a simple majority for passage? If so, we should have the 60 votes for cloture because any Dem voting against cloture would be in deep trouble.
See, this is what I don't get. Why does the final product, coming out of conference, have to be tied to the budget?

[TayTay]

12. Pay-go rules

The Democratic Party submitted a rules change this year that any piece of legislation, including all bills and all amendments, must be "budget neutral" in terms of cost or they must obtain a waiver in order to pass. A waiver requires a 3/5ths vote or 60 Senators, so it is, functionally, the same as a cloture vote to stop a filibuster.

Health care is absolutely not an exception to this. Health care reform will have a major impact on the budget this year and on every budget going forward. Should it become part of the ongoing budget of the US, it's future payment plans will be part of the budget of various agencies of the US govt and be subject to Congressional approval. (It will become a part of the monies and fees each year that are part of the operating budget of the federal govt of the US.)

Secnario One: A stand-alone bill gets to the Senate floor. It is subject to a cloture vote and would therefore need 60 votes to pass.

Scenario Two: Health care reform is tacked onto the regular budget of the US govt, a process that happens every year under something called "reconciliation." Because of the overall cost and it's impact on the US budget as a whole, it could and most certainly would, be challenged as not "budget neutral" and be subject to the Rules that govern debate while the Senate considers the budget of the US. Those rules would allow for this bill or a bill cut up into separate amendments to be subject to the Byrd Rule which would ask, in effect, how are we going to pay for this and is it budget-neutral. (Does it adhere to the "pay-go" rules?) Some of the amendments would most certainly not be "budget-neutral" and would have to get 60 votes to get a waiver to stay on the over all budget bill. That overall bill, not the parts, is subject to a simple majority vote, btw.

[Blaukraut]

13. Thank you. I think I get it now. So both scenarios are possible

if I understand you correctly. First scenario would rely heavily on a waiver, in case the bill isn't budget neutral, thereby also relying heavily on the conservative Dems to vote for cloture.
Second scenario would be less than ideal, and you explained that very well.
Thanks, Tay. I'm glad we have your wonky self here :)

[TayTay]

14. Thank you for the questions

This debate, in many ways, has been far less than enlightening. It is helpful to take some time to figure out what is going on. I actually do feel for people like Lincoln and Landreiu. They are in conservative states and they have a very different constituency from the one I know in MA. (And even in MA, we have our share of conservatives who don't want these changes to go through.)

I think any debate benefits from slowing down and looking at the pieces every now and then. I think I got most of this right, but no one died and elected me Queen of the Universe (no, still hasn't happened) so I am still looking stuff up.

More questions are most welcome. We have a lot of smart, savvy people in here and we have more knowledge than we think, especially when we get together and ask questions and do research. It's one of things that make this a great forum.

The first scenario, the stand alone bill, would probably fail because Repubs hate it and because we don't have enough Dems to pass it alone. Dems like the Nelsons, et al, are not committed to the public option. It would not have enough votes to get past an ordinary, regular, Senate filibuster.

The Second scenario is the one that would be a waiver-heavy thing. A health care bill would be carved up into a series of amendments, each one subject to the pay-go rules. If the Parliamentarian, the official Keeper of the Rules in the Senate, says the bill is "out of order" then it has to have a special waiver vote because it is adding money to the budget without an offset.

Is this clearer? I know it's confusing, I had to sort out the pieces like unbinding spaghetti strands.

[TayTay]

11. Also, if I may, a note on the anger on the blogs

I completely understand the anger that people are feeling over this debate. There are a lot of people who gave time, money and their passion to an election last year with the hope that they would get real, defining and meaningful change to our health care system. They have moral and personal arguments as to why they want this change and it is imperative that change happens. People have died because of the complicated system we have. It has to be changed for a host of reasons.

None of my posts here today are intended to take the sting out of those arguments. Those arguments and the passions invoked are real. I feel it as well, and I worked for change last year and so forth because of my own passion for reform. I have been affected by health care concerns in the last year and I have close relatives who live with the dread of losing care. I have a close relative, out of state, who is waiting to qualify for health care so that a tooth abscess, a very dangerous thing, can be cared for. This person can't afford basic dental care right now and has to wait to get an abscess taken care of by a doc. My god, how crazy it that?

We want people to care. A political system without people who care about the issues is a system that will be totally corrupt and totally unworkable. It would be, in practice, a totalitarian thing, unbeholden to anyone. I applaud the activists who are working to bring about fairness and justice on this issue. But, I also have tried to take an honest look at the system we have and explain what is going on there.

Governing and campaigning are two very separate things. There is a campaign to change health care going on. Liberal and conservative activists are waging this fight, outside of the halls of govt to affect what goes on in govt. There is also a fight in the Congress, a rules-heavy institution, that will carry out the actual production of laws in their own way. I wanted to do my small part to explain the later. I guess I should add parts where these things intersect and will try and do so. But they are, in many ways, separate things.

[Blaukraut]

15. The system is horribly flawed, imo

There really is a truer representation of the people in the House than in the Senate, but it seems as though the Senate has an unfairly weighted voice in creating legislation.

You're right. People did not work their butts of and fought for a majority in all three branches of the government to get what they've been getting so far. Healthcare reform (the fact that they started calling it health insurance reform is quite telling) is a must, and it really seems that our work as grassroots has not stopped on election day. Evidently we, the people, must hold our elected officials accountable for the promises they make and convince them that they work for us, not the Corporate lobbyists. It's a struggle, but it's worth the fight.

[TayTay]

16. We do not have a parliamentary system of govt

Voting for the Democratic Party does NOT mean voting for their platform. We are still voting for a series of individuals for individuals seats in the Congress. There is no guarantee that the person we elect will vote the platform of the Party. That is our system. Our Founding Fathers feared the growth of political parties and designed a system that was intentionally hostile to them. We have to live with those consequences.

Adventures in wonk speak:

The Platform = the official positions that a political party takes. http://www.democrats.org/a/party/platform.html">The platform is made up of a series of "planks" that speak about specific areas of concern. There might be planks on veteran concerns, health care, education, etc. The platform sets out the broad outline of what that Party stands for. Nothing in the platform is binding on elected officials.

Platforms are hotly debated each year. This is a source of great amusement to a lot of people as, ultimately, the platform doesn't mean anything. Well, it means something, it is a pretty good roadmap of what the political party stands for, but it is non-binding and widely ignored. The Dem Party of my state, for instance, spent months debating the platform, then minutes wrecking it and rewriting it at the Dem Convention. Much, much, much ado about a little.

[TayTay]

17. Dems might break HC bill into 2 parts

http://online.wsj.com/article/SB125072573848144647.html">New Rx for Health Plan: Split Bill
By JONATHAN WEISMAN and NAFTALI BENDAVID

The White House and Senate Democratic leaders, seeing little chance of bipartisan support for their health-care overhaul, are considering a strategy shift that would break the legislation into two parts and pass the most expensive provisions solely with Democratic votes.

The idea is the latest effort by Democrats to escape the morass caused by delays in Congress, as well as voter discontent crystallized in angry town-hall meetings. Polls suggest the public is losing support for the overhaul plans, giving Republicans less incentive to go along.

Greeley, Colo., citizens line up to attend a health-care town-hall meeting with Rep. Betsy Markey, (D., Colo.), on Wednesday. Rep. Markey had planned to speak to small groups, but so many people turned out that she ultimately had to hold a meeting in a college auditorium. Audience members, both for and against health-care reform, calmly questioned her on the issues.
Getty Images

Greeley, Colo., citizens line up to attend a health-care town-hall meeting with Rep. Betsy Markey, (D., Colo.), on Wednesday. Rep. Markey had planned to speak to small groups, but so many people turned out that she ultimately had to hold a meeting in a college auditorium. Audience members, both for and against health-care reform, calmly questioned her on the issues.
Greeley, Colo., citizens line up to attend a health-care town-hall meeting with Rep. Betsy Markey, (D., Colo.), on Wednesday. Rep. Markey had planned to speak to small groups, but so many people turned out that she ultimately had to hold a meeting in a college auditorium. Audience members, both for and against health-care reform, calmly questioned her on the issues.
Greeley, Colo., citizens line up to attend a health-care town-hall meeting with Rep. Betsy Markey, (D., Colo.), on Wednesday. Rep. Markey had planned to speak to small groups, but so many people turned out that she ultimately had to hold a meeting in a college auditorium. Audience members, both for and against health-care reform, calmly questioned her on the issues.

Democrats hope a split-the-bill plan would speed up a vote and help President Barack Obama meet his goal of getting a final measure by year's end.

Most legislation in the Senate requires 60 votes to overcome a filibuster, but certain budget-related measures can pass with 51 votes through a piece of parliamentary sleight-of-hand called reconciliation.

In recent days, Democratic leaders have concluded they can pack more of their health overhaul plans under this procedure, congressional aides said. They might even be able to include a public insurance plan to compete with private insurers, a key demand of the party's liberal wing, but that remains uncertain.

Other parts of the Democratic plan would be put to a separate vote in the Senate, including the requirement that Americans have health insurance. It also would set new rules for insurers, such as requiring they accept anyone, regardless of pre-existing medical conditions. This portion of the health-care overhaul has already drawn some Republican support and wouldn't involve new spending, leading Democratic leaders to believe they could clear the 60-vote hurdle.

More at the link

[sandnsea]

18. Thanks for all this info Tay

I still wish they'd just pass something out of Finance and let the House and Senate start hashing it over in conference. It certainly doesn't look like a good idea to do it in reconciliation though. The sad thing is most Republicans would be supportive of this bill if they'd stop listening to Rush Limbaugh and Faux News.

[Inuca]

19. TayTay, you are priceless :-)! n/t

[TayTay]

21. DKos post on reconciliation that reconsiders using this

and notes the drawbacks of it. However, this post also sees some positives in it. I know this "Byrd Rule" thing is really wonky, but this post is interesting. Passing health care under reconciliation is very risky. However, if the Dems decide to do this and do it aggressively and without regard for the rights of the minority party, then it might work. The repercussions of blowing up the Senate Rules this way will be quite serious, but it could be done.

Anyway, read for yourself: http://www.dailykos.com/storyonly/2009/8/20/769740/-Theyll-never-do-it.-But-maybe-thats-the-problem.">David Waldman, on DKos

Up to now, I've been one of the people warning that reconciliation isn't the magical procedure many health care reform supporters hoped it was, and that it wouldn't produce some kind of automatic, free shot at passing health care in a filibuster-free environment.

And that's true. It isn't, and it doesn't. It's now much more widely understood that reconciliation is a very specific sort of budgetary process that has no room for building policy from the ground up. That's because of the Byrd rule, which specifically prohibits the use of the reconciliation process for matters that don't have a direct impact on the budget, and don't meet the demands of the reconciliation instructions included in the budget resolution.

And it's for that reason that you're now seeing plans floated for splitting the health care plan up into two or more bills -- one to deal with the finances and that arguably can meet the reconciliation and Byrd rule requirements, and one to deal with the policy, but which comes to the floor under the normal rules.

But I'm actually thinking there might be some real value to being much more aggressive with it. Put together the best and most progressive health care bill that can get 50 votes, then essentially tell the parliamentarian thanks but no thanks, overrule him, and pass what you like.

Food for thought indeed. Remember, the Dems will not always be in the majority here and what is done under broken rules can be undone when the players change and also want the rules broken to work their will.

BTW, if you will permit it, I am glad I wrote about this. I didn't know a more aggressive approach to possibly using reconciliation might happen, but I'm glad I had some words on it with the good folks in this group. I think we managed to make some sense of the Rules of the Senate, something a lot of Senate staff struggles with on a daily basis. Kudos to you good people!

[Blaukraut]

22. Here is a detailed research on why co ops would not work

or would take years, if at all, to gain the bargaining power to drive down premiums.

On Edit: the paper also discusses in detail various forms of the proposed public options in the bills.

http://www.ourfuture.org/files/Hacker_Public_Plan_August_2009.pdf

Cooperatives might be able to provide some backup in some parts of the nation, but they are not going to have the ability to be a cost-control backstop, much less a benchmark for private plans, because—like private plans--they are not going to have the reach, authority, or desire to drive broadly implemented delivery and payment reforms or act as a strong public-spirited competitor that discourages private insurers from engaging in practices that undermine health security. As Senator Jay Rockefeller, a member of the Finance Committee, has concluded after extensive review of the issue: “What I have to worry about is, are co-ops going to be effective taking on these gigantic insurance companies? And from everything I know from people who represent them, the answer is a flat ‘no.’”65


Consumer cooperatives would have several severe disadvantages. First, they would require building a new set of plans largely from scratch in markets often dominated by one or two powerful insurers. This would mean forfeiting the administrative, economic, and political advantages of building on the Medicare infrastructure to a get a new alternative to private plans up and running quickly. Second, such models would also require forfeiting another major advantage of a Medicare-like public plan: the ability to provide enrollees with a broad choice of providers.

The only two sizable examples of consumer health cooperatives, Group Health Cooperative of Puget Sound and HealthPartners in Minnesota, are both health maintenance organizations (HMOs) with restricted provider networks.66 And they have had decades to become established.67 New cooperatives would face the same problems breaking into markets that smaller private competitors face in many markets today. Analysts at Oppenheimer, Carl McDonald and James Naklicki, report that “as the co-ops are currently described, we think they would be a big positive for the managed care group, but it seems to us that they would be destined to fail from the moment of creation.”

[YvonneCa]

23. Thank you. This is very helpful information. I have some reading...

...up and studying to do. :7