With their signature issue struggling for survival, liberal groups are now rallying behind the budget reconciliation route to pass health care reform, despite concerns about the practicality of the legislative maneuver and some skepticism on K Street about pursuing the politically troublesome issue.
Ralph Neas, president of the National Coalition on Health Care Action Fund, recently announced that his organization and other groups, including Families USA and the union-backed Health Care for America Now, would prod Congress to employ a procedure that will not require a supermajority in the Senate to approve health care reform.
Such an approach has become necessary, in the view of these groups, after the election of Republican Scott Brown to the Massachusetts Senate seat that deprived Democrats of the 60 votes they would need to approve the bill.
We have changed circumstances, said Neas, whose group was previously opposed to using reconciliation as a vehicle for health care reform.
Under the plan being floated, the House would pass the Senate health care bill and both chambers would approve a budget reconciliation measure that would include negotiated compromises between the two chambers. A reconciliation bill requires just a simple majority Senate vote but can only include budget-related provisions.
Neas expressed confidence that the tax and subsidy issues that still need to be resolved would meet the reconciliation rules. Neas group had previously maintained that the reconciliation limitations would preclude including important health care reforms, such as changes to the insurance market.
There would be many issues that would not be consistent with the reconciliation rules, Neas said. You would end up with Swiss cheese legislation.
But Neas said that those insurance provisions are already addressed in the Senate legislation, which the House could approve as long as its Members were satisfied that reconciliation would deal with their differences with the other chamber.
But not all Democrats in the House and Senate are sold on reconciliation. Nor has President Barack Obama recommended a path to proceed with health care, an issue he did not even mention until more than a half-hour into his State of the Union address last week.
Furthermore, experts in Congressional procedure warn that reconciliation is not a slam-dunk.
Robert Dove, a former Senate Parliamentarian who now works at Patton Boggs, said that every provision of the reconciliation bill can be challenged by any Senator who questions their budgetary impact.
It is a long, painstaking process, something I never want to do again, said Dove, who refereed a reconciliation measure in 1995.
He said reconciliation provisions are generally vetted months before the bill comes to the floor. Such an approach would also require the bills to go back to the two Senate and three House committees that originally handled health care reforms. The bills would then be bundled and sent to the budget committees before sent to the floor for a vote.
I dont think it will be easy, Dove said. If it were easy, it would have been done by now.
Others on K Street doubted that either the White House or Congressional Democrats are keen on pushing through comprehensive health care reform in the face of the difficult political environment.
There is very little appetite to pursue this in any meaningful way, said one longtime health care lobbyist who has supported the comprehensive health care effort.
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