With Reconciliation Tactic, Democrats Forge Ahead on Health Care Reform

President Barack Obama and congressional Democrats launched a last-chance push for health care reform this week and will likely use a tactic called "reconciliation" to pass the controversial legislation this year.

“I believe the United States Congress owes the American people a final vote on health care reform,” Mr. Obama said Wednesday in remarks at the White House.

Though the president did not specifically mention "reconciliation," which would allow the legislation to pass with a simple 51-vote majority in the Senate, he asked Congress to move forward with an "up or down vote."

Republicans, who want to start reform negotiations all over again, cried foul.

“They’re making a vigorous effort to try to jam this down the throats of the American people, who don’t want it,” said the Senate's top Republican, Mitch McConnell.

“We think that’s a policy mistake, and we think resorting to these kind of tactics, to thumb your noses at the American people, is something that ought to be resisted,” he said.

Health care legislation narrowly missed passage

	President Obama has argued that improving health care is key to improving the economy.

President Obama made health care reform his top domestic priority last year, but many Americans are more concerned about the economy and have grown weary of the bitter and complicated debate.

Democrats could have pushed through a reform bill last year when they had a shaky 60-vote coalition – enough to stop a filibuster. Senate rules allow for unlimited debate on a bill — a filibuster -- which the minority can use to prevent the passage of a bill or amendment.

But January's surprise victory for Republicans in a Massachusetts special election means that Democrats have to either convince some Republicans to vote with them, or resort to the controversial reconciliation process.

How does reconciliation work?

	Reconciliation would prohibit a filibuster, a process in which Republicans could delay a vote on the bill.

Reconciliation was designed to speed up Senate processes and keep spending and taxes within budget by prohibiting filibusters and limiting floor debate.

Reconciliation was adopted as a practice 36 years ago. When used to pass a budget-related bill, it requires only a simple majority in the Senate as opposed to the 60-vote "supermajority" needed to avoid the minority party's efforts to kill legislation.

According to the New York Times, the House of Representatives will have to agree on a budget reconciliation bill that would make changes to the Senate's version and then both chambers would have to pass a list of changes that "bridge gaps" between both.

Previous uses of reconciliation

	Former President George W. Bush's tax cuts were intended to help promote economic growth.

Sara Rosenbaum, chair of George Washington University's Department of Health Policy, told the NewsHour that this use of reconciliation would not be unprecedented.

"In fact, every major piece of health reform, with just a couple of exceptions, over the past 30 years, has been passed by Congress as part of a reconciliation bill," Rosenbaum said.

Republicans used the process in 2001 and 2003 to pass tax cuts under President George W. Bush. Current congressional Republicans, however, object to the possibility that Democrats could use the tactic to pass health care legislation that they oppose.

"You can say that [reconciliation] has been used before -- and that would be right -- but it's never been used for anything like this. It's not appropriate to use to write the rules for 17 percent of the economy," said Republican Sen. Lamar Alexander of Tennessee.

President Obama defended the tactic saying that, “[Health care reform] deserves the same kind of up or down vote that was cast on welfare reform, that was cast on the Children’s Health Insurance Program, that was used for COBRA health coverage for the unemployed and, by the way, for both Bush tax cuts — all of which had to pass Congress with nothing more than a simple majority,” President Obama said.

Check out this infographic on how both parties have used the reconciliation process in the past.

Here are more details about the 22 times reconciliation has been used before.

Even many Democrats still need convincing

	Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi are in charge of garnering support from fellow Democrats.

Congressional Republicans are not the only ones who have taken issue with passing health care reform through reconciliation. Many Democrats in the House of Representatives are not happy with certain parts of the Senate bill and don't trust the reconciliation process.

President Obama wants to proceed by having the House vote first on the existing Senate bill, and then the leadership of both chambers will fine tune the bill with tricky compromises that everyone can live with.

"If the House passes the Senate bill first, and then the fixes are supposed to happen after that, that's a lot of trust we've got to have. [The president] said he's going to make sure that those assurances are there. How he's going to do that, I'm not sure," said Democratic Congresswoman Barbara Lee of California.

The Senate would then have to pass the compromise bill through the reconciliation procedure with at least 51 votes. The bill would then head to President Obama for his signature.