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Could Budget Reconciliation Buoy Health Reform?

As Democrats prepare to move ahead with health reform, Kwame Holman offers a primer on how they may use Senate rules to advance the legislation without Republican support.

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    But first: an explanation of a Senate tactic that could help decide the fate of health care reform.

    "NewsHour" congressional correspondent Kwame Holman walks us through a procedure called reconciliation.


    Yesterday's health care summit featured disagreements over policy ideas, governing philosophy, and the Senate procedure known as budget reconciliation. It's a provision that was designed to keep spending and taxes within the parameters of the budget, a task made easier by an expedited process that prohibits filibusters and limits debate to 20 hours.

    THOMAS MANN, senior fellow in governance studies, Brookings Institution: Reconciliation brings to mind harmony, but, in fact, it's — it's to wage war.


    Congressional scholar Thomas Mann of the Brookings Institution says, in the 36 years since it was adopted, lawmakers have expanded the use of reconciliation.


    As time went on, members of Congress saw, hey, this is an opportunity to — to write some changes into law or new law. This train is leaving the station. It might be the only one that is. And, so, over time, you began to see these reconciliation bills do more and more things, including passing major programs.


    Those major programs include substantial changes to health care laws, among them, a provision in the 1986 Consolidated Budget Reconciliation Act, which allowed laid-off workers to continue their employer-sponsored health care coverage under the program known as COBRA, and the Balanced Budget Act of 1997, which created the Children's Health Insurance Program.

    SARA ROSENBAUM, department of health policy chair, George Washington University: It's definitely not 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.


    Sara Rosenbaum is chair of the Department of Health Policy at George Washington University. She says the procedure can help to break through legislative gridlock.


    The reconciliation process, technically, is not just about making reductions. It's about changing the structure of the mandatory spending programs that affect budgetings. And, so, it's actually better to think about reconciliation as the special procedural tool that Congress uses when it's changing the big spending and tax programs of the United States.


    According to the Congressional Research Service, 17 of the 22 bills passed under reconciliation have been advanced by a Republican-controlled Congress or under a Republican president. And, in some cases, it has been used to clear major social legislation, such as welfare reform in 1996, a cornerstone of the Republicans' Contract With America.

    Republicans also used the tactic in 2001, and again in 2003, to pass then-President George W. Bush's tax cuts.

    Mann says, that was a tipping point.


    The big change actually came under President George W. Bush in 2001. Heretofore, it was always designed as deficit reduction, but, this time, it was designed to cut taxes alone, and, in effect, increase deficits or reduce surpluses.


    But with the recent health care debate, Republicans have objected to Democrats using reconciliation to pass their comprehensive bill.

    Here's Tennessee Senator Lamar Alexander at yesterday's summit:


    You can say that this process 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.


    Rather than start at the outset talking about legislative process and what's going to happen in the Senate and the House and this and that, what I suggest is let's talk about the substance, how we might help the American people deal with costs, coverage, insurance, these other issues.


    But Senate Majority Leader Harry Reid reminded Alexander of the GOP's past use of reconciliation on significant pieces of legislation.

    SEN. HARRY REID, D-Nev., majority leader: Lamar, you're entitled to your opinion, but not your own facts. No one has said — I read what the president has online. No one has talked about reconciliation. But that's what you folks have talked about ever since that came out, as if it's something that has never been done before.


    And the Brookings Institution's Mann sees it being done again soon with the health care bill.


    After the summit, where it became crystal-clear that — that Republicans want to — quote — "start over and go step-by-step," that they're in no mood to negotiate changes in the underlying bill, that it's on the Democrats' shoulder to get it done.


    And when it comes to the Senate, all that might be needed is 51 sets of shoulders, a simple majority.


    This afternoon, White House Press Secretary Robert Gibbs said President Obama will announce a way forward on health care next week. But he declined to say whether that would include using reconciliation.