On the eve of President Obama’s State of the Union address, a coalition of groups held a press conference to encourage the White House and Congress to continue the quest for comprehensive health reform.
The election of Republican Scott Brown to the Massachusetts Senate seat formerly occupied by Edward Kennedy gave Republicans the 41 Senate votes needed to sustain a filibuster against Democratic health reform legislation. In the face of Brown’s win and of polls showing public disapproval of comprehensive reform bills backed by Congressional Democrats, some reform advocates have argued for aiming to pass incremental measures focusing on matters such as health care cost control and insurance market reforms like ending the ability of insurers to deny coverage for pre-existing conditions.
But the groups at today’s gathering emphatically rejected this approach as unworkable because of Republican intransigence and undesirable on its merits. “Because every element of the health system is interrelated and interdependent, piecemeal reform — especially a cherry picking approach — not only is not feasible but could make matters worse. Incrementalism simply could do more harm than good,” said Ralph Neas, Chief Executive Officer of the National Coalition on Health Care Action Fund. Other speakers included Ron Pollack, Executive Director of Families USA; Richard Kirsch, National Campaign Director of Health Care for America Now (HCAN); Mary Andrus, representing the Consortium for Citizens with Disabilities; Jack Lewin, CEO of the American College of Cardiology; Brent Wilkes, National Executive Director of the League of United Latin American Citizens (LULAC); and Mary Wilson, President, League of Women Voters of the United States.
Specifically, the group advocated a multiple-step process advanced by Pollack in a recent Politico article. First, the administration and Congressional negotiators would agree on a compromise, melding together the House and Senate health reform bills. Then language necessary to revise the Senate bill to conform to this compromise would be included in a “Budget Reconciliation” measure, which under Senate rules could be passed by a simple majority vote. Then the House would pass both the original Senate legislation and the Reconciliation measure, sending both bills to President Obama for his signature.
This course is also advocated in a letter to House Democratic leaders written by Harold Pollack of the University of Chicago and Tim Jost of Washington and Lee University and signed by over 50 other noted health policy analysts, including Henry Aaron, David Cutler, Jon Gruber, Theda Skocpol, and Paul Starr. Speakers at today’s press conference were careful to say they could not speak for the White House or Congressional leaders. However, Ron Pollack said, “I think we’re making enormous headway … While we have not had an explicit statement about ‘this is the precise direction to go,’ I think we’re clearly moving in that direction in terms of the leadership of the House and Senate and the President.”
Only matters with budgetary implications can be included in a Reconciliation measure, and some have maintained that key reform elements would not meet this test. However, Pollack asserted, “All of the key differences between the House and the Senate have fiscal implications.” He said two issues raise the biggest challenge is this regard: the structure of new health insurance exchanges included in both the House and Senate bills, and abortion coverage provided for by federally subsidized health coverage. But “how you structure [the exchanges] and how they work have very profound fiscal implications,” Pollack noted. Similarly, the abortion coverage controversy is “is not an issue of abortion, it’s an issue of federal funding for abortion, and that issue clearly has fiscal implications.”
In addition to the basic requirement of fiscal implications, there are a myriad of other substantive and procedural restrictions on the use of the Reconciliation process. Jeff Davis, the publisher and editor of Transportation Weekly, does a good job of detailing the rules in this post in The New Republic’s Treatment Blog.