Reconciling Reconciliation

It seems that they’re serious!!  On Sunday evening, the 2,309 page so-called “shell” bill for reconciliation was posted by the House Budget Committee in the first step of the process.  It’s referred to as a “shell” because it still does not contain the mark-up language, which will include the amendments or changes made on the Senate bill by the House.  The first mark-up session is slotted to begin today (Monday) at 3:00 p.m.  But, the excitement has not really started yet since the shell bill serves only as a vehicle for the Democrats to get the reconciliation process moving on healthcare.  Once the bill gains approval in the Budget Committee (again on Monday or possibly Tuesday), the Democrats will then need to send the phantom bill over to the Rules Committee.  In Rules Committee, Members will then strip out all of the items not needed and insert the actual changes which have been negotiated in the back offices of the Hill.

Though the Sunday airwaves were filled with Democrat predictions of success on the reconciliation route, House Democrat Whip Jim Clyburn (D-SC), while giving robust support to the prediction also extended caution by adding that he still did not have the required 216 vote margin needed in the House to pass the reconciliation bill.  There are still lots of concerns on using the reconciliation process in both the House and Senate.  The objections are ideological as well as procedural, and the biggest points of contention revolve around several key points.  First, there is distrust of the Senate by the House.  Second, to make this work, they have to bend the rules here and there.  If we bend them now, we will likely bend them again when the Republicans are in control.  Third, abortion.  It’s an issue that stands on its own, and the question remains on how to resolve the structure of reform around this issue.  Fourth, healthcare services for immigrants remains a highly contentious issue.  And finally – and, perhaps most importantly – we will be hearing a lot more about an obscure, unelected individual who will have much to say on the shape of the final package once the bill passes the House and arrives in the Senate – the Senate Parliamentarian Alan Frumin.  The bill has become all about process and procedure.  I wonder what kind of lobbying pressure he has been feeling this past week let alone what will happen this week?

There’s lots of movement by all the various sectors on the package.  The hospitals, the doctors, the insurers, the medical device manufacturers, the pundits, the policy wonks, and all of the others whose future hangs in the balance will be giving rapt attention to the House process.  Speaker Nancy Pelosi has already warned the Members and the staffers to plan on working “through the weekend” to get the package completed by Easter.  Increasing the drama is the fact that President Obama abruptly cancelled his Asia trip on Friday so that he could participate in the final discussions.  Participate is actually a soft word.  I anticipate he will need to serve as traffic cop, arbiter, guard, and “decider” (a George W. Bush word) as the final package winds through the process. 

Kevin Fickenscher, MD

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