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Health Care Reform 2009 Part 3: Congress (continued)

Finance Committee Senators Baucus and Grassley

Yesterday we talked about how health care reform will make its way through the House of Representatives.  Today– on to the upper chamber!

In the Senate

There are two committees in the Senate working on health care reform:

  • the Senate Committee on Health, Education, Labor, and Pensions (HELP), chaired by Ted Kennedy (D-MA), and
  • the Senate Finance Committee, chaired by Max Baucus (D-MT)

Each committee introduced its own version of the legislation, and both were similar to what the House proposed.  The HELP Committee has already reported a bill back, leaving Max Baucus’ Finance Committee as the only committee that hasn’t passed anything yet.  It’s hard to tell what will come out of the Finance Committee, since they’ve been meeting in secret, but it’s looking like it won’t have a public option.

At this point, it’s worth noting that Max Baucus receives more money from the health and health insurance industries than any other senator:

In the past six years, nearly one-fourth of every dime raised by Baucus, D-Mont., and his political-action committee has come from groups and individuals associated with drug companies, insurers, hospitals, medical-supply firms, health-service companies and other health professionals.

These donations total about $3.4 million, or $1,500 a day, every day, from January 2003 through 2008.

And if you’re into statistics and wondering what all that money might have bought the insurance industry, baseball guru Nate Silver at fivethirtyeight.com did a statistical analysis and found that because of those donations, the probability of Baucus supporting a public option dropped from 30% to almost 0%.

Once it gets out of the Finance Committee, the bill will go to the floor of the Senate.  At this point there’s a weird procedural thing: it could be sent to the floor as either a regular order or as a budget reconciliation vote.  You can see on the chart from yesterday, this is where it starts to get confusing:

chart of senate's procedure

Regular Order

If it goes to the floor as a regular order, then it follows normal Senate rules: opponents can filibuster (stall indefinitely) and it takes 60 votes to break a filibuster (ending a filibuster is called cloture).

When people like Finance Committee member Kent Conrad (D-ND) say that there aren’t enough votes in the Senate for a public option– he’s presumably talking about 60 votes.  But even though some conservative democrats might vote against a bill with a public option, it’s not clear that they would support a filibuster too.  Without a filibuster, the reform bill only needs 50 votes to pass (VP Joe Biden can break a tie).

But, we should emphasize that it will take at least 60 votes to break a filibuster– 59 won’t cut it.  Which means that if all the Republicans decide to filibuster, every Democrat and independents Joe Lieberman and Bernie Sanders have to vote on it.  With Ted Kennedy and Robert Byrd in poor health, and Joe Lieberman being, well… Joe Lieberman, Democrats might not want to take that chance.  However, there is another way…

Budget reconciliation

Even if there are enough Republicans and conservative Democrats to filibuster, a reform bill can still be passed.  We’ve talked about this on What If Post before— basically, the federal budget that was passed earlier this year says that if Congress doesn’t pass health care legislation by October 15, then it will go to a mandatory vote in the Senate.  This budget reconciliation vote cannot be filibustered, and would take only 50 votes to pass.  When people talk about ramming a bill through the Senate, they mean using the budget reconciliation option.

The problem with this approach is that some aspects of the legislation wouldn’t qualify for action [translation- some parts of the bill would have to be cut out].  Big parts.  Ezra Klein again:

The Health Insurance Exchanges would probably be thrown out. The insurance market reforms would probably be thrown out. Prevention and wellness, modernization, delivery system reforms, and much else would likely be out the window. And we can’t even quite predict what would be lost, so it’s hard to know what would actually work at the end of the day. We could end up with a bill that simply doesn’t work, much as a car doesn’t function without a transmission system.


[Side note: I felt a little bad for only picking on Max Baucus earlier, so… we mentioned Kent Conrad:  The analysis at fivethirtyeight suggests that political donations from insurance companies will play an even bigger role in whether or not he’ll support a public option- down from a 76% chance to a 25% chance.  Same with Harry Reid– in their model he drops from a 72% chance of supporting a public option to a 19% chance thanks to money from insurance companies.]


House-Senate Conference

All right, so by this point we’re down to only two reform bills- a House version and a Senate version.  A House-Senate Conference Committee will then meet and negotiate to come up with one bill that will be voted on by both chambers.  Then the floor process repeats itself.  In the House, the Rules Committee will set the terms of the debate and then the entire House will vote.  In the Senate, if it’s a regular order it can be filibustered.  If it’s budget reconciliation, then a filibuster is still not allowed, and only 50 votes would be needed to pass.

And then, FINALLY, the bill goes to the President who can either veto it or sign it into law.  Phew!

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